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Difference between revisions of "Six Pressing Issues when Living in Residential Care"
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Six Pressing Issues when Living in Residential Care (view source)
Revision as of 05:24, 13 May 2016
, 05:24, 13 May 2016→Resident to Resident Harms
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Care facility operators have a general responsibility to promote the health and safety of all residents, and to protect them from harm. This includes harms from other residents. Resident to resident conflict or aggression can have a significant effect on the emotional and physical well-being of the residents and others in the facility. | Care facility operators have a general responsibility to promote the health and safety of all residents, and to protect them from harm. This includes harms from other residents. Resident to resident conflict or aggression can have a significant effect on the emotional and physical well-being of the residents and others in the facility. | ||
It has been estimated that 11 per cent of the care facility residents are “aggressive” at some point. ([[{{PAGENAME}}#References| | It has been estimated that 11 per cent of the care facility residents are “aggressive” at some point. ([[{{PAGENAME}}#References|29]]) The Office of the Seniors Advocate found that there were ____ reports of resident aggression. ([[{{PAGENAME}}#References|30]]) In some instances this can lead to serious injury, even death. The geriatric literature now uses the term “responsive behaviour” to recognize the fact that “aggressive“ residents are often responding (inappropriately) to situations that are frightening to them or causing confusion, Residents may be responsive for many reasons, often it is because of confusion caused by dementia, inadequately addressed pain or an underlying medical condition that is not under control. The resident to resident harms can occur in general residential care facilities as well as those with special dementia units. | ||
The Residential Care Regulation requires care facility operators to report “aggressive or unusual behaviour”. This is defined as “aggressive or unusual behaviour by a person in care towards other persons, including another person in care, which has not been appropriately assessed in the care plan of the person in care.”([[{{PAGENAME}}#References| | The Residential Care Regulation requires care facility operators to report “aggressive or unusual behaviour”. This is defined as “aggressive or unusual behaviour by a person in care towards other persons, including another person in care, which has not been appropriately assessed in the care plan of the person in care.”([[{{PAGENAME}}#References|31]]) | ||
Resident to resident harms typically occur because of three types of factors intersect. There are individual resident factors, facility factors and factors from the broader care system. ([[{{PAGENAME}}#References| | Resident to resident harms typically occur because of three types of factors intersect. There are individual resident factors, facility factors and factors from the broader care system. ([[{{PAGENAME}}#References|32]]) The resident factors for aggression generally include: | ||
* where the residents are cognitively impaired (particularly if they have frontal lobe dementia which impairs inhibitions and their ability to control their behaviour), | * where the residents are cognitively impaired (particularly if they have frontal lobe dementia which impairs inhibitions and their ability to control their behaviour), | ||
* certain medical conditions and psychiatric illness (e.g. under-addressed pain and depression). | * certain medical conditions and psychiatric illness (e.g. under-addressed pain and depression). | ||
It is very common for residents who seem to be aggressive to also show signs of depression and delirium. ([[{{PAGENAME}}#References| | It is very common for residents who seem to be aggressive to also show signs of depression and delirium. ([[{{PAGENAME}}#References|33]]) Other factors can include their personality and their life experience (presence of trauma history, contact sports, the way they have resolved conflicts throughout life). | ||
If there has been a good assessment of the resident prior to coming to the facility (including communication with family or key contacts about whether the person showed aggression in the community), it should be evident whether or not these factors are present. | If there has been a good assessment of the resident prior to coming to the facility (including communication with family or key contacts about whether the person showed aggression in the community), it should be evident whether or not these factors are present. | ||
Resident assessment, however, is an ongoing process and is always required as the person’s health and conditions change. Worksafe BC has indicated that sometimes community service providers are reluctant to share information about a prospective resident’s tendency to respond aggressively, out of concern that the disclosure might breach provincial privacy law. However that it not the case; information about a prospective or current resident’s violence risk can be properly disclosed on a “need to know basis.” ([[{{PAGENAME}}#References| | Resident assessment, however, is an ongoing process and is always required as the person’s health and conditions change. Worksafe BC has indicated that sometimes community service providers are reluctant to share information about a prospective resident’s tendency to respond aggressively, out of concern that the disclosure might breach provincial privacy law. However that it not the case; information about a prospective or current resident’s violence risk can be properly disclosed on a “need to know basis.” ([[{{PAGENAME}}#References|34]]) | ||
The geriatric literature also shows a significant amount of resident aggression can also be reduced with staff trained in dementia care and particularly with training on “responsive behaviours”, such as “P.I.E.C.E.S.” , U – First, Montesorri, or similar programs, as well as staff trained with “Code White” protocols. ([[{{PAGENAME}}#References| | The geriatric literature also shows a significant amount of resident aggression can also be reduced with staff trained in dementia care and particularly with training on “responsive behaviours”, such as “P.I.E.C.E.S.” , U – First, Montesorri, or similar programs, as well as staff trained with “Code White” protocols. ([[{{PAGENAME}}#References|35]])In 2012, the Ministry of Health developed best practice guideline for accommodating and managing behavioural and psychological symptoms of dementia. ([[{{PAGENAME}}#References|36]]) In these guidelines, medications to control behaviours are only used after other less restrictive (but hopefully more effective) methods have been tried and ruled out. | ||
Several facility factors are also important in heightening or reducing the level of resident aggression in that facility. These include its size; whether the environment is over stimulating or under-stimulating; and the facility’s culture (whether it is institution focussed or uses a person centred care approach). Equally important are the staff factors - the staff members' style of approach to residents and work, the numbers and mix of staff, their training and available support, workplace wellness, and leadership factors. | Several facility factors are also important in heightening or reducing the level of resident aggression in that facility. These include its size; whether the environment is over stimulating or under-stimulating; and the facility’s culture (whether it is institution focussed or uses a person centred care approach). Equally important are the staff factors - the staff members' style of approach to residents and work, the numbers and mix of staff, their training and available support, workplace wellness, and leadership factors. | ||
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* should all situations require a police response? If so, what is the nature of the most appropriate justice and health system response? | * should all situations require a police response? If so, what is the nature of the most appropriate justice and health system response? | ||
This becomes particularly relevant when cognitively impaired resident does not appear to have the requisite mens rea for assault, the mental capacity to instruct counsel, or fitness to stand trial. Unlike younger adults who have become aggressive as a result of a mental condition, the difficulty for many residents is that dementia does not get better. Having a safe and appropriate place for them to live the last months or years of their lives, without leaving other residents at risk of harm becomes pressing. | This becomes particularly relevant when cognitively impaired resident does not appear to have the requisite ''mens rea'' for assault, the mental capacity to instruct counsel, or fitness to stand trial. Unlike younger adults who have become aggressive as a result of a mental condition, the difficulty for many residents is that dementia does not get better. Having a safe and appropriate place for them to live the last months or years of their lives, without leaving other residents at risk of harm becomes pressing. | ||
==Reporting Responsibilities== | ==Reporting Responsibilities== | ||
