Page 72 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
APPENDIX B
APPENDIX B
OBRA ‘87 Surveyor Training on Quality of Life. 1987. Selected excerpts. Autonomy: A Framework for Assessing Resident Rights and Quality of Life
All persons have autonomy, regardless of the range of their functional abilities. The concept of autonomy – the degree to which a person expresses his or her individuality – is useful to thinking about assessing a facility’s compliance with resident rights and quality of life requirements. The new nursing facility requirements recognize that autonomy is a basic human need. Autonomy has three dimensions:
-Independence -Self-control -Competence
Essential to reviewing resident rights and quality of life requirements is awareness of how the facility provides opportunities that enhance residents’ “highest practicable” autonomy – the ability to exercise the independence, self-control, and competence that characterizes adulthood. There are three ways in which residents can be deficient in autonomy:
-By being incompetent
-By being procedurally dependent -By lacking self-control
Through your interviews with individual residents, organized resident groups, and family members, and observations in the Quality of Care and Environmental Quality Assessments, your task is to separate out factors that affect adversely a resident’s autonomy.
Autonomy and the Nursing Facility Environment
Your review of resident rights and quality of life reduces to one basic question – how much control over their lives do residents living in a nursing facility have? The new nursing facility requirements challenge the assumption that institutionalization limits personal autonomy more or less by definition. Rather, assume that the nursing facility and environment is neutral with respect to residents’ autonomy. Everything depends on the way the facility sets up its institutionalized practices. Set up in one way, the facility is receptive to autonomy; set up in another way, it limits autonomy.
That is why in the training videotapes, we show residents who are able to exercise a high degree of autonomy. Residents’ interview responses indicate that the fit between what they want to do with their lives and what the institutional setting is designed for them to do is symbiotic.
69