Senior living is steeped
in the philosophy of respecting individual preferences. But what if a resident
refuses to cooperate with care strategies? How far should the community press
the resident’s rights when doing so may conflict with the views of family,
physician, and community staff? Two senior living executive weigh in …
A Case Study
As the
executive director of a mid-size assisted living community in a tight
market, Sandra is under pressure to keep occupancy as high as possible.
Usually this reality benefits customers, since the community is willing
to go the extra mile to attract new residents and help them stay.
However, she wonders if her community has gone too far in accepting
“Mrs. D,” who is gaining a reputation among the staff as a problem
resident.
Mrs. D has been in the community for about six months. When
she moved in, she was in reasonably good health for an 80-year-old; her
family’s main concern until then had been her failing vision. She moved
to the community from another state to be closer to her daughter, a
successful attorney. Mrs. D would seem to be a perfect match for
assisted living, except for one thing: She is not happy.
The problems began immediately after Mrs. D arrived, when it
became apparent that she and her family had a difficult relationship.
Mrs. D claimed to have been deceived by her daughter and son to get her
to move into assisted living and now she wanted to “go home.” She has
repeatedly announced she is going to leave, raising the concern that
she will try to elope from the non-secure community.
After living by herself for decades, Mrs. D is somewhat of a
loner and not willing to participate in group activities. She keeps
mostly to herself and mostly to her own room. Nevertheless, she draws
staff attention away from other residents with a constant stream of
minor complaints. When she is in the dining room, she complains loudly
of the food and casts a pall on the morale of other residents. While
her health was fine when she moved in, now she is declining almost by
choice. She won’t always eat or do what she needs to do to thrive. She
already has had one hospitalization due to dehydration, and is losing
weight. Her physician has prescribed an anti-depressant, but she
refuses to take it.
Mrs. D’s daughter is willing to pay top dollar to house her
mother at the community and help provide her with the resources and
care that she needs. But she, too, is growing frustrated. Lately, the
daughter has taken to working around her mother by going directly to
the staff with requests for her mother’s care, which puts the community
squarely in the middle.
What course of action should Sandra take to effectively
address the conflict among resident, family, and community staff? How
can she respect Mrs. D’s rights and dignity while also working
cooperatively with her daughter?
And how should Sandra direct frontline caregivers so they can
effectively do their jobs and provide the best care for Mrs.
D?
