Resident and Family Councils

Office of the State Long-Term Care Ombudsman

Program Field Representative, Kathryn White

Why have a council?

The lives of the residents are heavily controlled by laws, rules, and policies set by the government and nursing home. Compromises in lifestyle become necessary due to health problems and living conditions. These compromises and controls can make nursing home residents feel their opinions and preferences do not matter. A council gives the residents an active role in their life and a chance to influence decisions that affect them.

http://www.atlantalegalaid.org/fact16.htm

Image 1: Goodwin House Alexdria Resident Council

What is a resident council?

Resident Council-Resident councils are organized, self-governing, decision-making groups of long-term care residents meeting regularly to voice their needs and concerns and to have input into the activities, policies, and issues affecting their lives in the facility. http://health.mo.gov/seniors/ombudsman/pdf/HowToOrganizeAnd_DirectAnEffectiveResidentCouncil.pdf

What is a family council?

Family Council- A family council is a self-led, self-determining group of consumers - families and friends of nursing home residents that:

• Works to improve the quality of care and quality of life of the facility’s residents.

• Provides families with a voice in decision-making that affects them and their loved ones.

http://health.mo.gov/seniors/ombudsman/pdf/FamilyCouncils.pdf

• Improve the atmosphere. Surroundings• Promote support.• http://www.tjaaa.org/resident-family-councils-nursing-homes.aspx

Friendship

• Providing general information about long -term care.Education

• Effective way between staff and residents/ families.

Communication

• Learn reasons for proposed changes in policy and procedures and promote feedback concerning potential changes.Policy

• Help individuals speak out about concerns and help overcome fear of retaliation.

Advocate

• Departments as they relate to the resident’s care and service needs.Understand

• Present ideas, suggestions, and concerns and to work cooperatively towards a solution.

Voice

Family council is not….

FAMILY NIGHT is a name used in many

facilities for occasional

educational or social functions planned and

hosted by nursing home staff for families

and friends of the home’s residents.

While these programs may be beneficial,

they are not substitutes for family

councils.

A RESIDENT COUNCIL: Many homes have resident

councils. It may seem at first glance that the two

groups are the same. Combining the home’s

resident and family councils into one group may even be considered. However, this

ignores the fact that residents and their families

have different interests, needs and abilities.

Combined resident/family councils are usually

dominated by the families, who are quicker and better

able, in many cases, to express themselves.

Residents and families need their own councils geared to their special situations and

interests.

A VOLUNTEER GROUP OR AUXILIARY:

Occasionally, a family council will be started to meet a need within

the facility. Family councils provide many valuable services to residents, but they

must never be replacements for

adequate staff. Also, a council should not provide items or services that the

home is required by law to provide.

http://ec-online.net/Knowledge/Articles/familycouncil.html

Where to start?Do they want a council?Are staff and administration willing

to help the council get started?How to introduce members to the

council?How to participate?

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Laws and Regulations

Older Americans ActOmnibus Reconciliation Act of 1987

(OBRA ’87)Federal RegulationsState Nursing Home RegulationsAssisted Living RegulationsNursing Home Care ActEnforcement

Older Americans Act Every State Required to have a Long-Term Care Ombudsman

Program.

The OAA set out specific objectives for maintaining the dignity and welfare of older individuals and created the primary vehicle for organizing, coordinating and providing community-based services and opportunities for older Americans and their families.

Section. 712. STATE LONG-TERM CARE OMBUDSMAN PROGRAM.

(H)(i) provide for training representatives of the Office;

(ii) promote the development of citizen organizations, to participate in the program; and

(iii) provide technical support for the development of resident and family councils to protect the well-being and rights of residents

OBRA ‘87 1987 Congress passed the Nursing Home Reform Law

as part of the Omnibus Reconciliation Act of 1987 (OBRA 87).

Established national standards for care and residents’ rights for people in nursing homes.

Each resident be provided with services sufficient to attain and maintain his or her highest practicable physical, mental, and psycho-social well-being.

New federal requirements were established, including: a resident assessment process leading to development of an individualized service plan, the right to organize and participate in family or resident councils, the right to be free of unnecessary restraints (physical or chemical), and specific requirements for those most responsible for resident dignity and care.

Federal regulation 42 C.F.R. § 483.15 explains the role of the resident and family council:

(c) Participation in resident and family groups. (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 facilitywith the families of other residents in the facility;(3) The facility must provide a resident or family group, if oneexists, with private space;(4) Staff or visitors may, attend meetings at the group'sinvitation;(5) The facility must provide a designated staff personresponsible for providing assistance and responding to writtenrequests that result from group meetings;(6) When a resident or family group exists, the facility mustlisten to the views and act upon the grievances and recommendationsof residents and operational decisions affecting resident care and lifein the facility.

State Nursing Home Regulations

OSDH 310: 675-7-7.1 Resident’s Advisory CouncilEstablish CouncilConsist of all current NH facility residents or their

designated representative, facility coordinate and assist , and respond to request

No one from facility memberPrivate spaceMinutes prepared/ maintained by staffCommunicate to administrator opinions/ concerns

Assisted Living RulesOSDH 310:663-15-1 Residents Rights

Observe all residents rights and responsibilities enumerated under Title 63 O.S. Section 1-1918 (B)

Nursing Home Care Act Title 63 O.S.

State Statue 63-1-1918 Rights and Responsibilities

2. Every resident shall have the right to have private communication, including…..and meetings of family and resident groups……….

3a (1) Present grievances…….

3b The family of residents shall have the right to meet in the facility with other residents’ families.

http://www.ok.gov/health2/documents/HRDS%20675%20NHCA%201113.pdf

http://www.ok.gov/health2/documents/LTC%20Continuum%20of%20Care%20&%20AL%20Rules.pdf

Enforcement F-243

State Statue 483.15 © Participation in Resident and Family Group

-organize and participate

-family members meet with other families

-private space

-staff/visitors attend by invitation

-provide staff person

If one does not exist, determine if residents have attempted to form one but have been unsuccessful; and if so, why.

This requirement does not require that residents’ organize a resident or family group, however facilities must allow them to do so without interference.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

Enforcement F-244

State Statue 483.15 © (6) When a resident or family group exists, the facility must listen to the views and act upon the grievances and recommendations of the residents and family members concerning proposed policy and operational decisions affecting resident care and life in the facility.

http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

By-Laws

Who will facilitate?

Topic/Guest Speakers/ Presentation

Agenda

Meeting Length

Regular Meeting Time

Goals/ Ground Rules

Meeting Procedures

Leadership

Preparation for Meeting

Minutes

Liaison

Confirm Meeting Room/ Refreshments

Image3: clipart_people_desk_meeting_19909_1920x1200.jpg

Initial MeetingAgendaSign-in SheetNext MeetingGuest

SpeakerHandoutsInvite

Enthusiasm

Participation and Sharing

Leadership & Structure

Models Of Leadership

Traditional/Town Meeting-Chair Person/ President, Vice-Chairperson/ Vice-President, Secretary, and Treasurer.

Co-Leaders- Two members share responsibility. Leadership Committee-several family

members share responsibilities, or for first few months then have formal election.

Leadership committee with rotation Alternating Leader Representative-residents bedfast, serving as

liaison for other residents.

Leadership & Structure

Elections Job DescriptionTraining for LeadersTerm Limits

What makes a good leader?IdentifyPersonal QualitiesRelate to PeopleLifetime LearnersSeek Assessment

Image 3: Does it look like what makes up a good leader.

Duties of Officers

Chairperson/ President-Presides over meeting, seeing by-laws and procedures are followed, keeping control over meeting, maintaining impartiality, coordinates activities, maintain communication with staff.

Vice Chairperson/ Vice President-Fill in when chairperson is unable to fulfill duty.

Secretary-Taking notes at meetings, recording and maintaining a file of the minutes, maintaining correspondence, and having by-laws handy at meetings in case of questions.

Treasurer- Receiving and dispensing funds, maintaining proper financial records, and reporting to the council on status of treasury.

http://health.mo.gov/seniors/ombudsman/publications.php

Liaison/ Staff AssistantA facility appointed staff advisor or liaison is required to support the council and respond to written requests/concerns arising from the council meetings.  The liaison may or may not be invited to attend the meeting. In the beginning be clear of the role of the assistant. http://www.tjaaa.org/resident-family-councils-nursing-homes.aspx

• Help to tell families/ new residents• Advise council on changes in facility• Explain the facility's policies and procedures• Help council communicate its questions • Help to book guest speakers• Provide refreshments and make copies• Share information • Educate staff • Enthusiasm

No…NoPlanning and running meetingsSpeaking on behalf of residentsSelecting meeting times and dates, topics, activities…

Image 4: Runnells Hospital Staff Members Honored by Resident Council

Parliamentary Procedure

Robert’s Rules of OrderThe Standard Code of Parliamentary

Procedure ( formerly the Sturgis Standard Code of Parliamentary Procedure)

Why Do Groups Use Parliamentary Procedure?

To give everyone a chance to be heard

To allow members to participate in an orderly group

To establish and maintain order in a meeting

To prevent confusion when discussing club business

To keep things moving

Opening Activity-Roll call/ name tags everyone becomes acquainted

Read Minutes from last meeting-what has happened since

Receive Reports-discuss needs, concerns, and activities of residents they represent

Unfinished Business- review from previous meeting

New Business-New concerns and ideas

Resident Concerns

Facility News-information to share from department heads

Social Time-Wind down/ refreshments

Image 6: graphics-agenda-603334.jpg

MinutesWHAT: Accurate record made of all happenings at each meeting, who served, facility’s actions in response to concerns of the council.

WHY: Communication tool/sharing outcomes and useful written record.

WHO: Secretary takes minutes or designate someone.

Brief, Legible, and for anyone to understand, typed and copies made for distribution (given to all residents or posted).

The name of the person presiding

Members present

Who took minutes

Date and time of the meeting

All items discussed, actions taken

Date and time of next meeting

Formality of Structure

Ensure that the council knows where it is heading and that there is a democratic and fair way for the council to do its work and make decisions. http://theconsumervoice.org/uploads/files/family-member/Developing-and-Suporting-Family-Councils.pdf

By-lawsPolicies

By-Laws

Written guidelines by which the group operates. Name

Purpose/ Mission Statement

Membership (criteria)

Officers and committees (tiles, responsibilities, terms)

Meetings (when and how is conducted)

Elections (nomination, procedures)

Rules of Order (raise hand, talking stick)

Future Amendments

Policies

Communication with administrator/staff

Communication of concerns to administrator/ staff

Communication with other family members

Communication with residentsHandling individual concerns

Problem SolvingWill this help improve resident care and residents’ lives?

Narrow down and pinpoint the specific problems

Learning current policy on a facility issue

Learning what laws and regulations require

The role of the council is not just to identify problems, but to offer ideas and suggestions about how to resolve them.

http://www.ltcombudsman.org/sites/default/files/norc/issues/Omb-and-Family-Councils-LAFMC.pdf

Image 7: Problem-Solution-Magnifying-Glass-1220488.jpg

Promoting

Many family councils have active participation of 10% of families of the residents. http:/theconsumervoice.org/uploads/files/issues/promoting-participation-2012.pdf

Flyer Newsletter Membership Form Permission to Contact Greeter in lobby Mailings Staff

What to say?……………. Image 8 megaphone.png

Ombudsman Role

Yes! Encouragement!

(Yoga instructor from Couples Retreat Movie)

CoachEducator/ TrainerConnectorMediator

Communication/ Meeting• Respect• Trust, Care, and Concern• Good Listener• Observation• Give/ Receive/ Share Information• Confidentiality• Recognition• Patience• Sense of Humor• Criticism• Mistakes• Laugh at Self• People’s Well-Being• Admit not knowing• Alternatives• Praise(Retrieved from Resident/Family Council folder in Ombudsman Office)

Communication/ Processing Concerns Officers having regular monthly meeting with

administrator/ keep members informed (make an appointment in advance).

Allow reasonable time for complaint to be resolved.

Hear constructive input/ get all facts.

Address small concerns before they become major problems.

Work toward meaningful change, avoid unreasonable demands.

Present ideas in a non-threatening way (friendly, but firm).

Avoid generalities and exaggerations.

Show appreciation.

Facility clear on the purposes and rights of your council / value of cooperation.

(Retrieved from Resident/Family Council folder in Ombudsman Office)

ObstaclesFEAR OF RETALIATIONLACK OF INTERESTLACK OF TIMELACK OF INFORMATIONLACK OF SUPPORT FROM THE

FACILITYDISCOURAGED EASILYLOW PARTICIPATIONNOT WANT LEADERSHIP ROLE

Benefits

In-service training

Improve staffing assignments and stopped staff rotation

Survey, improvements to facility

Better service to residents (food, daily care, bathing time, activities, etc...)

Grievance Forms at nurses station

Staff appreciation and educational programs

Billing/ Delivery issue with pharmacy

Council put in admission packet

Open lines of communication

ResourcesHow to Organize and Direct an Effective Resident Council: A Technical Assistance Manual of the Missouri Long-Term Care Ombudsman Program. Emmelene W. Kerr. Missouri Long-Term Care Ombudsman Program. This manual covers all aspects of council work – from forming a new council to improving an existing council Written by a former coordinator in the Missouri Ombudsman Program who draws upon many years of ombudsman experience with resident councils, ombudsmen will find straight forward information and tips to use when assisting in the formation or strengthening of a resident council. http://health.mo.gov/seniors/ombudsman/publications.php

Family Guide to Effective Family Councils Prepared by Robyn Grant for The Legal Assistance Foundation of Metropolitan Chicago and the Evanston Commission on Aging Additional copies: Kathy Swanson c/o Legal Assistance Foundation of Metropolitan Chicago 111 W. Jackson Boulevard 3rd floor Chicago, IL 60604http://theconsumervoice.org/uploads/files/family-member/Guide-toEffective-Family-Councils.pdf

Long Term Care Ombudsman Guide to Developing and Supporting Family Councils Prepared by Robyn Grant for The Legal Assistance Foundation of Metropolitan Chicago 111 W. Jackson Boulevard 3rd floor Chicago, IL 60604http://theconsumervoice.org/uploads/files/family-member/Developing-and-Suporting-Family-Councils.pdf

Parliamentary Charts and Handouts

http://www.jimslaughter.com/uploads/OrderofBusiness.pdf

Image References

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Image3: Retrieved from http://www.northsidenaz.org/images/clipart_people_desk_meeting_19909_1920x1200.jpg

Image 4: Retrieved from

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Image 5: Retrieved from

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Image 8 Retrieved from

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Image 9: Retrieved from

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