Page 71 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
Appendix A
tube even if he strongly objects to it? What about residents who decline to take medication or other treatments prescribed to manage their chronic disease? Should dietary preferences of a resident override adherence to a medically prescribed dietary regime? Should a frail, unsteady resident with osteoporosis, who insists on walking by herself, be permitted to walk around unescorted even though there is a substantial risk that she will fall and suffer a hip fracture?
For the very sick and disabled, the quality of the care and the way it is provided are probably the most significant contributors to well-being.
...residents who receive good personalized care and opportunities for choice have higher morale, greater life satisfaction, and better adjustment.
Modern management theory holds that excellent results are more likely to be achieved when the members of an organization are motivated not by fear of sanctions for inadequate performance, but by pride, accountability, cooperation and loyalty. The HCFA (now CMS) and state governments can apply this concept in their dealings with nursing homes. The current federal regulatory system is structured only to punish poor behavior. Good behavior goes unrecognized. Only a few states have developed systems for rewarding good or outstanding facilities. In part, it is attributable to the crudeness of the survey instruments. After the HCFA has implemented the new survey process recommended in Chapter 4, and after some statistically derived outcomes standards are developed, it should be possible to reliably distinguish the very good from the poor or merely acceptable performers. It will then be possible to reward facilities for excellent performance and thus to encourage continued excellent performance.
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