Where is Culture Change When You Need It?

My apologies to those readers expecting an exploration of the use of the Living Lab methodology to improve elder care in Finland (and there are many of you). You will need to wait another week. A friend's story about how his mother was recently treated in a supportive living facility reminds me of how challenging it is for residents and their representatives to navigate the elder care ecosystem.

As I've written about previously, the Supportive Living Facility  (SLF) program in Illinois is an exemplary Medicaid-waiver program which created 124 affordable assisted living facilities caring for approximately 12,000 Illinois citizens. SLFs are, more or less, the equivalent of assisted living facilities (ALFs), with the chief differentiator being that SLF's accept Medicaid as a payment source. ALFs serve a wholly private pay population.

Although the recently passed SMART Act will limit access to SLFs, this nationally recognized program remains a viable and vital component of the Illinois elder care ecosystem. Therefore, it is critical that a SLF's administration is conscious of how the whirlwind of events leads many elders (and their representatives) to their door, in a bewildered state with little knowledge of what to expect from institutional living.

Too often, the unfortunate consequence of an admissions office which is more anxious to fill an empty apartment, rather then to counsel, is that an elder may find herself admitted to a facility, which is compliance with the resident rights as guaranteed by the Illinois Administrative Code (here), but where her dignity is sacrificed on the alter of facility policy.

In the case at hand, a newly admitted SLF resident moved in with a small kitchen appliance (e.g. a coffee pot) and a desire to continue to take her medications on a schedule meeting her personal desires, rather then all at once. No mention was made at any time prior to admission that either desire would be a problem. Unfortunately, after only a few days in the facility, the resident was told in no uncertain terms, that neither would be tolerated.

Illinois SLF regulations allows a resident to prepare food in his or her apartment to the extent the health, safety and well-being of the resident and others is not endangered and provisions of the resident contract are not violated. In other words, the resident has this right unless the facility disallows the right. Gosh, it's a good thing the US Constitution is not as easily abrogated. To my reading of the relevant regulation regarding a resident's right to determine their course of treatment (e.g. medication regimen) is similarly treated. Interestingly, the rights of nursing home residents, as guaranteed by federal regulations do not permit facilities to dismiss rights as easily.

So there she is. An elder, with no cognitive impairment, unable to enjoy a hot cup of coffee in the morning and forced to take her multiple medications at once, simply because that is the way the facility administration wants it to be. Her dignity and autonomy disallowed because she happens to live in an institutional setting. As often as I write about culture change and how it is improving the lives of older adults, I forget about the antediluvian administrators who have yet to hear the good news about person-centered care. It's a shame. Learn more on Twitter @aginginchicago.


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    Bruce Lederman has over 25 years experience in the senior care field as a direct care provider and thought leader. Bruce was CEO and president of his own firm that operated skilled nursing facilities in Illinois. He is a former nursing home administrator and has consulted to numerous elder care providers on planning for strategic growth as well as process improvement. Recently he served as board chair of CJE SeniorLife, a leading non-profit elder care provider in the Chicago area. Bruce is currently employed as chief strategy officer for a company providing skilled nursing services in communities throughout Illinois and Missouri.

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