Take a new look at resident and family councils: developing effective nursing home councils is good business practice.

Nursing home leaders continue to be faced with growing challenges to provide good care for their residents, meet consumer demands, and remain economically sound. Over the past 30 years, industry-wide improvements have promoted quality of life for nursing home residents. However, the majority of nursing homes still operate on a hospital/medical model and are reimbursed accordingly. The medical model inhibits the growing consensus regarding the future of long-term care--resident-directed care.

For the past 30 years, ElderCare Rights Alliance, joined by thousands of other advocates for nursing home residents, has promoted the benefits of nursing home councils. The emphasis, as it should be, is on the well-being of residents; valuing their quality of life, quality of care, and legal rights. This emphasis is at the heart of implementing resident-directed care in our long-term care system.

The good news is that the responses to the demands that nursing home leaders face and the efforts of advocates for nursing home residents are coming together.

Nursing Home Councils Support "Culture Change"

Today, across the nation, a growing number of nursing home leaders are beginning the journey to implement "culture change" in their nursing homes. Culture change transforms traditional hospital/medical-model nursing homes into facilities that center on resident-directed care. The movement fosters a sense of hope, not only for residents and their families, but for nursing home owners, administration, and direct care staff--anyone who genuinely cares about elders and individuals with disabilities living in nursing homes today. This "system change" is redefining the way aging is viewed in America and how consumers shop for long-term care facilities. Establishing effective nursing home councils is an important step on this journey.

Consequently, a growing number of nursing home leaders are also taking a new look at the benefits of establishing effective resident and family councils. They are discovering the teamwork among staff, residents, and families that councils can produce. They are discovering that promoting effective nursing home councils can improve the satisfaction levels of residents and their families--and can improve the operation of their nursing home in terms of time management and staff satisfaction.

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About Councils

"Good nursing homes have councils." This statement was made in Consumer Reports' September 2004 article "Shopping for Nursing Homes" and again in its 2006 "Nursing Home Watch List." It is becoming apparent that this sentiment is growing. Many organizations (government, nonprofit, for-profit; both state and national) that produce tip sheets and Web tools about shopping for a nursing home recommend that the consumer ask: Does your home have a resident council and family council? Who do I contact and how?

Each resident and family council is unique and operates differently. Some groups have just a few members who meet informally. Other councils are larger and meet formally--typically once a month. Council participants can structure the group to fit their nursing home and work on projects that best meet residents' wants and needs.

"The success of a resident or family council is largely dependent on the support of the nursing home administrator and staff," says Mark Wandersee, director of Council Services with ElderCare Rights Alliance. "I find in working with councils, throughout Minnesota, that members of both resident and family councils feel the greatest sense of satisfaction and success when they are able to establish good communication with the administration and staff," he says. "Everyone works as a team in an 'us' environment rather than a 'we, they' one."

Not a Gripe Session

Administrators are sometimes wary of encouraging resident and family councils for fear that they are inviting regular and permanent gripe sessions. A resident or family council that is a gripe session is not an effective council. Administrators can deal with this concern by understanding the council process and becoming educated on what makes an effective resident and family council. In addition, they must educate staff on the benefits of councils. Establishing effective resident and family councils is a process and an attitude, and it requires education on how to do so properly.

It's the Law

Nursing home staff are discovering that improved communication with consumers is an asset to residents and the nursing home operation. Communication among residents and their families and friends has been found to be so important that Medicare and Medicaid nursing homes are required by law to allow resident and family councils to exist and to assist them in their mission. F-tags 243 and 244, Participation in Resident and Family Groups, state that:

(1) A resident has the right to organize and participate in resident
groups in the facility; (2) A resident's family has the right to meet in
the facility with families of other residents in the facility; (3) The
facility must provide a resident or family group, if one exists, with
private space; (4) Staff or visitors may attend meetings at the group's
invitation; (5) The facility must provide a designated staff person
responsible for providing assistance and responding to written requests
that result from group meetings; (6) When a resident or family group
exists, the facility must listen to the views and act upon the
grievances and recommendations of residents and families concerning
proposed policy and operational decisions affecting resident care and
life in the facility.

Increasing Job Satisfaction

Typically, nursing homes that do not have active, effective councils must address resident/family concerns on an individual basis, often using whichever staff member is handy. When nursing homes make resident and family councils an integral part of their operations, concerns can be addressed more efficiently. Councils meet as a group to prioritize concerns and can communicate these concerns to staff council advisers, reducing the burden on direct-care staff.

One Minnesota nursing home administrator has included resident council members in the facility's new staff orientation. This lays a foundation for residents and staff to connect. Given the low pay and demanding jobs that direct-care staff face, often their main source of satisfaction is their connection to and understanding of residents. This innovative idea allows residents to get to know the new staff hired, and staff can also connect with residents from the start. For more benefits of having a resident council, see the sidebar.

Conclusion

The administrator should encourage the development of effective resident and family councils because organizational tone is set from the top down. Enthusiasm is contagious! This facilitates a cooperative attitude among all parties (staff, residents, families, and friends) who understand that there is a system in place to address residents' care and quality of life in an organized and productive manner.

Joan Aasve is Director of Communications for the ElderCare Rights Alliance. Phone [phone] or visit www.eldercarerights.org for details on the newly updated 164-page publication, The Resource to Effective Nursing Home Councils. This resource, supported by more than 30 years of experience working with nursing home councils, features step-by-step ways to develop and strengthen effective resident and family councils. To send your comments to the author and editors, e-mail [e-mail].

RELATED ARTICLE: Benefits of Effective Councils

* Councils allow administration and staff to deal directly with residents' and families' ideas and concerns, convey needed information to families, and decrease staff turnover by creating workable ways to deal with dissatisfaction.

* Effective resident and family councils support facility staff and include them as part of the facility community by holding staff appreciation events/projects that improve morale.

* Staff members can learn more about individual residents, making their job easier and more time efficient, which increases residents' quality of life and improves the care staff provides.

* Administrators will become aware of potential systemic problems or areas of needed improvement before the issues escalate.

* Councils can help facilities prioritize and focus their efforts on issues that residents and families identify as most important, which increases consumer satisfaction.

* Councils can be a sounding board for new ideas.

* Involved resident and family council members can effectively reach out to new residents and family members and incorporate them into the facility's community.