Running a Nursing Home
Democratically
by Dennis Shaughnessy
Copyright 2012
Smashwords Edition
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Statements of patient rights are currently popular with care institutions, stating that care will be respectful of patient needs and desires, free from abuse and neglect. A patients' constitution that would make their rights a reality is the subject of this paper. After reading accounts of the inadequacies, abuse and neglect at nursing and boarding homes, I wrote the following letter to the editor.
Give Residents a Vote
In regard to the Feb.3. 1998 South County Journal (Kent,WA) article "Ombudsman's Report Blasts Adult Boarding Homes," I advocate democracy for adult boarding homes
My proposal is for a boarding or nursing home to be run like our country - with staff and residents each having one vote. Massachusetts' Sudbury Valley School has been successfully running this way for 30 years with students and staff having one vote each at weekly meetings. Complaints are handled by a judicial system "of their peers." And staff are voted upon annually.
I favor this school model be appplied to a nursing or boarding home with residents that could understand the idea. Adoption of this model would avoid reinventing a democratic institution.
Expenses would be saved in this type nursing home by not having to buy supplies and services until they are wanted by residents. Administrative costs would be cut by democratic meetings taking more managing roles such as hiring and firing staff. Democracy could help residents and staff have a sense of ownership in their boarding homes and lives.
Dennis Shaughnessy-Caregiver
One Fictitious Patient
Oscar is one of many of our nursing home population that have a mind that understands democracy. His eyes looked out at the institution that had become his home when a brain blood vessel was blocked, paralyzing half his body. This nondescript old building with rooms sprouting from polished hallways was named Sudbury Residence. Nursing home is not in name of care facilities now. Nursing home conjures up the end of the line, where those that enter await death with hopelessness and despair. And a place where patient life is directed and controlled by others. As it had been for African-Americans and women when they couldn't vote. And it was assumed these groups, like patients and students, preferred it that way, being incapable and/or too immature. He wondered if the model of our country's governance could improve his life. Could the model work for patients as it had for Sudbury Valley School students that he read about? Oscar's mind wandered to the ancient Greeks who used the transforming power of democracy and US founders over 200 years ago thinking up a new government and life.
Oscar had tried another, more conventional nursing home before the Sudbury Residence. It had a patient council whose proceedings were printed noting understaffing and whatever else. It had reminded him of the powerless student government of his high school. This prior home had a Patients' Bill of Rights however would they insure his butt would be wiped well? This home's staff was largely benevolent which was better than a malevolent one. However it was still not elected. It took courage to move to Sudbury Residence. He was dependent, alone and could have just turned on the TV. But now he was at his new residence and heading toward the weekly Residence Meeting that runs it.
It is Tuesday, 2 PM and wheelchairs are moving toward the meeting with purpose equal to that of mealtime. Seeing and hearing accommodations were in evidence as the elected chairperson called the meeting to order. It had been a challenge for patients to decide on what to vote on, what mattered to them - acting again like responsible and mature people with unique perspectives and values. Staff and patients are voting about $300 for the Dance Corporation. The executive director of the corporation has made a good case and the funds are voted for. The corporations come and go as patients' interests do. Other agenda items included requests for organic foods, alternative therapies and a children's playground. Residence Meetings pass a yearly budget that must be approved by another body - the Residence Assembly - consisting of staff, patients and elected community and family. A third body - Residence Trustees - is advisory.
Staff, especially nurse aides, usually the heart of care, get a voice which they don't have in the conventional institution. Pay for these people was increased at Sudbury Residence as these workers are "where the rubber hits the road." Although new immigrants are increasingly used to fill a nurse aid shortage, what can we do to make it a better job? And although lawyers handle abuse and neglect cases at nursing homes, what is a basic change of operation that doesn't involve more money that is scarce? Staff would need more than certification and performing the governmental mandates - they would need the vote.
Center regulations are voted upon at Residence Meetings. Violations, as a last resort, are handled by the Judicial Committee consisting of rotating staff and patients. This is the only mandatory activity as it is in our country for voters to serve on a jury. Oscar preferred Sudbury Residence where, if he was drifting in and out of dementia, would be asked at a Judicial Committee "Are you able to judge the complaint?"
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E-mail me to discuss this idea - denshau@yahoo.com
Dennis Shaughnessy