Why resident and staff autonomy should be at the center of SNF policy decision-making

Why resident and staff autonomy should be at the center of SNF policy decision-making

Political decision-making – especially around infection control and prevention – needs to be more inclusive as the sector moves forward. Namely, residents, their family members, and direct care staff must have a seat at the table when it comes to broader policy decisions.

It all starts with cultural change in long-term care, according to a report by Rand Corp., a nonprofit focused on improving policy and decision-making through research and analysis .

The researchers suggest operators are emphasizing resident and staff autonomy, referring to small-scale policy-making models that could be scaled up for wider adoption.

Twenty-three stakeholders contributed to the project, including residents, direct care staff, clinicians and researchers, as well as administrators, consumer advocates and long-term care associations.

Lori Frank, co-author of the report, said she wanted to expand on the idea of ​​culture change and political decision-making after the release of the National Academies of Sciences, Engineering and Medicine report ( NASEM) in April.

“It’s had such a ripple effect on the entire healthcare ecosystem,” Frank added. “By amplifying the points on culture and adding some of what we have found through our work, we can truly expand the potential transformative impact of this report.”

According to the researchers, participatory governance, or a mix of selected stakeholders and operational leadership, are models of policy-making necessary to ensure that policies meet the needs of residents.

Researchers have described three models of political decision-making: Representation by petition is more traditional, with directors and owners raising their concerns with officials. Participatory representation is at the opposite end of the spectrum, with all stakeholders raising their concerns with government officials.

“If you have different voices under this governance structure, you are likely to see different things, think things differently, and come to a richer set of conclusions in any policy-based decision,” said Frank.

A hybrid model sits somewhere in the middle, which includes a mix of selected stakeholders, family members and residents, as well as administrators and staff who come together to make policy recommendations.

“Maybe there’s a middle way where we can start getting that feedback directly from residents and family members, maybe using some of the infrastructure that’s already in place,” added Frank. “There are family councils and residents’ councils that could be a step ahead.”

The sector has already seen an increase in attendance from families and community groups during the pandemic, when visitation was non-existent or severely limited during Covid surges.

Political decision-making should also consider system-wide pressures, the researchers said. Regulatory realities, financial management and staffing “must be acknowledged” in cultural shifts.

Leadership is key to advancing cultural change, the researchers added, setting the tone for staff action and resident well-being.

“Among all the many people we spoke with, there was a real consensus on the importance of leadership within the institution,” Frank said. “It was spurred in large part by my own experience with my mother-in-law and assisted living. It was so fascinating to hear… [everyone] highlight the importance of leadership within the institution to set the tone and enable different types of conversations that can support these types of decisions and this type of culture change.

Operators need to spend more time on leadership training, the report says, and on “funding reviews” of communication between staff and management.

Through such examinations, according to the researchers, age, gender, race, and ethnicity can be assessed in relation to collaborative decision-making.

Further reviews should seek to balance individual preferences for infection prevention with community-level needs and demands for people in long-term care, the researchers noted.

In other words, resident autonomy should be factored into infection control policies.

“If there is going to be a lockdown, or if these are my last years of life and I choose to have this birthday party with my family, is there a way to fit my preferences into this conversation?” asked Frank.

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