PART 2, By Susan Misiorski

Susan Misioriski

Susan is the National Director of PHI’s Training and Organizational Development team.

Choice. Self Determination. Control. These are words that hold great importance to all of us, and these words are no less significant for individuals living in residential care settings. Elders interviewed regarding what matters most to their quality of life clearly expressed the importance of these principles, naming them as one of four primary themes contributing to a meaningful living experience in the nursing home:

• Competent staff who meet their individual care needs
• Freedom to make personal choices
• Relationships in which each person is able to both give and receive
• Opportunities for meaningful activity

In this second of a four-part series on what matters most to elders living in nursing homes, we’ll focus on freedom to make personal choices. [Read PART 1]

The elders living at the Pleasant View Center in Concord, New Hampshire, offer an excellent example of voicing their individual and collective choices. I was invited to meet with members of Pleasant View’s culture change committee, which includes numerous residents who are very proud to call Pleasant View home. These individuals work together to suggest changes that affect their quality of life.

Committee member Shirley Frederick described just a few of the changes they have seen through to implementation:

• Hooks in the bathrooms to hang clothing/robes
• The purchase of softer towels
• Replacement of one-ply toilet paper with two-ply
• Family style dining where elders serve themselves from bowls and platters placed on their tables
• Memorial services honoring elders who have passed away

I was struck by the simplicity of most of these requests. I was also deeply impressed by the broad range and depth of decision-making elders are genuinely invited to exercise at Pleasant View. It is not often we see elders living in nursing homes have the opportunity to choose products as basic as toilet paper! These decisions are usually made by purchasing managers whose offices may be located far from the elders who are using the products.

According to Fredericks, administrator Mark Latham brought in multiple brands of toilet paper for the elders to “try and test.” Following this trial, they selected a brand of two-ply paper that they described as significantly better than the previous product throughout the home.

Other examples of choice, self-determination, and control that elders describe as important include such things as waking at the time of their choice rather than a time determined by “the assignment they are on,” when and how to bathe, who they would like as their caregiver(s), how they will spend their time, and when they would like to eat their meals.

The ability of staff to be able to honor these personal choices is largely dependent upon how well they know the person(s) they are supporting. Stable, consistent staff who have long-term relationships with the elders are in the best position to understand both the choices individuals make and the impact on the person’s quality of life.