Good! Maybe She'll Wake Up! Part 3 of 3

Too long ago I promised a third and final entry on the issue of advocacy “for anyone who has some responsibility for an elder in a nursing home through some appointed position or because of the bonds of relationship.”

This last entry gives a brief overview of the ‘skill set’ of a good advocate. One content area of an advocate’s skill set is a basic knowledge of what the standards are in a given setting. In a licensed aging services organization, those standards are known as the Federal Minimum Standards of Care or ‘the regulations.” In unlicensed retirement settings, the same standards should be adhered to, even though the State regulatory agency does not survey for compliance.

If there is some responsibility for a person in a licensed retirement setting, it is important for that person to know what standards the organization is held to. Reading the regulations is not a treacherous experience.* One may even have an ‘aha’ experience, realizing that what you thought should be is required to be. For example, a nursing home is mandated to reasonably accommodate the “needs and preferences of the resident except when the health or safety of the individual or other residents would be endangered.” This obligation of the organization and the rights of the resident come into play dozens of times a day. Starting at the beginning of the day, a resident should not be forced or expected to get up in order to be at the table when the institutionally-set meal time is operative. Another simple example: My mother preferred buttermilk over milk; that is what she was served each day at lunch.

In addition to being familiar with the regulations, participation in a Family Council is very helpful. Such a gathering allows family members and friends to voice what are probably common concerns and seek solutions.

Lastly, a good advocate will have an empathy that prevents him/.her from seeing the elder as “other”. This empathy is akin to identification with the elder, the opposite of viewing, even subconsciously, the elder as “other.” When the view is that of “other” the ‘viewer’ is incapable of seeing a situation or condition that might apply to him or her personally, and therefore imagining, understanding the responses natural to such a situation.

My sister-in-law’s adult children continue to be strong advocates for their mother as she continues therapy following a broken hip. My nephew told me recently that he had to address an issue with his mother’s nurse over what medications she was getting. In the course of the conversation, the nurse apologized for what she said could have been a curt and abrupt manner. But, the nurse explained, “you have to understand that our schedule is so busy and . . . .” At one point the nurse had described his mother as “noncompliant.” To my nephew’s credit, as a good advocate who is focused on assuring that his mother’s services are appropriate and focused on her full recovery, he addressed both of these issues with the nurse. He did so politely, but firmly. He and his sisters do not settle for poor care. Nor do they consider staff convenience, or task before person to be viable operating principles.

So being a good advocate requires knowledge of what the standards are and it requires an advocate’s heart and sensitivity.
*If you would like information on how to access these Minimum Standards of Care, or if you have a question about any standards of care, you can contact me at imeldacdp@istoo.org