Honoring Individual Choice in Long-Term Residential Communities When It Involves Risk: A Person-Centered Approach

Abstract

Nursing homes that are working on adopting person-centered care (PCC) practices express concerns about giving residents the freedom to make their own decisions and the accompanying risks. This challenge is especially true for those who are at the beginning of the PCC change process. Although the Centers for Medicare and Medicaid Services regulations are clear that residents have the right to a dignified existence and self-determination, and that the facility must protect and promote their rights, examples abound of care communities coercing, cajoling, or requiring residents to do things they do not want to do (e.g., take medications), or the reverse of not letting them do what they want (e.g., eat a regular diet). The current article discusses a process that helps care communities follow the regulations about education and offering choices while honoring resident preferences and documenting the process for surveyors. [Journal of Gerontological Nursing, 42(8), 12-17.].

Revisiting the Role of Physicians in Assisted Living and Residential Care Settings

“…Caring for AL/RC residents involves balancing clinically desirable goals with residents’ preferences and values ( McConnell & Meyer, 2019 ). All care team members must understand how to support informed choices for those in their care to ensure resident well-being and cooperation ( Calkins & Brush, 2016 ). The relationship between residents and their physicians is influenced by care staff, nurses, specialists, and families ( Kemp et al, 2019 ; Schumacher, 2006 ).…”

“…Proponents of AL/RC settings promote the social model of care and home-like environment that supports resident choice through community operations (Brown Wilson, 2007;Carder, 2002;Carder & Hernandez, 2004;Kane & Wilson, 1993). Providers must balance these personcentered values with operations, regulatory oversight, and health care provider goals of safety and beneficence (Calkins & Brush, 2016;Kapp, 1997;Morgan, 2009;O'Dwyer, 2013). Each state regulates AL/RC differently, using statespecific terminology (e.g., assisted living facility, residential care facility, community residence, personal care home, dementia care units) to license operators (Carder et al, 2015).…”

“…Proponents of AL/RC settings promote the social model of care and home-like environment that supports resident choice through community operations (Brown Wilson, 2007; Carder, 2002; Carder & Hernandez, 2004; Kane & Wilson, 1993). Providers must balance these person-centered values with operations, regulatory oversight, and health care provider goals of safety and beneficence (Calkins & Brush, 2016; Kapp, 1997; Morgan, 2009; O’Dwyer, 2013).…”

Assessing Quality for People Living With Dementia in Residential Long-Term Care: Trends and Challenges

“…Both of these efforts highlighted the importance of balancing good care with personal preference. For example, in the United States, as noted by Calkins, Schoenman, Brush, and Mayer (2018), regulatory guidance can seem conflicting because care homes are required to accommodate resident preferences, including their right to decline treatments such as a therapeutic diet, whereas the home is still held accountable for the resident’s care and safety, including the outcomes of those decisions. In these circumstances, the Pioneer Network recommends engaging with residents, and surrogates whether decision-making capacity is impaired, to modify therapeutic diets to maximize the resident’s preferences.…”

“…A key challenge to making care standards more resident-centered is a commonly held belief that professionals know what is best for the resident (Calkins et al, 2018). Although professional inputs are important, collective living in LTC requires thinking beyond the individual.…”