Quality Measure 6: Resident Rights

The State of California recently updated the rights of residents inside assisted living facilities in order to better protect and enforce them.[1] Highlights of resident rights listed in the laws include--

-Dignity in personal relationships with staff, residents and other persons; 

-Freedom to accept or reject medical care;

-Freedom to leave or depart the facility at any time;

-To receive unannounced visitors during reasonable hours; and

-To make choices concerning their daily lives. 

Most of the time it's easy to uphold these rights.  At other times, however, honoring a resident’s right to choose might feel at odds with the care and supervision facilities are responsible for providing.  A resident’s refusal to bathe is a good example.  On the one hand, facilities must promote resident hygiene but must also balance this with a resident’s right to make choices about their daily life, like when they wish to bathe.

Current research suggests facilities should focus on redirecting residents in positive ways to accomplish tasks while still respecting resident choice.[2]  Listed here are two examples of where facility operations and resident rights meet, along with some suggestions on how facilities can support resident rights.

(1) Staff Turnover - Staff turnover is quite common in assisted living.  Not only is it disruptive to facility operations and finances, it is also disruptive to residents.   Residents report staff turnover threatens their sense of control.  Residents must adjust to new personalities, and also report feeling a need to “retrain” new staff to maintain their routines and preferences. 

When faced with staff turnover, facilities can show their respect for residents by involving residents in the interview or orientation process, providing special training for new caregivers on each resident or allowing time for informal meetings before official staff/resident assignments. 

(2) Concept of Reframing – In the face of change, residents reportedly benefit from “reframing” a new situation.  "Reframing" is as simple as changing one's mindset from glass half empty, to glass half full.  Within a facility a good example might be the sign in and sign out sheet maintained at the facility entrance.  When faced with the new rule of signing in and out of the facility, residents may be more accepting of this rule if they see it as an expression of the facility’s desire to meet their needs when they return.  Another example might be the experience of needing supervision when taking a walk outside.  Reframing the assistance as a meaningful activity for both staff and residents (i.e. an activity where both parties can make time to enjoy the outdoors) may prove uplifting.

Some residents may reframe instinctively, but others might need some creative help and reassurance from staff to reframe the changes they experience as positive (or neutral) rather than viewing them as a reminder of loss and dependency.   

Looking at all facility operations with a focus on resident rights may suggest new ways to provide care while helping staff to adopt a culture that empowers and dignifies residents.  October is also Residents' Rights Month.  For ideas on how to celebrate resident rights in your facility, we invite you to visit The National Consumer Voice for Quality Long-Term Care website.