Page 73 - The Deep Seated Issue of Choice

THE DEEP SEATED ISSUE OF CHOICE
APPENDIX B
In surveying resident rights and quality of life, you are evaluating the extent to which the nursing facility’s social and physical environments advances resident autonomy. Think of your job as searching for organizational traits that assist residents’ autonomous behavior – exercising independence, self-control, and competence. Assessing two characteristics are critical:
-Flexibility -Controllability
Flexibility means that the facility provides opportunities for residents’ autonomous participation. The resident may or may not seize these opportunities. Bringing flexibility into the nursing facility does not mean deinstitutionalizing it. It means organizing the facility in specific ways, like flexible seating arrangements that allow residents to sit alone, participate in small groups, large groups, and carry on private conversations, or serving a buffet breakfast on certain days encouraging residents to exercise their self-control, competence, and independence.
Controllability means that to some degree that facility allows residents to have an on-going role in shaping the institution – to have a say in how the facility functions. The group interview videotape shows a high degree of controllability – of a facility’s response to residents influencing the life that institutional rules demand of them.
When thinking about flexibility consider how the facility is set up. When considering controllability, consider what residents can do to set up the facility differently.
Insofar as it is flexible and controllable, the nursing facility becomes an environment with opportunities for residents to live autonomously. What is beyond the control of the facility, and the regulatory process, is residents deciding to seize these opportunities.
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