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Difference between revisions of "Common Care Issues when Living in Residential Care"
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Common Care Issues when Living in Residential Care (view source)
Revision as of 21:33, 2 July 2014
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* promptly and appropriately treat the condition or respond to the situation if it arises. | * promptly and appropriately treat the condition or respond to the situation if it arises. | ||
==Continence Care== | ==Continence Care== | ||
The term “continence care” refers to helping individuals with their bladder or bowel functions, either to maintain independence or deal with incontinence. Older adults living in residential care facilities often have balance or mobility problems, which means that they may need help to safely move to the bathroom, or to transfer from a wheelchair to a toilet and back. | |||
Continence care may include helping to improve or maintain the person’s mobility generally. It generally means assessing the person’s current abilities in self care and planning how to improve that if possible. It may include care plans to help the person to the bathroom, if needed, good hydration and efforts to keep the bladder healthy so the person does not develop urinary tract infection (which in many cases can lead to delirium), as well as proper incontinence care and skin care if the person becomes incontinent. | |||
Residents and families often identify several common problems around continence care: | |||
* residents who were continent before admission to the facility lose the ability because there are not enough direct care staff available to help them to the bathroom; | |||
* non response to call buttons, resulting in residents trying to access the washroom on their own, risking falls and injury; | |||
* residents left waiting long periods of time to be helped from the toilet; | |||
* the misuse of continence products (limiting number of pads or briefs, limiting when the resident can be “changed” [“the 75% rule”], or doubling the pads to reduce number of changes); | |||
* restricting fluids for a resident to reduce the use of continence products; | |||
* financial aspects, such as being charged fees for catheters and continence products (these are actually an included benefit in the assessed client rate for residential care. | |||
===Is there a legal “right to good continence care”?=== | |||
Good continence care is part of the broader responsibility of the Operator to provide good care and meet the individual resident’s care needs. Legal analysis on continence issues in residential care has underscored a number of policies and practices that clearly violate the concepts of individualized care and personal dignity. For example, it is not appropriate for an operator to allow only a certain numbers of continence briefs per resident, per shift, or per staff, nor is it appropriate to put front line staff in the position where they are, in effect, told to ration these supplies and care necessities. | |||
In British Columbia, individual health authority practices vary when it comes to continence care. Interior Health, for example, has a short policy that is focused on maintaining maximum independence for residents by providing assistance when needed. Vancouver Coastal Health has a policy on “bowel function promotion and maintenance.” The other health authorities do not have specific policies on providing bathroom assistance. | |||
Interestingly, sometimes information from health authorities can add to the public confusion on continence care issues. For example, guidebooks may ask people to check if the facility has additional charges for incontinence pads. This leaves the public with the impression that residents can legitimately be charged for these, when they are actually part of the basic cost. | |||
==Risk Taking== | |||
One commonly asked legal issue in residential care is: “Which personal risks are residents ‘permitted’ to take?” The issue revolves not only about the perceived risks for the individual (or sometimes other residents), but also is about the efforts taken to mitigate risks and who has the final say in the various “risk” decisions. | |||
===An example from falls prevention=== | |||
Falls are a common concern in residential care facilities, and happen with considerable frequency, as a result of many interrelated factors including frailty, medications, staffing and environmental factors, as well as cognitive impairment. In some cases, family will ask (“strongly request”) staff to take stronger efforts to help reduce the risk of a resident falling. They may erroneously believe that if staff restricts the resident’s movement (“make her stay in bed”) or if they use physical restraints, this will prevent falls. | |||
Research clearly and consistently indicates that physical restraints do not increase safety. In some types of cases, physical restraint use actually leads to a higher risk of falls. Even the litigious American system has recognized that a facility is much more likely to be held liable in a lawsuit for an injurious fall where proper falls risk assessment and proper falls management were not done, than if the facility was not using physical restraints. From a legal perspective, restraints do not reduce liability. | |||
By law, the operator is required to undertake a falls risk assessment for each resident and develop a falls management plan for those at risk, record it and regularly review it. However, operators have an overall responsibility to provide good information for people who are making decisions with or on behalf of the resident. As part of this responsibility, operators may need to help families and others | |||
* develop a better understanding of the issues (e.g. the resident’s risk to take certain risks, the harms from the restriction), as well as | |||
* the best practices in the area (e.g. ways that the facility works to reduce risks of falls through environmental means, through rehabilitation and mobility preservation). | |||
===Leaving the facility=== | |||
In some residential care facilities, competent residents may be denied the right to leave the facility to visit a nearby coffee shop, or the operator may require that the person only leave with a staff person, family or a companion. If those people are not available, the resident is effectively restricted to the facility. The facility may adopt the policy from a risk management perspective including out of concern for the safety of residents, taking into consideration local traffic, vision or hearing impairment, fall risks, and environmental hazards. Nevertheless it can be a violation of a competent adult’s autonomy. At law, it may be considered forcible confinement, and may be a criminal offence. | |||
When the resident has been transferred to the facility under the extended leave provisions of the Mental Health Act, the issue of leaving the facility also becomes problematic. The person may be mentally capable of making that kind of decisions, but may be restricted from leaving because the Mental Health Act takes away all the person’s decision-making rights. | |||
==Private Communication== | |||
Because care facilities are relatively “closed systems”, separated from the broader community, the opportunity for residents to remain in contact with family, friends and other people on the outside is very important. The Regulations require the Operator to have at least one conveniently located private line telephone, for use only by residents. The phone must have “adaptations, as necessary, to meet the needs of persons in care”, and be accessible to residents at all times.” | |||
==Paid Companions in Residential Care== | |||
Family members or friends may wish to hire a paid companion to supplement time spent with the resident. Companions may be hired under the direction of family or friends or a home care agency to provide companionship for individual residents. This is a private arrangement between the family/resident and the companion. In some care facilities, families feel pressured to hire from an agency with whom the Operator is doing business. | |||
Companion services are primarily social in nature and may include: conversation, reading, card/letter writing, music, recording life stories, shopping, games, and attending appointments. Typically the care facility operator does not assume liability or responsibility for these arrangements. They may request the companion to sign a waiver “to provide clarity regarding the services provided”. | |||
==Renovations and Closure of Facilities== | |||
Throughout the 2000s, a number of care facilities in British Columbia were closed or renovated. In many circumstances, this process happened in a way that left residents and families with little if any notice, distressed and feeling very uncertain about the residents’ future. The Residential Care Regulations require the Medical Health Officer to be informed about closures, but is silent as to residents or families to this information. The Ombudsperson’s Best of Care report recommended that health authorities promptly inform residents and families decisions about closure decisions. | |||
The Ministry of Health (Home and Community Care) Policy now has a special section on expectations of Operators and the health authorities when Operators or others are planning to close the facility. At least one health authority has identified that care facilities under a certain size (125 beds) are not economically viable, and consequently should be closed. This will be a very important consideration for current and future residents. | |||
{{REVIEWED | reviewer = BC Centre for Elder Advocacy and Support, June 2014}} | {{REVIEWED | reviewer = BC Centre for Elder Advocacy and Support, June 2014}} | ||
{{Legal Issues in Residential Care: An Advocate's Manual Navbox}} | {{Legal Issues in Residential Care: An Advocate's Manual Navbox}} | ||