Balancing autonomy and safety is one of the biggest challenges for an assisted living facility (ALF) to manage for the individual resident. When a resident moves into an ALF, what are the initial preconceived ideas that the resident and family has about what kind of oversight and support the resident needs? Often times, the resident may be capable of more independence than the family acknowledges. The family may have unrealistic expectations that the resident will change their preferred routine to fit the ALF daily agenda. Families will sometimes insist their loved one is involved in every activity scheduled when, in fact, their loved one would prefer to quietly crochet in her room.
There are also times the family does not recognize that the behaviors they are describing to ALF staff indicate a need of memory care support. Families are looking through the eyes of love and stress and do not always see the obvious behaviors clearly. A family member may tell you that on a regular basis, her mother calls the police at night because she thinks someone is in her home, but then denies that this behavior is possibly related to dementia. The resident’s 1823 may reveal symptoms or a diagnosis of dementia but the family is in denial. Balancing these issues can be challenging.
As always, there is no simple, one-line answer to these challenges. However, there are some principles that can be used consistently. Start with education from the initial meeting with the resident and family. It is true you are “selling” your facility, but you have the obligation to be realistic in meeting the resident’s and family’s needs. It is true that we live in a “Disney World” type society where we want everything to be wonderful, but that may not be the reality when you analyze the individual’s person-centered care unless you do so purposefully.
Educate the potential residents and families on their choices and remind them they help by communicating when you miss something. If you assume the resident knows he can have his breakfast at 10:00 a.m. instead of 7:30 a.m., he may have to change his routine and preferred meal time without knowing. Facility rules do apply, but are those rules so restrictive that person-centered care cannot be realized? Person-centered care is recognizing that each resident has the right to autonomy to whatever extent is possible.
Educate your staff specific to residents having choices and being individuals. Create a culture of choices in which residents can thrive. A staff member who recognizes resident choice can create a more pleasant experience for residents who do not have cognitive impairment and the same for residents who do. Some residents are not safe to manage their own medication needs but can maintain some autonomy when they choose to take their bedtime medications at 10:00 p.m. instead of 8:00 p.m.
When a resident or family presents a situation to you as the administrator, do you review the situation to determine if the resident has had their abilities promoted or taken away? Often it happens that staff, with all goodness of heart, actually overdo for a resident and unintentionally take some of the resident’s independence away. As residents decline over time, we should be providing more support, but choices should not be diminished because a resident is more dependent. It just means we shift what questions we ask. Maybe a resident can no longer bathe himself independently, but we can make sure that he bathes in his preferred manor. Showers, tub baths and bed baths all have the same end result, but the choice of arriving at the end result belongs to the resident.
This concept starts with administration and leadership. Residents lose so much of their independence when they need assisted living care. Have you asked the questions to yourself and your staff if the way you provide care promotes autonomy, or does it just get the tasks done? Take time to review your process of educating potential residents and families. How do you teach person-centered care to your staff? Autonomy versus safety will always be a challenge, but don’t forget that we take care of people and they both matter.
