State and Federal Regulations and Policies in Client Communities recognize that residents in Adult Care Homes have every right other citizens enjoy, even if the resident is not a citizen of the United States. In general, resident rights may be grouped into several broad categories:
The right to be fully informed
The right to participate in their own care and to make choices
Admission, transfer and discharge rights
The right to be treated with dignity and respect
The right to voice their concerns
The right to privacy and confidentiality
The right associate with others of their choice
Within each of these general areas are specific rights spelled out in regulations and policies. It is important that each of us work to assure that residents are supported in exercising of their rights. That can be very challenging for Cornerstone staff since we don’t know the residents very well and because we want to make a good impression on the client community so they will encourage us to work additional shifts. Following are examples of specific resident rights and suggestions on your personal responsibility to honor resident’s exercising their rights.
The Right to be Fully Informed
This area includes informing residents of facility rules and regulations, about how much the resident will be charged for services and about access to the three most recent State surveys. Because you are a temporary employee, you won’t know much about how much the resident is charged. But you can help them exercise their rights by reporting questions or concerns a resident may share with you to the person in charge of the shift you are working. You also may not know much about all the rules and regulations in the facility. But you can relay the resident’s questions to the person in charge and reassure the resident that you have done so. One thing you can usually discover easily is the location of the “Survey Book”. Every nursing home must make available a copy of the three most recent annual surveys. It is usually kept in a three-ring notebook with a sign stating its location. If asked, let the resident know where the survey book is located. And let the person in charge know, too, so they may answer any questions a resident might have.
The Right to Participate in Their Own Care and Make Choices
This area includes informing residents about changes in their condition. While it is a right, it is not your role to tell residents if their condition is getting worse. In general, work with the nurse in charge to let them know if a resident is asking about how they are doing. If they ask you about their temperature or blood pressure after you’ve taken their vitals, please give them an update as you are finishing up but the nurse is responsible for communicating other information. Resident participation in their own care includes participating in care plan meetings but its unlikely you will experience this during your time in a client community. Resident participation will most likely impact you when they make choices and give you directions about the care you are providing. Residents may refuse medications, treatments, baths and showers, changing a brief, getting out of bed for meals, the food they are being served and any other care which you may be responsible for providing. Sometimes a resident needs some encouragement to accept care from a stranger. Be friendly, smile and encourage the resident to let you help them. However, don’t push resident to do what they don’t want to do. Let the person in charge know about the resident’s refusal and ask for guidance. You may be encouraged to provide care to another resident and then attempt to re-engage the resident who refused the care you were offering later. Or, the nurse may have someone else attempt providing the care. As long as we are working together to provide the care residents need in the time and manner in which they can accept that care, we are honoring their rights and fulfilling our responsibilities.
Other aspects of participation in care and making choices include the residents right to review their medical record, to pick their own Doctor and to have their needs and preferences honored to the extent doing so doesn’t infringe on the safety and well-being of others. For example, if a facility allows staff and residents to smoke outside in a designated area, residents who prefer to smoke in bed while falling asleep would be making a choice that endangers others and your responsibility would be to report the situation to the nurse in charge and assist in intervening to stop the resident from an unsafe practice.
Admission, Transfer and Discharge Rights
Residents have the right to remain in the nursing facility unless doing so is unsafe for themselves, for others, if they’ve refused to pay their bill or if their condition improves so they no longer need the services offered. Once admitted, the facility may transfer the resident from one room to another within the facility after informing the resident of the planned move. The resident must be informed of the move in advance and must also be informed, in advance, of a change in their roommate if in a shared room. You likely will not be involved in a situation where a resident is being involuntarily discharged for one of the reasons listed above. You may have opportunity to work with residents who are getting a new roommate or who have a roommate moving out. Recognize that this is a big change for many residents and listen to any concerns or comments the resident may have about the change. As with other aspects, you should communicate the resident’s comments and any concerns to the nurse in charge for your shift.
Dignity and Respect
Each of us have the responsibility to treat others with dignity and respect for their personhood. For nursing home residents, this general area of rights includes being free from abuse, neglect, exploitation, involuntary seclusion and to be treated as an adult. Dignity includes addressing them respectfully with the name they prefer we use—staff of the facility may be able to help you with these types of resident preferences. Abuse, neglect and exploitation (taking a resident’s property for one’s own use)—known in our lingo as A N E—are crimes and must be reported to the person in charge immediately. Failure to report concerns instances of suspected ANE are as serious as committing the acts themselves. Involuntary seclusion includes isolating a resident in their room when it is not needed for a medical condition. It also includes restraining residents with chemical and physical restraints. Many client communities have restraint-free environments as it relates to physical restraints. Kansas nursing homes have a great deal of progress to make in reducing chemical restraints. Some clients do better than others. The challenge you will face is comparing one building you work in against another. If you focus your energy on treating residents as adults—respecting who they are and the life journey that has brought them to their current situation—then you will almost certainly honor their rights to be treated with dignity and respect.
Resident have the right to voice their concerns and most nursing facilities offer a variety of formats in which a resident may exercise this right. There may be a resident council. There is always a Grievance Policy and Procedure. There are required postings about the Ombudsman and how to contact the Abuse Hotline maintained by the State. Some facilities have volunteer Ombudsmen who visit regularly. Your responsibility is listen if the resident has something to say and then do something with the information they shared. Most likely, that will be to inform the person in charge of your shift about the concern that’s been raised.
Privacy and Confidentiality
This general area includes respecting the private space of residents, keeping information about them confidential and respecting their privacy when providing personal care. You will come in contact with very personal information about every resident for whom you provide care. It is your responsibility to share that information only with those people that need to know it and who will use it to provide care and services to the resident. For most of us, the essence of privacy is assuring care is provided in a manner that protects the resident from the embarrassment all of us feel when someone walks in on us in the bathroom. Be mindful of resident’s personal privacy—pull the privacy curtain, close the drapes/blinds on outside windows, close the door to the room if possible—before you start providing care. And if you’re on your way into a room to provide assistance, always knock and ask for permission to enter. Treat residents like adults and in a manner you want to be treated! Privacy also includes the right for residents to have private time with a spouse or partner so long as both parties consent to the relationship.
Association with Others
Residents have the right to see anyone they want and to change their minds if they no longer want to see someone. This includes the obvious things like family and friends, pastors, other healthcare providers, attorneys, government representatives including surveyors, etc. It also includes participating in Resident Council meetings, going out on pass, attendance at group activities, etc. And its okay if the resident decides they no longer what to participate in those things, too. You most likely won’t have much involvement in who the resident does or doesn’t want to associate with but should always respect the residents right to chose.
The common element running through all resident rights is that the resident is to be in control of their life and we are responsible for respecting and supporting residents as they exercise that control. Ultimately, as temporary support to staff and residents in client communities, we have an additional responsibility to communicate with community staff when residents have questions about or provide direction as they exercise their rights.