When the psychologist arrived at Mrs. Winters’ room, she found her distraught and disheveled. “Last time you saw me I was stuck by that dresser in the corner and couldn’t get out. This time it’s something else!” She shook her fist at the ceiling and looked heavenward. “You know what that aide said to me?” She continued without waiting for a response. “When I told her I wanted to take my shower at night instead of this morning, she said I couldn’t! It was this morning or nothing. Of course I refused. What kind of nonsense is that? I’ve been taking nighttime showers my whole life!”This article, which follows last month’s post on physical design features in the long-term care setting, addresses two additional areas of care that can be modified to offer more control and autonomy to those we serve—scheduling and training. Increasing control is important because residents often enter long-term care due to sudden and unexpected health problems that have thrown them intocrisis. When residents perceive control over what is generally a highly structured new environment, it helps them cope with stressors, reduces their depression and anxiety and increases their satisfaction with care.
Offering increased flexibility within daily schedules can provide opportunities for residents to have more choice in how their days unfold. They engage in the same activities such as rehab and dining, but they can arrange their days to meet their own preferences rather than subsume their desires to the nursing home schedule.
Many adjustments in scheduling can be made without dramatic shifts in the staff routine, such as offering residents their choice of shower time. Rather than incorporating a multitude of changes simultaneously, new areas of flexibility can open up sequentially, giving the staff (and residents) time to adapt and to consider other parts of the schedule that can become more adjustable.
Offering more choices for residents will be as successful as the reception from the staff. If resident requests receive sighs, frowns and obvious irritation, residents will quickly learn that the options are for marketing purposes only and that they won’t be implemented without repercussions. In that case, because their wellbeing depends on the good will of the staff, only the feistiest residents will take advantage of newly created choices.
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