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Why most resident council meetings in nursing homes are a sham

June 17, 2009
by ebarbera
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The first of a three-part series. To come:

Part Two: How to run effective resident council meetings; Part Three: For residents: Reclaiming the resident council

I must confess, the only time I've actually been to a Resident Council Meeting was when I was invited to speak about psychological services. Aside from invitees, the only people allowed at the meetings are the residents and the staff person in charge of running the group. My information about them comes from the residents themselves and sometimes from the staff leader, who is often the Recreation or Social Work Director. With one notable exception, the consensus on Resident Council Meetings is that they are a sham.

Why are the meetings a sham? There are two answers to that question. The first has to do with group dynamics. Often, the residents attending the meetings are the "regulars" who attend all activities. They tend to be the most accommodating residents and the ones who are generally satisfied with nursing home life, so their observations about the nursing home are less often geared toward change. Members of the group may have varying levels of dementia, and varying levels of familiarity with organizational dynamics. A well-attended Resident Council Meeting can absorb confused or off-topic residents, but frequently there is not enough of a critical mass to do so. Astute, alert new residents attending the meetings for the first few times encounter an ineffective group and quickly decide not to continue. Contributing to the ineffectiveness of the meetings is the fact that the staff person assigned to run the meetings generally doesn't have true support from the administration, so the complaints and suggestions of the group are not met with a resolution. This creates a disheartened leader and a demoralized, depressed, and sometimes acting-out resident population.

The second answer is that the administration doesn't realize and/or know how to utilize the potential power and value of the Resident Council Meetings. The residents are the eyes and ears of the nursing home. They see things the administration can't possibly know about, but should. The residents have years of experience in jobs, families, and society. They know a thing or two about how things work and how they can be fixed. The current cohort of residents is, generally speaking, a congenial bunch, not accustomed to bucking the system. The upcoming cohort of residents, the first of the Baby Boomers, is used to promoting change, and they will. Look around facilities now, and the early arrivers can be seen, angry, demanding, and knocking on the doors of the administrators. They can see things aren't as they should be, or could be. The administration can harness their experience and fervor for change by offering them an avenue to discuss concerns and to be part of the treatment team, not just in their own care, but in the overall quality of life offered at the facility. Empowering the residents leads to happier, more satisfied residents, families, and staff, and to a better nursing home.

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The notable exception will be explained in Part Two of the series. Stay tuned.

EFB

This is a great posting Dr. Barbera. You pose an interesting argument and I look forward to the remaining pieces of this series.

However, I did feel left in the dark on one reference. You say, "With one notable exception, the consensus on Resident Council Meetings is that they are a sham." Can you explain that one exception?

Perhaps it is difficult for me to be objective about this topic considering I am one of Recreation Directors who has been appointed the liason between the Council and facility Administration. Please note, Resident Councils are (at least in theory) independently functioning groups. A staff member may (and usually is) appointed facilitator/liason by the Council. As you stated, all others may attend by invitation only. Your statement regarding group dynamics of the Resident Council is accurate. However, I find it offensive that you use the word "sham" to make your point. I see myself as a strong resident advocate, but being a Director also puts me on the other side of the fence. I encourage all residents to resolve issues, complaints etc. prior to attending the Council meeting. No one should be waiting for a facility meeting to get a problem solved. Meetings should be forum for improving life in the facility, resolving problem trends. Unfortunately, many residents, even representatives of the Resident Council are unable to differentiate between the two. Empowering the residents both individually and as a group is important, however, there are ways to do this without the formation of an angry, rabble-rousing group. I believe good Administrators, too, operate on both sides of the fence and that change is coming, despite the systemic problems with our health care system.

I do not feel Resident Council Meetings are a sham, when facilitated properly they give the opportunity for empowering residents with diverse abilities and disabilities.

Thanks, Sue, Kathleen, and Susie, for your comments. I'm glad to see this post is generating discussion, both here and on my blog.

I do believe the players involved are trying to do their best, from the residents involved, to the staff leaders, to the administrators of the facilities. It's the systemic problems that get in the way, and which I'll address in upcoming posts. These include group dynamics and lack of a facility-wide understanding of and support for what the meetings can accomplish. I recently learned that the minutes of the meeting are reviewed by surveyors, which would account for Kathleen's observation that certain discussion points are being lost.

It's great to hear reports of meetings that are successful, not only to get ideas of how they are used, but also to provide reassurance that it's possible to work as a team with the residents to improve the quality of life in nursing homes.

As Director of Social Services, I have been holding 'neighborhood meetings' ( our name for resident councils within the Eden Alternative) on a monthly basis for our residents who are religious living within a care center in their convent. Our meetings have been very effective in creating positive changes. The residents comment on the care of the more diminished including their support at meals and time spent in hallways in geri-recliners. They give feedback on meals, on activity programs and the use of common areas. They have requested expanding informational bulletin boards and demanded information of the care of our animals. The minutes are done in a timely manner and distributed to all departments including food services and posted in large print on info boards. We listen, validate and follow up on their issues and have brought about many positive changes. The attendance is steady if not growing among the alert but physically impaired. This is a wonderful vehicle for change if we allow it to be so! -Susie

I attend Resident Council every month and am president as well. There are many residents who are quite content with the way their nursing home experience is going. Many do not think that residents should ever disagree with the way things are run.

There are always regulars at meetings. It was like that during school and during our work lives. Some people just show up either because they are curious or want to have something to do. I don't think there's necessarily anything wrong with that.

It is difficult to figure out what we should discuss at resident council. It there have been a bad few days prior to the meaning, whatever has happened will likely be discussed. But I do think that residents pay attention to what is going on. We have several baby boomers here and we are the most vocal of all the residents.

It is difficult to figure out how things will be followed up on after a meeting. Usually our activity director takes our concerns to whichever department head is responsible. But many times there are gaps and follow up is shaky when the designated staff person is on vacation or ill.

Our administrator has attended our meetings now for several months. We had a problem with one resident filibustering and holding up our meetings. I was a perfectly comfortable with making sure that one resident did not monopolize Resident Council. But our administrator attends so that she knows what is being said.

I have noticed that relevant meeting discussions often get lost on the brief, designated Resident Council form.

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ebarbera

Dr. Barbera is an author and a licensed...