Starting Points for Problem Resolution in Residential Care: Difference between revisions
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Starting Points for Problem Resolution in Residential Care (view source)
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The rationale of the Bill of Rights was to | The rationale of the Bill of Rights was to | ||
* clarify and help promote the rights of residents | * clarify and help promote the rights of residents ([[Chapter Five Legal Issues in Residential Care References|39]]) | ||
* “reduce misunderstandings and miscommunications and facilitate consistency of expectations and service delivery” | * “reduce misunderstandings and miscommunications and facilitate consistency of expectations and service delivery” | ||
* assist in the early recognition and resolution of complaints. | * assist in the early recognition and resolution of complaints. | ||
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*'''(ii) employing “only persons of good character who meet the standards for employees specified in the regulations”.''' | *'''(ii) employing “only persons of good character who meet the standards for employees specified in the regulations”.''' | ||
As previously noted, the Bill of Rights is educative and provides context. It can help residents and others know their rights, as well as how to raise concerns and complaints better. It also has considerable potential for helping people approach the diverse issues that may arise in care appropriately, focusing first on the resident (“person-centred”). The Bill of Rights places responsibilities on the facility staff, the operator, and the health authorities to respect and promote the rights. However, while all these identified rights in the Bill of Rights are important, there is a risk that by focusing on these rights, operators, staff, residents, family, advocates or even people providing redress are left with the mistaken impression that other rights which the people have are absent or less important in residential care. | As previously noted, the Bill of Rights is educative ([[Chapter Five Legal Issues in Residential Care References|40]]) and provides context. It can help residents and others know their rights, as well as how to raise concerns and complaints better. It also has considerable potential for helping people approach the diverse issues that may arise in care appropriately, focusing first on the resident (“person-centred”). The Bill of Rights places responsibilities on the facility staff, the operator, and the health authorities to respect and promote the rights. However, while all these identified rights in the Bill of Rights are important, there is a risk that by focusing on these rights, operators, staff, residents, family, advocates or even people providing redress are left with the mistaken impression that other rights which the people have are absent or less important in residential care. ([[Chapter Five Legal Issues in Residential Care References|41]]) | ||
As previously noted in Chapter 2, in British Columbia, the Bill of Rights does not give rise to a separate basis of legal action (that is a person cannot sue for breach of contract or negligence, based solely on a violation of the rights). However, it is an important legal mechanism to interpret and understand the required approach to care and quality of life for residents. It can also provide supporting evidence if an issue needs to go through administrative or other legal channels, including civil lawsuits. | |||
As previously noted in Chapter 2, in British Columbia, the Bill of Rights does not give rise to a separate basis of legal action (that is a person cannot sue for breach of contract or negligence, based solely on a violation of the rights). However, it is an important legal mechanism to interpret and understand the required approach to care and quality of life for residents. It can also provide supporting evidence if an issue needs to go through administrative or other legal channels, including civil lawsuits. ([[Chapter Five Legal Issues in Residential Care References|42]]) | |||
====Special Note==== | ====Special Note==== | ||
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*(d) rights to transparency and accountability. | *(d) rights to transparency and accountability. | ||
The Bill of Rights identifies that these rights are not passive; they are to be respected, actively protected and promoted by the operator, staff and health authorities. Operators have a responsibility to prominently display the Bill of Rights in a prominent place in the facility so that residents, staff and other people are aware of the rights. | The Bill of Rights identifies that these rights are not passive; they are to be respected, actively protected and promoted by the operator, staff and health authorities. Operators have a responsibility to prominently display the Bill of Rights in a prominent place in the facility so that residents, staff and other people are aware of the rights. ([[Chapter Five Legal Issues in Residential Care References|43]]) The operators also have a responsibility to make the residents’ rights “known, orally and in writing, to persons in care and their families and representatives.” | ||
The term “family “ is not defined in this context. The Bill of Rights, however, is expected to be interpreted in a wide and purposive manner. The term can reasonably be taken to include any person that the resident formally or informally identifies as supportive and acting on their behalf, which may include relatives, extended family, close friends or neighbours. The Residential Care Regulations defines “representative” as those with authority to make health or personal care decision on behalf of the adult under specific pieces of legislation. That may include legally authorized representatives (committee, person appointed under a representation agreement or power of attorney, statutory representatives- temporary substitute decision-maker). | The term “family “ is not defined in this context. The Bill of Rights, however, is expected to be interpreted in a wide and purposive manner. The term can reasonably be taken to include any person that the resident formally or informally identifies as supportive and acting on their behalf, which may include relatives, extended family, close friends or neighbours. The Residential Care Regulations defines “representative” as those with authority to make health or personal care decision on behalf of the adult under specific pieces of legislation. ([[Chapter Five Legal Issues in Residential Care References|44]]) That may include legally authorized representatives (committee, person appointed under a representation agreement or power of attorney, statutory representatives- temporary substitute decision-maker). | ||
The scope of the rights is set out in the last clause. The listed rights are placed in the context of | The scope of the rights is set out in the last clause. The listed rights are placed in the context of | ||
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However whenever there is an effort to justify a limiting a particular right, these will need good evidence from the operator to justify that limit or restriction. Bills of Rights are expected to be given broad interpretation that will match their underlying purposes. | However whenever there is an effort to justify a limiting a particular right, these will need good evidence from the operator to justify that limit or restriction. Bills of Rights are expected to be given broad interpretation that will match their underlying purposes. | ||
The Bill of Rights is not a new idea to long term care. To a large extent, it is a codification and simplified statement of operators’ and staff’s legal responsibilities set out in the residential care regulations, which have been in place for over two decades. While the Ministry of Health has described these rights as “comprehensive”, | The Bill of Rights is not a new idea to long term care. To a large extent, it is a codification and simplified statement of operators’ and staff’s legal responsibilities set out in the residential care regulations, which have been in place for over two decades. While the Ministry of Health has described these rights as “comprehensive”, ([[Chapter Five Legal Issues in Residential Care References|45]]) these are at best a brief statement of only some of the rights held by residents in care facilities. | ||
Residents (along with their families and friends) retain all their rights and entitlements as adults. This includes, for example, common law rights, rights under provincial or federal laws, the Canadian Charter of Rights and Freedoms in respect of government actions, as well as rights from other sources (e.g., duties that are described in medical codes of ethics). | Residents (along with their families and friends) retain all their rights and entitlements as adults. This includes, for example, common law rights, rights under provincial or federal laws, the Canadian Charter of Rights and Freedoms in respect of government actions, as well as rights from other sources (e.g., duties that are described in medical codes of ethics). | ||
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===Compliance=== | ===Compliance=== | ||
[[File:compliance.jpg | right | frame | link=| <span style="font-size:60%;">Copyright www.shutterstock.com</span>]] | [[File:compliance.jpg | right | frame | link=| <span style="font-size:60%;">Copyright www.shutterstock.com</span>]] | ||
Compliance with the Bill of Rights is monitored in two ways. Patient Care Quality Offices of each health authority (described below) are required to track complaints about non-compliance with the Residents’ Bill of Rights and report this information to the Ministry of Health on a quarterly basis. The community care facilities licensing programs (also described below) within each health authority are required to monitor the facility’s compliance with the rights, typically as part of routine or unscheduled inspection by licensing. | Compliance with the Bill of Rights is monitored in two ways. Patient Care Quality Offices of each health authority (described below) are required to track complaints about non-compliance with the Residents’ Bill of Rights and report this information to the Ministry of Health on a quarterly basis. The community care facilities licensing programs (also described below) within each health authority are required to monitor the facility’s compliance with the rights, typically as part of routine or unscheduled inspection by licensing.([[Chapter Five Legal Issues in Residential Care References|46]]) | ||
===Information rights (The right to know)=== | ===Information rights (The right to know)=== | ||
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The specific provisions of the Bill of Rights are described in detail in Chapter 2. Section 4 of the Bill (rights to transparency and accountability) is particularly germane to remedies and problem resolution. It sets out that residents have a right to ready access to: | The specific provisions of the Bill of Rights are described in detail in Chapter 2. Section 4 of the Bill (rights to transparency and accountability) is particularly germane to remedies and problem resolution. It sets out that residents have a right to ready access to: | ||
*(a) copies of all laws, rules and policies affecting a service provided; | *(a) copies of all laws, rules and policies affecting a service provided; ([[Chapter Five Legal Issues in Residential Care References|47]]) | ||
*(b) a copy of the most recent routine inspection record made under the Act. | *(b) a copy of the most recent routine inspection record made under the Act. ([[Chapter Five Legal Issues in Residential Care References|48]]) | ||
Section 4 of the Bill of Rights also sets out the consumer rights of residents to know in advance what they will be charged for accommodation and services, and any refund options. | Section 4 of the Bill of Rights also sets out the consumer rights of residents to know in advance what they will be charged for accommodation and services, and any refund options. ([[Chapter Five Legal Issues in Residential Care References|49]])It also sets out that residents have a right to have their family or representative informed of all these requirements in order to have greater transparency and better accountability ([[Chapter Five Legal Issues in Residential Care References|50]]) so that people can help residents properly exercise the rights. | ||
The Bill of Rights does not set out how this information is to be provided. It does however mean that residents, their family or representative have the right to expect their requests for information (for example about what has happened, why particular actions are being taken) will be answered in a timely manner by the staff, administration, or the health authority, according to the situation. | The Bill of Rights does not set out how this information is to be provided. It does however mean that residents, their family or representative have the right to expect their requests for information (for example about what has happened, why particular actions are being taken) will be answered in a timely manner by the staff, administration, or the health authority, according to the situation. | ||
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The Ministry of Health uses the following definition for the councils: | The Ministry of Health uses the following definition for the councils: | ||
:“A resident/family council is a group consisting of persons in care and/or their representatives, family members and contact persons who work together with staff to maintain and enhance the quality of life of residents and to provide a voice in decisions within the facility that affect them.” | :“A resident/family council is a group consisting of persons in care and/or their representatives, family members and contact persons who work together with staff to maintain and enhance the quality of life of residents and to provide a voice in decisions within the facility that affect them.” ([[Chapter Five Legal Issues in Residential Care References|51]]) | ||
The membership thus is wider than just those with legal authority to speak for an individual resident. A resident council is a group of persons who live in a residential care facility. A family council is a group of persons who are the contact persons, representative or relatives of care facility residents. Both types of councils meet regularly for a common purpose related to discussing and working to promote residents’ wellbeing , as well as address issues or concerns within the care facility. | The membership thus is wider than just those with legal authority to speak for an individual resident. A resident council is a group of persons who live in a residential care facility. A family council is a group of persons who are the contact persons, representative or relatives of care facility residents. Both types of councils meet regularly for a common purpose related to discussing and working to promote residents’ wellbeing , as well as address issues or concerns within the care facility. | ||
Both family councils and resident councils are intended to be self-led, self-determining and democratic. According to the government resources “Councils exist to engage the resident community in collaborative activities which will advance the quality of life for residents.” A staff liaison from the residential care facility may be appointed to support and facilitate the council. | Both family councils and resident councils are intended to be self-led, self-determining and democratic. ([[Chapter Five Legal Issues in Residential Care References|52]]) According to the government resources “Councils exist to engage the resident community in collaborative activities which will advance the quality of life for residents.” A staff liaison from the residential care facility may be appointed to support and facilitate the council. | ||
One of the key roles that a family council or a resident council can play is to promote improved communication and collaboration between family members and the facility staff or management. This may involve working collaboratively on projects that enrich the lives of persons in care, making recommendations to decision makers, communicating common concerns and ideas for improvements. | One of the key roles that a family council or a resident council can play is to promote improved communication and collaboration between family members and the facility staff or management. This may involve working collaboratively on projects that enrich the lives of persons in care, making recommendations to decision makers, communicating common concerns and ideas for improvements. | ||
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Family and Resident Councils face a number of challenges to becoming an effective recourse for addressing concerns within a residential care facility or among facilities. First, few residents or family are there long enough to be involved in a council. A high percentage of the residents may experiencing some degree of cognitive impairment, making participation in residents councils far less likely or less intensive and responsive. | Family and Resident Councils face a number of challenges to becoming an effective recourse for addressing concerns within a residential care facility or among facilities. First, few residents or family are there long enough to be involved in a council. A high percentage of the residents may experiencing some degree of cognitive impairment, making participation in residents councils far less likely or less intensive and responsive. | ||
At the same time, there continues to be significant barriers in British Columbia to creating and maintaining family councils. There is a lack of knowledge among families and other supporters of how the health care, residential care and related systems work (“institutional knowledge”). It can take a lengthy period of time (months, even years) for people to understand how their particular facility functions and the potential positive role and function of the councils. It has been noted by council members that just as people begin to gain an understanding of this, “their resident” dies and in most cases, the family member loses contact with people at the facility. The lack of continuity of institutional knowledge can be further weakened where care facility operators try to require that council members who no longer have a resident living there anymore resign and no longer participate. | At the same time, there continues to be significant barriers in British Columbia to creating and maintaining family councils. There is a lack of knowledge among families and other supporters of how the health care, residential care and related systems work (“institutional knowledge”). It can take a lengthy period of time (months, even years) for people to understand how their particular facility functions and the potential positive role and function of the councils. It has been noted by council members that just as people begin to gain an understanding of this, “their resident” dies and in most cases, the family member loses contact with people at the facility. The lack of continuity of institutional knowledge can be further weakened where care facility operators try to require that council members who no longer have a resident living there anymore resign and no longer participate. ([[Chapter Five Legal Issues in Residential Care References|53]]) | ||
===What is the legal requirement for Family/ Resident Council?=== | ===What is the legal requirement for Family/ Resident Council?=== | ||
The requirements and support for Family/ Resident Council are not as strong in British Columbia as some other provinces. However, the Residential Care Regulations sets out a number of minimum standards: | The requirements and support for Family/ Resident Council are not as strong in British Columbia as some other provinces. ([[Chapter Five Legal Issues in Residential Care References|54]]) However, the Residential Care Regulations sets out a number of minimum standards: | ||
1. The operator must provide an opportunity at least once a year to establish a council or similar organization to represent the interests of the persons in care, or their parents or representatives, family members and contact persons, or both. | 1. The operator must provide an opportunity at least once a year to establish a council or similar organization to represent the interests of the persons in care, or their parents or representatives, family members and contact persons, or both. | ||
