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Long Term Care Administration


Long Term Care Administration Week 10 November 11, 2010 Empowerment, Autonomy, Ethics, & Law Legislative Context With regionalization, governments rely much more ... – PowerPoint PPT presentation

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Title: Long Term Care Administration

Long Term Care Administration
  • Week 10 November 11, 2010
  • Empowerment, Autonomy,
  • Ethics, Law

Legislative Context
  • With regionalization, governments rely much more
    heavily on legislation regulations to
    accomplish the goals they want to achieve.
  • Governments must conform with the Canadian
    Charter of Rights and Freedoms, Canadian
  • Chapter 15 of the Charter, governments cannot
    discriminate on such grounds as ethinic
    background, national origin, age, sexual
    orientation, or physical or mental disability
    when formulating policies, whether these policies
    are adopted by legislation or not.

Legislative Context
  • Chapter 15 of the Charter allows for certain
    facilities to give preference to individuals from
    a particular ethnic background or age group, as
    long as placement in a similar facility within
    the same general geographic area will be possible
    as an alternative.
  • German, SUCCESS, Louis Brier, Icelandic, Finnish,
    Kopernick Lodge,

Specific Rights in Facilities
  • Common Law, Regulation, Legislation, Funding
    Contracts determine rights of residents in LTC
    Facilities and clients in home support agencies.
  • Caregivers should ensure that residents have
    certain rights related to privacy and autonomy.
  • These rights should be jealously safeguarded and
    subject only to such reasonable limitations as
    arise out of living in an environment together
    with other individuals.

Privacy and Autonomy
  • Residents should have the greatest control over
    their rooms.
  • Staff should ask permission to enter.
  • Should be allowed the choice of uninterrupted
    sleep and without bed checks would not be
    assisted in a life threatening situation.
  • Residents who are capable of unlocking their
    door, should be able to lock it.

Privacy and Autonomy
  • Balance right to privacy and autonomy with the
    rights of others to be free from risk and
  • Right to smoke balanced with the right of others
    to be free from smoke.
  • Television viewing not a choice, its a right.
  • Alcohol usage acceptable within limits.

  • Only medication administered by a MD can be
    provided to residents.
  • Medication Safety Advisory Committee
    interdisciplinary committee that reviews
    medications and consults on the continuation of
    the medication.
  • Protection of seniors in LTC facilities from
    non-prescribed medication.

Use of Restraints
  • Adult Care Regulations
  • Definition of restraints
  • When they may be applied
  • Reassessments
  • Monitoring and Documentation
  • May only be used in an emergency or when it
    preserves life or prevents serious harm to the
    person or to others

  • Admission of persons with Alzheimers Disease who
    need facility care in a closed unit but are
    incapable of giving consent.
  • Advance Directives allow for people to make plans
    in the future if they become decisional
  • Guardianship and Committee

Right to Sexual Expression
  • It is the residents legal and morale right to
    have their wishes complied with.
  • The views of the staff or other residents as to
    what sexual relationships, should be allowed
    within the facility has absolutely no bearing on
    the matter.
  • Right to dignity and individuality.

Abuse and Neglect of Residents
  • Physical, sexual, financial abuse and neglect
    must be reported.
  • Abuse is a criminal offence.
  • Facility is liable for incidence that occur.
  • Due diligence to reduce risk exposure.
  • To reduce liability some agencies ensure that
    individuals are being cared for by same sex
    formal caregivers.

Right to Long Term Residency
  • Right to die in a care facility where the
    individual has lived for many years.
  • Any transfer should be handled with great
  • Spouses when one needs to be transferred and the
    other does not require higher levels of care.
  • The only answer is the need for more multilevel

Transfer and Discharge
  • No facility shall transfer a resident without
    their consent.
  • Formal process exist to determine if the
    residents needs can continue to be met.
  • Notice must be given to the resident.
  • Before discharge, the resident must be assisted
    by identifying alternate arrangements or
    community resources.

Consent to Health Care
  • Right to consent to as well as to refuse any care
    and services offered.
  • Informed consent must first be obtained before
    any treatment can take place.
  • Common law, legislation allows for obtained
    consent in advance directives.
  • Proxy and instructional advance directives.

Physicians and Written Treatment Orders
  • MDs have refused to sign orders indicating that
    no resuscitation should be attempted, or any
    other aggressive treatment or transfer to acute
  • Disconnect between individuals wish and the MDs
    own moral and religious views.
  • DNR orders futile treatment.

  • No information should be released to anyone
    unless the resident has consented.
  • Individuals may access their medical information
    except where there is a significant likelihood of
    a substantial adverse effect on the physical,
    mental or emotional health of the individuals or
    harm to a third party.

Rights of Long Term Care Facility Staff
  • Violence in the Workplace.
  • WorkSafe BC has targeted this area as a focus to
    reduce risk to injury in LTC.
  • Zero Tolerance not acceptable.
  • Too many staff members have been assaulted or
    insulted and told to put up with this because it
    goes with the territory.

Relationships with Other Health Care Professionals
  • Chiropractors, podiatrists, massage therapists,
    and other health care professionals have the
    right to provide treatment or care in the
  • MDs must abide by rules and regulations of the
    facility such as documented a visit.
  • Medical coordinators work with MDs to ensure
    consistent medical practice.

Home Care and Support Issues
  • Advance directives are more difficult to exercise
    in an individuals home.
  • Home care workers are more at risk in someone
    elses home.
  • Workers are subject to discrimination by clients,
    even if they are disabled.
  • Financial abuse accusations are more common in
    home support.

Mental Incapacity
  • Adult Guardianship
  • To obtain substitute consent to provide major or
    minor health care to an adult, a health care
    provider must choose the first, in listed order,
    of the following who is available and qualifies
  • the adult's spouse
  • the adult's child
  • the adult's parent
  • the adult's brother or sister
  • anyone else related by birth or adoption to the

Mental Incapacity
  • Adult Guardianship
  • To qualify to give, refuse or revoke substitute
    consent to health care for an adult, a person
  • be at least 19 years of age,
  • have been in contact with the adult during the
    preceding 12 months,
  • have no dispute with the adult,
  • be capable of giving, refusing or revoking
    substitute consent, and
  • be willing to comply with the duties in section

Empowerment to Meaningful Autonomy
  • Balancing respect for the autonomy of residents
    with the duties to protection and care,
    especially for those with diminishing autonomy.
  • Societal and family responsibilities to the
    elderly and the care dependent.
  • Limits of caregiving obligations of both family
    and professional care providers.

Empowerment to Meaningful Autonomy
  • Balancing privacy and the rights of individuals
    with safety and duties to others
  • Responsible management of limited resources
  • Promotion of truly meaningful autonomy

Context of Long Term Care
  • Diverse set of goals, care recipients, care
    providers and various forms and levels of care.
  • Primary goal is to enable residents to have as
    meaningful a life as possible, for as long as
    possible, given their interests, abilities and
  • Goals could include rehabilitation and functional

The Context of Long Term Care
  • Increasing number of younger persons also receive
    long term care with physically disabled adults
    with conditions such as
  • Multiple Sclerosis
  • Spinal cord and head injuries
  • Late stage cancer and HIV-AIDS
  • Technology dependent disabled children
  • Developmental delayed cerebral palsy

Meaningful Autonomy
  • Self governance or self rule
  • Deciding what to have for lunch and higher stake
    decisions like whether to use a feeding tube to
    prolong ones life.
  • Allows people to live purposefully and
    meaningfully, responding to their own goal,
    values, wishes and plans in ways that they
    perceive as giving their lives purpose and

Meaningful Autonomy
  • Two Strategies
  • Recognition affirmed in resident centred mission
    and values statements, put into practice through
    strategic plans and policies.
  • Creating opportunities for choice and providing
    resources for learning, can help to empower
    people to achieve autonomy.

Challenges for Meaningful Autonomy
  1. Becoming Committed to promoting, sustaining and
    not frustrating meaningful autonomy.
  2. Viewing patients as more than dependent.
  3. Moving beyond a focus on advance directives and
    advance care planning.
  4. Achieving meaningful autonomy despite cognitive

Challenges for Meaningful Autonomy
  • 5. Achieving meaningful autonomy in light of
    significant life long disability.

Challenges for Meaningful Autonomy
  • Becoming Committed to promoting, sustaining and
    not frustrating meaningful autonomy.
  • Learn how the interests and well being are
    understood and desired by the recipients of care.
  • Participation in health care decision making may
    facilitate good care.

Challenges for Meaningful Autonomy
  • 2. Viewing Patients as more than Dependent
  • Dependence and independence are not absolute.
  • One can only be independent within a set of
    constraints ones body, relationsjip and the
  • To eat people are dependent on others

Challenges for Meaningful Autonomy
  • 3. Moving Beyond Advance Directives to Advance
    Care Planning
  • Surrogate decision makers (SDM).
  • SDM makes decisions in accordance with the known
    wishes or choices made by the resident when
  • Instructional directives and proxy directives.

Challenges for Meaningful Autonomy
  • 4/5. Cognitive Impairments Disabilities
  • Empowerment needs to emphasize the psychological
    and spiritual aspects of autonomy in face of the
    obvious limitations in physical autonomy.
  • Care providers should be acutely aware that these
    young and middle aged adults are writing their
    life history with limitations.

Making It Happen
  • Role in respecting residents autonomy in long
    term care.
  • Role in offering and supporting choices beyond
    those occasions when written consent is required.
  • Maintenance of personal integrity enables
    relationships that matter and support personal
    and spiritual values.

Making It Happen
  • Role in accepting and honouring choices and self
  • Role of facilities which have the power to
    severely constrain residents autonomy.
  • Role in providing guidance to care providers and
    resident when the law and professional codes are
  • Physical environment should foster achievement of

Making It Happen
  • Role as educating the delivers of long term care
    of the importance of autonomy.
  • Role of policies and procedures to create and
    protect organizational climate that fosters
  • Eliminate anti-autonomy polices.
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