Ensuring resident self-determination and empowerment in Virginia nursing homes

In Virginia, nursing home residents hold fundamental rights that must be protected to ensure their dignity, autonomy, and quality of life. At the core of these rights are the principles of self-determination, empowerment, and freedom from coercion, which are essential to fostering an environment where residents feel respected and valued.

As Virginia’s State Long-Term Care Ombudsman, I have the privilege and responsibility to advocate for these principles and protections for our long-term care recipients every day. Our office and its local representatives throughout the state work daily to try to ensure that all long-term care residents understand and can freely exercise their rights and that nursing homes do their part to promote and protect these rights for their residents.

Let us explore how nursing homes can actively uphold these rights and empower residents to lead meaningful lives.

Resident Self-Determination

Self-determination is the cornerstone of resident-centered care. It means recognizing that nursing home residents are individuals with unique preferences, histories, and aspirations. It also means involving residents in decisions about their care, routines, and daily lives.

With the enactment of the Nursing Home Reform Law (part of the Omnibus Budget Reconciliation Act of 1987, often referred to as “OBRA ‘87”), residents rights’ protections became a part of federal requirements for all nursing homes that accept Medicare and/or Medicaid payments (almost all of Virginia’s nursing homes). This law secures the rights of residents to be treated with dignity and respect, and to participate in planning their care and making decisions about their treatment. Care teams must respect these preferences, whether they are about care plans, meal choices, sleep schedules, or participation in activities.

To support self-determination:

• Encourage open communication: Care staff should actively listen to residents and include them in discussions about their care.
• Respect autonomy: Even when residents require assistance, they should be empowered to perform tasks and make decisions to the best of their ability and in accordance with their comfort level.
• Adapt care plans: Regularly review and revise care plans to reflect the evolving preferences of residents.

Freedom from Coercion

A critical component of resident rights is the guarantee of freedom from coercion and undue influence. Coercion undermines a resident’s autonomy and can lead to feelings of helplessness or fear.

To protect residents from coercion:

• Educate staff: Provide training to help staff understand the various forms coercion can take and to recognize resident behaviors and responses that may suggest the resident is experiencing some form of coercion. Train staff on how to foster respectful interactions that honor the dignity of the resident.
• Promote informed consent: Residents must fully understand and voluntarily agree to any treatment or intervention. This includes providing clear explanations and addressing questions.
• Monitor care environments: Ombudsman programs and facility administrators must be vigilant in identifying and addressing instances of coercion, whether from staff, other residents, or even family members.

Resident Empowerment

Empowerment involves giving residents the tools, knowledge, and support to take an active role in their lives and care. Empowered residents are more likely to experience higher satisfaction and well-being.

Steps to empower residents include:

1. Education: Residents should be informed of their rights and available resources. The Virginia Long-Term Care Ombudsman Program and its local program representatives can be a valuable resource for helping residents and staff strengthen awareness of the importance of residents’ rights.
2. Support resident councils: These councils provide a platform for residents to voice concerns, share ideas, and collaborate on solutions. Facilities must support these councils and act on their feedback.
3. Encourage advocacy: Residents should feel confident advocating for themselves without rear of retaliation. At the resident’ invitation, families, staff, or ombudsmen can attend/ participate to provide additional support.

The Role of the Ombudsman

Virginia’s Ombudsman Program representatives work tirelessly to ensure that residents’ voices are heard, and their rights are upheld. We serve as the resident’s advocate in addressing concerns about care and exercise of rights and help ensure the resident’s voice is heard and respected. This can be particularly important when there are disagreements among multiple parties. Our focus is on resolving problems to the resident’s satisfaction.

If you or a loved one has concerns about resident rights in a Virginia nursing home, please do not hesitate to contact our office. Together, we can continue to build an environment where residents feel respected, valued, and empowered to live their lives with dignity and purpose.