Tips on How to Offer Choice to the Elderly in Care

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Jennifer Stone writing in 2012

Many
elderly people who move into care homes are suddenly faced with very
few choices in how to live their lives. They are told when to get up in
the morning, and when to go to bed, what to eat and when, what they are
expected to do throughout the day, and even when it is convenient for
them to go to the toilet! When choices are taken away from a person like
this it can have a very negative effect on their well being. A person
can become depressed and see no point in living. Incontinence increases
as do behavioral problems, as this is sometimes the only way a person
can take any control over their own lives.

It is very easy for a care home, whether nursing or residential, to
fall into this trap. You only have a certain number of staff on shift at
any one time and there is an awful lot of work for the staff to do
during their shift to ensure all the residents receive the care they
need. With strict budget restrictions placed on the home by the owners,
changing a routine that appears to work so that the staff get all their
duties completed in the allotted time can seem like an enormous
undertaking, and even impossible!

Institutional Abuse

Institutional
abuse occurs when a home is run to suit the staff rather than the
residents. By not offering any choices to the service users of the home,
their needs are not being met. Health and well being issues are over
looked, service users are over medicated and staff tend to be stressed
in this environment because the residents are displaying behaviours that
are difficult to deal with. This kind of environment breeds abuse
either unintentional or intentional, so the systems and processes of
running the home need to changed.

Good carers can turn into abusive carers without even realising it,
due to stress, time restrictions and bad management of the home!

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Time for Change!

Whether
your home is rated poor, good or excellent, your systems and processes
of running the home need to be reviewed regularly to ensure that the
staff are not falling into institutionalised routines that could be
harmful to the well being of your service users. Here are the choices
that should be offered to all the individuals living in the home on a
daily basis, and some ideas in how to implement them.

Establishing Person Centred Routine

Routine
can be very important to an elderly person who has moved into care,
especially if they have memory problems and health issues that need to
be taken into consideration. However, each individual will need their own
routine, not the same as all the other service users. This can be
established when they move into the home, but remember, people have the prerogative to change their minds! Here are some questions that should be
asked:

  • What time do they like to get up in the morning?
  • What do they like to eat and drink, and when?
  • What are their interests, what activities can you offer them that will keep them active and alert?
  • What time do they like to go to bed?
  • How do they want their personal care to be delivered?
  • How can you meet their individual health needs whilst still respecting their individual choices?

Lets look at how to respect these choices in a little more detail.

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Getting Up and Going to Bed

  • People
    like to get up and go to bed at different times, so the staff need to
    organise their time to account for this. It’s easy really, if someone
    likes to get up early, then attend to them first, leaving the people who
    like a lie in until later.
  • If someone likes a lie in, it is important to check on them early to
    ensure they are OK to be left lying in bed. Do they need a pad change
    or a trip to the toilet so they can sleep for a couple more hours
    comfortably and without the risk of pressure sores developing? Do they
    need turning? Do they actually want a lie in that day? It won’t always
    be the same people each morning that want to get up early or want longer
    in bed. Offer the choice!
  • Management need to organise the shift times according to the needs
    of the residents, which do change over time! It’s no good starting the
    early shift at 6am, if no-one likes to get up until after 7am, and vice
    versa. Staff need to be flexible so that shift times can be changed to
    reflect the busy periods within the home.
  • The residents should not be expected to go to bed by a particular
    time i.e. before the night staff arrive! If you have lots of service
    users who like to stay up watching tv, or chatting regularly, then
    adjust the shift times to account for this.
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Meal Times

  • People
    like to eat their meals at different times of day. Breakfast should be
    offered when they get up. There should be no restriction on how late
    breakfast is served, it’s not a hotel, it is the residents home!
  • There should be menu choices for all meals, and snacks available at
    all other times. Elderly people often end up in care as a result of not
    eating properly, so it is important to offer a well balanced healthy
    diet as well as tasty treats such as cake to encourage people to eat.
  • People have different dietary needs due to their health, culture and
    life choices. For example a vegetarian needs to be offered as many
    choices as a meat eater. Special diets need to offered to reflect health
    issues such as diabetes.
  • Ideally there should be no set meal times. It should be individuals
    choice as to when they have their lunch or tea. However, it is
    beneficial to the service users to promote socialising and some routine,
    so having a meal in the dining room with others can become an enjoyable
    activity, that encourages people to socialise and to eat! So meal times
    need to be flexible to reflect the needs and wants of the people living
    in the home. Someone who does not want to eat at the same time as most
    of the others, should be able to have their meal whenever they are ready
    for it.
  • “Tea rounds” are commonplace in residential and nursing homes, they
    happen at specific times throughout the day. They are important for
    ensuring that the residents are offered enough to drink and do not get
    dehydrated, which can lead to an increase in falls and other health
    problems. Tea, coffee or a soft drink should be offered to each
    individual on every tea round! People change their minds, they
    may usually want tea but they are quite within their rights to decide
    they want coffee for a change! Drinks should also be offered and
    available at all other times of day!

Activities

  • There should be an activities program that
    reflects the interests of the residents of the home. A choice of group
    activities need to be available every day, as well as things that people
    can do alone according to their likes, interests and abilities.
  • An activities coordinator needs to be employed to ensure that all
    residents have enough to do to stop them getting bored and to keep them
    active and alert, and to keep the activities program up to date.

Personal Care

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  • Ask
    people what help they want or need with their personal care.
    Independence needs to be encouraged, so even if it takes longer for them
    to complete a task by themselves, it is preferable to a carer doing
    everything for them. This is important for a persons self respect and
    dignity.
  • All service users should be offered a choice of what to wear, every
    day! It can be an informed choice i.e. you’ve told them what the weather
    is like or what activities are on that day that they may want to take
    part in and dress appropriately.
  • Individuals should be able to bath or shower morning or evening as
    they choose, and as often as they choose! Of course sometimes staff need
    to encourage residents to bath or shower regularly, this can be
    addressed in the individuals care plan.
  • Toileting is important, and although staff will be sticking to set times for some pad changes, there should never be an occasion when the staff are too busy to assist someone to the toilet if they wish to go!
  • Cultural needs are important to consider, for example, in some
    cultures women would never let a man other than her husband see her
    undressed. To ignore this in an elderly person can cause great distress,
    so should be considered when organising who does what amongst the staff
    team.

Finally…

Every
aspect of an elderly persons life in a care home should revolve around
choices they have made. The staff need to be suitably trained and have
enough time to implement these choices whilst ensuring that all their
duties and paperwork are completed by the end of their shift. There are
many good carers out there. They need to be feel valued by the
management of the home and have enough time to do their jobs properly to
ensure that the residents are well cared for and their choices are
respected. Management can create a happy working environment for the
staff, thereby creating a happy living environment for the residents by
ensuring all training is up to date, necessary equipment is available
and working, and by listening to what the staff say and talking to the
residents to ensure their choices are being met.

Some Further Reading

How to Care for Aging Parents, 3rd Edition: A One-Stop Resource for All Your Medical, Financial, Housing, and Emotional Issues

Published by Residential Forum

The Residential Forum is to promote the achievement of high standards of care and support for children and adults living in residential care and nursing homes, supported housing, residential schools and colleges, hospices and hostels. It contributes to improving the quality of service to the public. Members of the Forum are people of standing and experience drawn from the public, private and voluntary sectors, as well as some who can speak for service users and carers.

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