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Advising Clients How to Recognize Ten Real Expectations for Quality of Life in a Well Managed Long Term Care Facility
Institutionalization of Elderly - 10 Real Expectations for Quality of LIfe in a Well Managed Long Term Care Facility
Ten Real Expectations for Quality of Life
by Jill B. Thomas RNC, LNHA is the Vice President and Founder of Advance Care Planning, Inc
Advising Your Client How to Recognize Ten Real Expectations for Quality of Life in a Well Managed Long Term Care Facility
Long term care facilities will become home to millions of "Baby Boomers," in the coming years. Many people fear the move from their own home to a long term care faciliy.. they just don’t know what to expect. Every person has a right to good care under the 1987 Federal Nursing Home Reform Law. The law, which is part of the Social Security Act, states that a long tem care facility must help each resident 'attain or maintain' his or her highest level of well being - physically, mentally and emotionally. This report sets the expectations of those needing to address the long term needs of their family members. Through the use of the Advancer Care Plan, a family member can count on these expectations, and more importantly, can be assured that the care is specifically tailored to the loved one's needs.
Rights of an individual who enters a long term care facility are the same as anyone living in the larger community. These rights are guaranteed by the federal government. The law requires nursing homes to 'promote and protect the rights of each resident' and places a strong emphasis on individual dignity and self-determination. What does that really mean? It means if your lifestyle preferences, habits and values are known, they can be incorporated into your life at the long term care facility. This includes a short, long or intermediate length of stay.
The 4 goals of the long term care facility:
Rehabilitate the resident to maximum potential and enable him or her to return to independent living arrangements if possible;
Maintain maximum rehabilitation as long as possible within the realities of age and disease;
Delay deterioration in physical and emotional well being, and
Support the resident and family, physically and emotionally, when health declines to the point of death.
In pursuit of accomplishing the above goals the following are
10 Real Expectations!
Expectation 1 - To be free from physical, mental and psychological abuse:
You should be able to express complaints and concerns without fear and retaliation.
Physical and chemical restraints may be used only with your permission and under order from your physician. All other methods to address or treat your condition should be attempted first.
Expectation 2 - To be treated with respect:
You should be addressed in the manner you choose. Mr. Mrs., Ms., (last name), professional or military title, by first or by nickname.
Many well intended caregivers refer to their clients using terms of endearment, e.g., honey, sweetie, grandma, papa etc. Most clients do not mind, but if you prefer not to have those terms used, make your wishes known.
Your personal care should be provided with privacy. Visual barriers should be in place to prevent others from viewing care and treatment.
Staff and visitors should knock on the your room door or announce themselves and wait for you to answer before entering.
Expectation 3 - Unlimited access for immediate family visitations:
There may be some reasonable restrictions for non-family members, such as no visitors after 9:00PM, or before 9:00AM. If any visits interfere with the rights of your roommate or other residents, some flexibility will be required.
Pet visitations within the guidelines of the facility.
Privacy provided, by request, for intimate visits with a significant other.
Trips out of the facility for lunch or dinner, to go for a family holiday or weekend visit. There may be some restrictions depending on your care needs and your payer source.
Expectation 4 - Medical care:
To have access to all needed medical services. For example, dental, eye, podiatry, physicians or any specialists.
To choose your own physician. They must comply with facility regulations. If the physician does not have privileges with the facility, you will need to make arrangements to see them at their office.
To expect prompt pain relief medication or other therapies, as ordered by your physician.
You have the right to refuse treatment or medication. The facility staff and your physician have the obligation to inform you of the consequences of refusal and then may require you to sign a waiver.
To be informed of and have input into all decisions which impact your medical care.
Expectation 5 - Advance directives and care plan:
To have advance directives honored and only changed at your request.
To have significant input into your care plan.
To have your values respected and considered in your plan of care.
To receive an on-going assessment of needs and preferences.
To be informed of, and have input into, all decisions which impact your life and lifestyle.
Expectation 6 - Activities of daily living:
A choice of a bath or shower, including frequency and times within reason. The recommendation is 3 times a week unless there are special needs.
Assistance with any needed personal care activities, such as facial hair removal, washing hair, shaving legs, and underarms on reasonable schedule.
To continue with previous life styles of massage, manicure, hair styling etc. Your will have to pay for services and may need transportation if the service is not available at the facility.
To be dressed in the clothes of your choosing daily, keeping in mind that there may br some adaptations needed. This also includes the choice of sleepwear.
Expectation 7 - Dining:
To eat food of your choosing, following the diet of your choice. Medically, it is best to comply with physician recommendations. There will be choices in facilities and your likes and dislikes should be honored. Food can be ordered from a restaurant or family and friends can bring in food.
To eat meals where you would like. The dining room is the best place since studies show more weight loss occurs in residents who choose to eat in their room. There is more supervision and assistance in the dining room in the event of choking or other socialization, relieving the problem of isolation and resultant depression.
To consume beer, wine, or liquor. This will require a doctor's order and you will have to supply the beverages. Know your doctors and ensure that they will honor your request, if possible. If alcohol consumption is against your doctor's advice, you or your Durable Power of Attorney for healthcare may need to sign a waiver.
Expectation 8 - Accommodations/Personal possessions:
You can have reasonable input into your room and roommate.
You can have a private room if one is available and you have finances.
You can have a choice of roommates, as reasonable. You do not need to feel committed to your first roommate. If you are dissatisfied, there may be a possibility of changing rooms.
Personal possessions are allowed, as space permits. For example, your own dresser, pillows, blankets or comforters, TV, radio, VCR/DVD players, computer.
You may have your own pictures on the wall. You may also bring the knick knacks and stuffed animals you are so fond of.
Bringing your own bed may or may not be allowed.
You can expect a clean, comfortable homelike environment, free from urine and other unpleasant lingering odors.
Expectation 9 - Lifestyle preferences:
Access to current reading materials, daily newspaper at your expense.
Accommodations to practice religious, spiritual and cultural activities and preferences.
The right to participate in holiday celebrations of your choosing.
To promote as much independence as possible with therapy and use of adaptive equipment.
Carry out your normal routine and lifestyle habits with necessary compromises.
Awake when you want. If it is too early for breakfast, getting a cup of coffee and toast should be accommodated. You may sleep in and get cold cereal for breakfast but do not expect hot meals at off hours.
If you are a night owl, that can be accommodated but there will be fewer focused activities hot meals, therapy, etc.
Smoking may be allowed in certain facilities but, if it is not allowed on the premises it should be stated in the admission agreement. Depending on your situation, there may need to be a schedule and supervision when smoking. You may not be allowed to keep cigarettes or lighter.
Sleeping accommodation with a reasonable temperature for you, number and type of pillows, which you may have to provide. If you have a particular type of bedding you like, that should be accommodated.
An attempt to facilitate your communication. An interpreter can be provided if yours is not the primary language for the facility. The use of speech therapy and/or a communications board. Plenty of time should be allocated with no rushing if finding the right words is difficult.
Activities of your choosing. For example, if the facility does not have card games scheduled and you enjoy and want to play cards, attempts should be made to find other residents, staff, or volunteers to play on an ongoing, reasonable basis.
Expectation 10 - Immediate needs met:
Your call light answered within 5 minutes to assess your immediate needs. When determined you are safe, you may have to wait to get the need met, as the staff may have to prioritize care based on a variety of factors.
Needs that should be met immediately are a request to go to the bathroom, safety, acute illness or pain relief interventions.
The Plan of Care
The Advance Care Plan spells out in detail all the information about you that makes you - YOU! The 10 Real Expectations become a way of life for you, not merely an expectation. It is federal law that every care facility is required to create a care plan. However, only by planning in advance when you have to clear mind and the ability to communicate effectively can you guarantee that your wishes, lifestyles and desires are documented and well known and communicated to your future caregivers. Your care plan is the strategy for how your will live every day with the assistance of the facility staff and your needs will be met. Most facility plans are based on your problems, not your needs.
The Advance Care Plan was developed by long term care nurses with over 100 years experience. They saw a need to document a resident's wishes, lifestyle and desires after seeing how many residents had simple needs that were not being met.
Be sure to read Ruth’s story at http://www. Advancecareplan.com
You can become your own healthcare advocate with the Advance Care Plan.
For additional information about the Advance Care Plan call 1-877-227-7235. | 
