It’s the week of Independence Day and freedom is on my mind. Residents frequently speak to me of their dissatisfaction with the limitations on their liberty, from being told to sit in a communal room when they want to be alone, to needing a family member to sign them out on pass.
“Me and the other inmates,” they say, trying to use humor to cope with their confinement.
Constraints on residents are generally due to a combination of factors, first and foremost being the physical and/or cognitive impairments that led them to require rehab or nursing home care. Psychotherapy often addresses residents’ feelings about having become ill through aging, accidents, life choices and other circumstances and it can reduce some of the blame of the nursing home for curbing their freedom.
It must be acknowledged, however, that there are many aspects of long-term care itself that limit residents, including the facility’s desire to protect residents from harm and themselves from litigation, regulatory requirements, risk-avoidance policies and routines (because “that’s the way it’s always been done and we keep passing surveys”) and inadequate staffing.
As we celebrate our freedoms in the country this week, perhaps we can consider ways in which to create a better balance between the need to provide a safe environment for residents and their right to make their own choices.
Below are just a few of the many aspects of care that could be adjusted for increased autonomy:
- Reevaluate practices that restrict residents as a matter of routine and consider instead ones that are based on their capabilities. For example, rather than disallowing all motorized wheelchairs, offer the opportunity to residents who are found to be physically and cognitively capable, pass a periodic “driver’s test” and follow established guidelines for use.