There's No Place Like Home: Home-Like Environments in Aged Care Facilities
When we refer to the resident’s rights in healthcare, we are usually referring to the rights, duties and obligations exercised in a relationship between resident/nurse, resident/doctor and/or resident/care provider.
To me, this is where dilemmas arise: from the clash between the resident’s rights to choice, decision-making and risk taking, versus the nurses’/doctors’/providers’ obligations to provide safe services, albeit heavily regulated, within a home-like environment.
If you’re like me, and you hear the term ‘home-like environment‘ again, you’ll go crazy! This is because the environment is not at all like their home used to be. The home we provide is full of rules and regulations. In fact, when a resident enters residential care they often begin a slow but steady downhill journey where free will and decision-making is slowly stripped away, until they can become quite dependent.
Let’s consider how we do this with regards to:
Freedom of Movement
The cognisant but infirm resident can often be brow beaten into immobility by being constantly required to ring the buzzer for a nurse when she/he wants to mobilise. The resident is constantly reminded that they are at risk of falling, and that a fall could mean a fractured hip and going away to hospital. We all know that sedentariness increases the risk of falling when a resident does eventually mobilise.
The non-cognisant wanderer often intrudes upon other residents, entering their room and touching their belongings. The intruded-upon resident can become quite upset, and rightly so, but the answer is not in further restricting the wanderer’s movements. Closing off a wing to make it more secure, or fencing off a portion of the garden to restrict wider access is not the answer, in fact it will increase agitation and behaviours can become destructive, as well as intrusive.
So, rather than restrict, identify the possible reasons why the resident wanders, and importantly, review your recreational program. Minds, even with dementia, need to be occupied.
Freedom to Experience a Relationship
The sexuality and intimacy needs of residents was touched upon in last month’s article, Aged Care Sexuality. The piece demonstrated that this largely overlooked and/or under-assessed need prevents the resident from his/her right to sexual expression.
Freedom to Self-Care
Physiological and cognitive decline is a normal part of the ageing process, but we (unintentionally) hasten this process by slowly eroding what little independence remains. Maybe the resident cannot cook a meal or operate a washing machine, but perhaps they can still: self-administer their medications; make a cup of coffee (don’t worry if its only lukewarm); make their bed (who needs mitred hospital corners in a nursing home?); or dress themselves (so what if the colours aren’t coordinated?)
Freedom to Enjoy the Nightly Tipple and Other Treats
With regard to alcohol consumption, I have witnessed: an allowed two standard ports per evening, watered down fifty per cent; one resident told he drank his second stubbie, and that he just doesn’t remember it (when in fact he only had one); and a nurse complaining that she has more important things to do than ‘playing barmaid.’
And what of food treats? Does it matter if a seventy eight-year-old person with diabetes is given a large slice of chocolate cheesecake every Sunday when their son visits? Does it matter if a resident on level two or three thickened fluids enjoys a daily can of their favourite soft drink when their partner visits? I think we have to be commonsensical in such matters and not take offence if a resident’s ‘wants’ challenges our educated clinical assessments and recommendations.
Freedom to Enjoy Your Own Company or the Right to be Alone
A nursing home abuzz with activities and laughter is a sure sign that the residents are happy, but what of the residents who all their lives have been content with their own company? Or of those, since ageing, now prefer their own company, to others? How often do we make them feel guilty or anti-social because they choose to eat in their room most of the time, or watch their own TV, or just don’t want to play bingo? They have their reasons and we need to respect this.
Yes, there are the necessary rules, regulations and restrictions in residential care, and these are particularly important in the areas of management, staffing, clinical care and environmental safety, but with regards to resident lifestyle, we need to focus more on the areas of personal freedoms, choice and decision-making, and finding joy.
Sadly, I think there’s not too many of us in aged care who know what brings actual joy to our residents. Life has to be worth living what’s left of it. It is the simple things in life that give us long-lasting pleasure and joy: our favourite foods and beverages; a walk in the garden; times of solitude to reflect; and finding company and comfort with another. These may be the last real social pleasures we can experience in life.
Our residents have the right to make informed decisions and take risks, and the people best equipped to assist the resident in this regard are those on site – the multi-disciplinary team of nurses, medical and allied health professionals – and let’s not forget, the resident, and their relative / support person.
Christine (RN, BN, MPHC) is an RN with 40 years experience, traversing the profession as an AIN, EN, RN, RM N.ED. to DON. She is currently in transition-to-retirement and working as a casual RN on the floor in a small rural hospital with an aged care facility attached. Her interests are aged care and particularly nurses; their working relationships, team dynamics and how nurse leaders and managers deal with the day to day complexities of leading and managing. See Educator Profile