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Resident and Family Councils

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1 Resident and Family Councils
Office of the State Long-Term Care Ombudsman Program Field Representative, Kathryn White A council can be a powerful force for change in a facility, but starting one can be tremendously difficult. Creating a new council can require a lot of time and energy. Ombudsman can play a critical role in providing assistance. The Older Americans Act requires local ombudsmen to support the development of resident and family councils. The role of the ombudsman is consumer empowerment, you can provide information and suggestions. Give them the tools to take the next step. We are going to go over things that we can do as ombudsman to assist in resident and family council. We will talk about regulations, laws, preparing for a council, leadership, structure (ex. bylaws, agenda), promoting council, problem solving, communication, benefits, obstacles, resources, and examples on packet. But most important what role as the ombudsman.

2 Why have a council? Image 1: Goodwin House Alexdria Resident 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. Ask Ombudsman why have a council? Going to a nursing home is change…health, lifestyle, surroundings, family, belongings, privacy, roommate.. The purpose of the council is to provide a forum for the residents to express themselves and suggest positive changes, many voices are stronger then one. An effective council reflects and meets the needs. Residents want to be heard and that they matter. This gives them a chance to share with each other and devise strategic wants. This can be a place for family council members to constructively channel their anger and concerns as an alternative to filing a complaints with outside agencies. The facility can focus on common facility-wide concerns. It builds a trusting relationship with the facility staff, while maintaining open communication. Council members can come up with creative ideas how to address concerns. Can give validation. Research has shown that when residents are encouraged in maintaining a sense of autonomy and control over their own life-there is less mental confusion and physical dependency (study by Elaine Brody of the University of Southern California Gerontology Center). Residents may fear retaliation, and the council provides support. Going back to Residents Rights

3 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. There is no typical council, depending how it is set up. The structure can vary and how it is organized. A council gives resident input into their daily lives, and give them a sense of purpose. Ask: How many have set up or assisted with a family council? Who did you invite or did the residents or nursing home?

4 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. Usually 5-10 members Support for families Education and information Services and activities for residents Joint activities for families and residents Action on concerns and complaints Legislative action and many others Purposes vary greatly from council to council, depending upon the interests of council members. A general set of purposes should be agreed upon when a council is new and revised as the goals and interests of members change. Resident and family councils should work together and family council find out resident’s needs.

5 Policy Understand Voice Advocate Education Communication
Providing general information about long -term care. Education Effective way between staff and residents/ families. Communication 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 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 What can a council provide? Education- Regulations, policies, and resources Communication-Building trust, understand how things work, staff know what to look for Understanding-ex. CMA and CAN-helping know staff and duties, may get reported to wrong department, complaint log on shifts so current person gets complaint when staff busy forget to tell or write down. Voice-Validation Policy-Know how things work, copy of policy ex. Prairie Winds Advocate-make a difference Surroundings-Tension, avoidance with staff and family, only resident suffers. Friendship- Common concern, understand struggle Surroundings Improve the atmosphere. Friendship Promote support.

6 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. Family Night- Hosted by staff with purpose for social or educational ex. Staff appreciation Resident Council- Different interest, needs, or abilities Guardians or legal representative at meeting-regulations say they have a right to be there, the health dept. has a history of not overriding that. Volunteer Group- Auxiliary-additional, supplements, substitute in case of need Replacing things facility needs to do, don’t realize could be problem Ex. Feeding other residents

7 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? Any interest, leave time slot open on calendar, residents know there is one if they want to start. Ex. Elmcroft Problems in the past-what happen, staff not informed, new administrator No guidance, not sure where to start, too much work, don’t want to tell people what to do What it encompasses and time Image 2: avoidance300.jpg

8 Laws and Regulations Older Americans Act
Omnibus Reconciliation Act of 1987 (OBRA ’87) Federal Regulations State Nursing Home Regulations Assisted Living Regulations Nursing Home Care Act Enforcement Different laws, regs, and enforce. To protect residents rights Go over areas related to resident and family council Different laws, regulations, and enforcement to protect residents rights Go over areas related to resident and family councils.

9 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 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 Enacted in 1965 fund critical services healthy and independent –services. Meals, Job Training, Senior Centers, Caregiver Support, Transportation, Health Promotion, B.enefits Enrollment OAA was response to congressional concerns about lack of community social services for senior citizens. First federal level initiative-provide comprehensive services for older adults Act divided into seven titles (1992 amendments to OAA) address need for strong advocacy to protect and enhance the basic rights and benefits of vulnerable older people VII creates grants for “vulnerable elder rights protection programs”.

10 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. Establish basic rights and services for residents of NH Require that state and federal government to inspect NH and to enforce standards by using a range of sanctions. In 1987 Congress passed the Nursing Home Reform Law as part of the Omnibus Reconciliation Act of 1987 (OBRA 87). Passage of this law was a watershed event in our country’s approach to nursing home standards. Following an Institute of Medicine report to Congress which identified widespread problems of abuse, neglect and inadequate care, the law was promulgated to protect nursing home residents and to put an end to widespread, unnecessary suffering. OBRA 87 established national standards for care and residents’ rights for people in nursing homes. At its heart is the requirement that each resident be provided with services sufficient to attain and maintain his or her highest practicable physical, mental, and psycho-social well-being. To realize this mandate, many 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 - nursing home inspectors (surveyors), long term care ombudsmen and direct care workers. The impetus for the present study lies in the failure to achieve so many of the promises codified in OBRA 87. As we approach the 20th anniversary of

11 Federal regulation 42 C. F. R. § 483
Federal regulation 42 C.F.R. § 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 facility with the 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 operational decisions affecting resident care and life in the facility. A facility must care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident's quality of life.

12 State Nursing Home Regulations
OSDH 310: Resident’s Advisory Council Establish Council Consist of all current NH facility residents or their designated representative, facility coordinate and assist , and respond to request No one from facility member Private space Minutes prepared/ maintained by staff Communicate to administrator opinions/ concerns

13 Assisted Living Rules OSDH 310: Residents Rights Observe all residents rights and responsibilities enumerated under Title 63 O.S. Section (B) Nursing Home Care Act Title 63 O.S. State Statue 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.

14 Enforcement F-243 This requirement does not require that residents’ organize a resident or family group, however facilities must allow them to do so without interference. State Statue © 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.

15 Enforcement F-244 State Statue © (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.

16 Preparation for Meeting
Leadership Who will facilitate? Liaison Regular Meeting Time Goals/ Ground Rules Meeting Length Planning the Introductory Meeting When considering the creation of a resident/family council, it is important to hold a meeting to which all residents and families of residents are invited. The purpose of the meeting is to explain the concept of resident/family councils, determine the level of interest in having a council, and to begin organizing one, if the residents and families are interested in forming a council. The introductory meeting should include the following components: 1. The purpose of a resident/family council, including identifying common goals, outlining a proposed structure, and the processes and supports available to make the resident/family council successful. 2. Identifying the level of interest residents and family have in forming a council. 3. Identifying residents and family interested in taking a council position. 4. Determining the frequency and structure of future meetings – deciding on regular or as needed meetings, and how information about the meetings will be circulated, and how residents and families will be kept informed about discussions at the meetings. Your role as ombudsman is to guide Offer assistance to steering committee/ introductory meeting Points on planning process Develop Agenda Let them decide your role After the meeting… Check with steering committee see how things are going Make sure they are getting the support they need from facility Publicize…contact families you have worked with in the past Provide training to staff liaison Ground Rules: Discussions confidential, discuss ideas, not individuals, protect resident’s privacy, disagree with respect Topics: Pick 3 things liked changed Confirm Meeting Room/ Refreshments Minutes Topic/Guest Speakers/ Presentation Meeting Procedures By-Laws Agenda Image3: clipart_people_desk_meeting_19909_1920x1200.jpg

17 Participation and Sharing
Initial Meeting Agenda Sign-in Sheet Next Meeting Guest Speaker Handouts Invite Enthusiasm Invite-Notice of meeting posted and get information out Agenda-Formalize the meeting/ timeline Handouts-People can only absorb so much info, handouts deliver message and reminders, people who can’t attend Next Meeting-What will work for people Sign-in Sheet-Feedback/ who to talk to about future meetings Guest Speaker-First hand of experience Enthusiasm-Ensure positive experience Participation and Sharing- Generate information questions Participation and Sharing

18 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. Representative-speaks with individual residents prior to council mtg .(ex. on each floor) Suggestion box for anonymous –suggestions and complaints Highly Structured – has bylaws, officers, committees & Informal Structure – no bylaws, officer, committee, and can be led by a staff person who believes residents should be express concerns and wishes Town Meeting Model – effective in smaller homes where each resident is considered a member and encouraged to attend Representative Model – effective in larger homes where representatives from various areas of the facility are elected to represent other residents Committee Model – six to ten residents serve on committees that function similar to the representative model b. Co-chair model. This model involves sharing offices between 2 members. This can be a helpful model when one person does not want to fill a position alone, but will do so along with another council member. In this way, members can split the duties between them or perform the duties of the office in whatever way works best for them. This model provides moral support and encouragement to those who want to play an active role, but are somewhat hesitant. c. Leadership committee model This model involves leadership by a small group of family members who divide up duties among themselves. This model distributes the work among more people and can lighten the load for any one individual. In a small council, everyone could serve on the leadership committee in some capacity. See Appendix 3 for more information about this model. d. Rotational model In this model a leadership committee is formed, but leaders rotate the duties among themselves on a regular basis. 2. Important points about leadership and structure. a. You can mix and match the above models to form a hybrid that works for your council, or you can create a totally different model. The important thing is to have some system for leadership that is recognized and followed by the council. This promotes more effective organization and lets the nursing home know whom to talk to when it wishes to communicate with the council. b. An important key to council success is to distribute tasks and leadership roles as widely as possible among members. This is critical for several reasons: • It lightens the load on the leaders. • It develops abilities and skills in those who could become future leaders. • It is what the spirit of the council is all about – everyone pulling together in the same direction. Organized strength comes from working together, not from one person doing it all!! c. The role of the leadership committee is to work with the council to determine the type of leadership structure the council would like and to oversee the council until elections have been held and new leaders are in place. d. As a council changes in size over time, it may need to change its structure.

19 Leadership & Structure
Elections Job Description Training for Leaders Term Limits Officers are not required to ensure success, what is important is that members are given a chance to volunteer, be elected, or appointed to their position. Elections should be well-planned. Usually take more than one meeting as several steps are involved. Members should be notified in advance of the upcoming nominations and elections. There is no right or wrong model of leadership; the council should develop a structure that works for its members. At this point the council has developed some temporary leadership structure to see it through to its first election. The council may wish to make this structure permanent. There is nothing wrong with that if the structure is working. HOLDING ELECTIONS. There are many different ways to hold elections. The following is one way in which elections can be conducted. A. Before The Elections. The preparation process for elections should start at least a month in advance of the election date. 1. Develop a system for coming up with a slate of candidates. This can be done by creating a nominating committee or by setting aside time at a council meeting. Whatever approach is taken, it is important to be clear about how council members, or preferably any family member, can present nominations. Give families advance notice about the nomination process and deadlines. 2. Ask the selected nominees to write a paragraph about themselves. Distribute the list of nominees along with the candidates’ description to council members, and if possible, to all family members prior to the election. Make sure the date of the election is clearly publicized. B. On Election Day. 1. Conduct the voting by secret ballot at a council meeting. 2. Have a neutral third party, such as the ombudsman, count the votes and announce the new officers. C. After The Election. 1. Ask the outgoing officers to orient the new officers to their duties. 2. Ask the ombudsman to meet with the new officers to see if they need or want training. 3. Acknowledge the work of the outgoing officers at a meeting and thank them. Give them some token of appreciation, such as a plaque, to recognize their contributions.

20 What makes a good leader?
Identify Personal Qualities Relate to People Lifetime Learners Seek Assessment How to Identify a Good Leader A leader is someone who has influence over a group of people. This can be an executive, a pop star or an employee who has the ability to influence coworkers' thoughts, feelings, beliefs and actions. A leader does not necessarily have a specific title. You can tell a leader by his influence over others. Personal Qualities of a Good Leader Personality theories of leadership identify five major leadership qualities, called the Big Five: conscientiousness, agreeableness, neuroticism, openness and extroversion, according to Michelle C. Bligh in "Personality Theories of Leadership." However, according to Bligh, more specific research findings indicate that intelligence, self-confidence, determination, sociability and integrity are more consistent characteristics of a good leader. It doesn’t have to be someone outgoing, could be quite person. Good Leaders Relate to People Good leaders listen, motivate, delegate and provide vision. Leaders can improve listening skills through practice and education. A leader motivates those under her to work hard, and she inspires productivity. Knowing when and to whom to delicate tasks is an important leadership skill, along with providing a vision that is clear and comprehensive. Good Leaders are Lifetime Learners Although leaders may be born with qualities that make them effective at influencing others, good leaders are always learning. Good leaders involve themselves in accountability groups, attend leadership conferences and read books that strengthen leadership skills. Good leaders are self-motivated, set personal and professional goals and plan ahead, says Bob Pearce in his article, "Leadership -- What Makes a Good Leader," published on Good Leaders Seek Assessment To improve his leadership skills,, a leader's strengths and weaknesses are identified and an action plan is developed to address needs in both personal and professional concerns. Have council evaluate meetings and take survey. An effective resident council leader -understands that the council represents every resident -has an understanding of the resident council’s goals and responsibilities Is capable of fulfilling the job description of the particular leadership role -has a steady interest in the resident’s quality of life and care issues. -is willing to speak up on behalf of residents with enthusiasm and confidence -is able to validate and draw out other resident’s interests -has an understanding and knowledge of resident rights -can work effectively with the council advisor. Image 3: Does it look like what makes up a good leader.

21 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. President-Responsible for much more than facilitating the meetings and the contact person. They are the main advocate and oversee program issues. It is common for the president to be the organization’s check-signer. Vice President- Or be readily available as a permanent replacement should the president step down. The vice needs to be aware of everything that goes on and able to step in and work in partnership with the president when needed. Secretary- General mailing list, databases in safe place, cleaning up rough meeting notes that will become part of the permanent record of the organization. , website current, and anything else that involves communication, and creates reports within a regular time frame. Treasurer- Basic checkbook and balancing and bill paying. The official check-signers and has access to any bank accounts, prepare yearly financial report, and fundraising efforts. They need to be comfortable handling money and working with numbers. * Duties are separate intentionally which provides a minimal level of checks and balances with the organization.

22 Liaison/ Staff Assistant
A 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. 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…No Planning and running meetings Speaking on behalf of residents Selecting meeting times and dates, topics, activities… Facilitator-make easier, to assist of help There are many ways staff can provide assistance or advice without violating their right to self-determination Example of advice meetings disorderly and no decisions made, staff might be able to train council officers Staff-Run council are rarely effective Staff are not council members Invite staff only when needed Have them come to only part of the meeting Walk a fine line Important skill of an effective advisor is keeping communication objective Ability to walk a fine line between loyalty to employer and fairness to council Council advisor understands meaning “ resident-directed care, upholding resident rights, and allowing councils the opportunity to influence and recommend changes to quality of life ad nursing home policies Positive attitude-sincerity is reflected in actions “ The Art of Listening”-good tool Image 4: Runnells Hospital Staff Members Honored by Resident Council

23 Parliamentary Procedure
Robert’s Rules of Order The 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 Depending on how structured they want the meetings…. Methods of Voting Roll call Ballot Standing or showing of hands Voice General consent Voice Vote  The chair asks those in favor to say, “Aye” or “Yes.” Those who are opposed are asked to say, “Nay” or “No.”  The president should not ask those who are opposed to “respond with the same sign.” Show of Hands  This method is recommended for small groups.  Chair asks members who are in favor to raise their right hands. After the count is taken, those who are opposed are then asked to raise their right hands. Rising to Vote  This method should be used to verify a voice vote and on motions requiring a 2/3 majority vote.  Chair asks those in favor of the motion to rise. After counting, these members are asked to sit. The chair then asks those opposed to rise. Ballot Vote  This method involves writing a vote on a slip of paper.  This is a good way to vote for officers, or to vote upon controversial motions.  The chair should appoint individuals to distribute, collect, and tally the ballots. In all of the methods of voting, the chair should always say what happened as result of the vote. Parliamentary procedure is the body of rules, ethics, and customs governing meetings and other operations of clubs, organizations, legislative bodies, and other deliberative assemblies. Five Basic Principles of Parliamentary Procedure  Discuss one subject at a time.  Allow full and free discussion of each idea presented.  Treat all members with justice and courtesy.  Carry out the rule of the majority, and respect the rights of the minority.  Bring together the wishes of all group members to form a cooperating, united club.

24 Opening Activity-Roll call/ name tags everyone becomes acquainted
Image 6: graphics-agenda jpg 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 Planning and Preparing an agenda is an essential first step in conducting an effective meeting Is a sequenced list of matters to be attended to in the meeting Informed on topics Expected Outcomes Key components-date, place, time, purpose, list of topics, time allocated, person responsible for each topic, outcomes expected Staff advisor may assist Allocating time on items needed items Some things should be on the agenda routinely-minutes of previous meeting, old business and new business Send out ahead of time, post, , copies available Person brings up something not on agenda, ask them if it can be put on next agenda End on positive not Put most important things in in middle, since that is when most people will be there

25 Minutes WHAT: 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 Task involve Taking notes, formalizing notes, distribute What to write down Start/ end of mtg. Attendees Amendments to previous minutes Actions Decisions made Summarize discussion Items to be held over for further discussion Produce concise minutes Impractical to write everything down End-asked what should be minuted Record all decision and actions TIPS: clarification Skeleton of minutes Alert any task assigned

26 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. Suporting-Family-Councils.pdf By-laws Policies

27 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 Each council unique, tailor them to fit Make sure language clear and simple Purpose ensure council knows where it is heading and it is a democratic and fair way to make decisions. Infrastructure in place-ombudsman can help with this Each article should be concerned with only one idea When thinking of structure think of size, style and needs of the facility Be amended in future Draft given to council to look over Distribute, refer often Don’t put them away Post

28 Policies Communication with administrator/staff
Communication of concerns to administrator/ staff Communication with other family members Communication with residents Handling individual concerns

29 Problem Solving Will 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. Identify problem Develop concrete and factual statement of the problem Identify the result the council is seeking Think about causes Identify possible solutions Identify possible obstacles and ways around them. Might raise broad concerns ex. Complaints about food, probed for more information-revealed that problem is over cooked vegetables, cold oatmeal, and hard butter. When the problem starts out vague and elusive, it is difficult to find a solution. Once primary issue identified it is usually easier to find workable solution. 5 Basic Steps to Problem Solving Identify the problem or concern Decide on a solution-possible solutions, recommended solution Implement the plan of action-solution Evaluate results-recommendation implemented, action by administration Seek outside advocacy-solution not agreed upon or no action taken by administration, outside assistance may be necessary Image 7: Problem-Solution-Magnifying-Glass jpg

30 Promoting Many family councils have active participation of 10% of families of the residents. Flyer Newsletter Membership Form Permission to Contact Greeter in lobby Mailings Staff What to say?……………. Meet with administrator Not run by facility Benefits Ombudsman involvement Concerns or Objections What the council will need (liaison, private space, support, respond and listen to concerns) Ask staff liaison if they know family members to connect you with families (release phone number and speaking directly) Do a presentation and ask if any interested-residents rights Can meet you outside facility What to say to initial family members.. Explain what council is Point out benefits to them and their love ones Let them know they were I identified due to their active involvement and leadership skills Ask if they would be willing to serve on a steering committee to organize a family council introductory meeting in the facility If they agree… Obtain contact info Provide them with the resources Set up first steering committee to plan introductory meeting If not….. Know any families that might be interested Encourage them to participate in the family council as a member Give out fliers to family members if family members interested in family council Sponsor activity-cookout or tea Welcome letter Buttons-ask me about our family council Contact person and number Welcome table-hand out materials Badges to wear so residents can identify them if they have issues or concerns Ask staff if they know of anyone interested-nurse, social workers, and other staff Council members contact information included in monthly billing Sponsor activity cookout or tea Give little card to other family members Image 8 megaphone.png

31 Ombudsman Role Coach Educator/ Trainer Connector Mediator
Yes! Encouragement! (Yoga instructor from Couples Retreat Movie) Coach Educator/ Trainer Connector Mediator Coach-provide encouragement and support to council Motivate and give successful stories of other facilities. Inspire to keep up good work Suggest strategies, techniques, and approaches Motivate staff Provide suggestions Remind about professional demeanor Point out accomplishments Come up with new ideas Educator /Trainer Important Info and Knowledge Educate staff- “Did You Know” included with staff checks and employee newsletters, employee bulletin boards about councils Train council on topics Ex. Communication Running effective meeting Problem Solving Process Goal Setting/ Prioritizing Recruitment Effective Leadership Negotiation Techniques Assertiveness Techniques Legislative Action Connector Staff, members, resources in community, other councils, residents, families, speakers/ trainers, long-term care system network Mediator Go-b/w prompt and communication with facility staff and members

32 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) Do I Know How to Work with People? A two-way communication process is essential in the establishment of working relationships. Often, with the helping process, non-verbal communication is equally as important as verbal communication. You will establish positive relationships with people when you show: 1.Respect for the dignity of the person. 2.Trust in the individual. 3.Care and concern for people. 4.Readiness to share purpose of visit or conversation. 5.Good listening habits. 6.Good techniques of observation. 7.Willingness to give requested information or help. 8.Willingness to request needed information or help. 9.Willingness to share information on a realistic and truthful basis about what can’t be done. 10.Assurance of confidentiality. 11.Recognition of the strengths of a person. 12.Patience. 13.A sense of humor. 14.Ability to take criticism. 15.Capacity for admission of mistakes. 16.Ability to laugh at one’s self. 17.Capacity for saying, “I don’t know, but I’ll try to find out”-like in ombudsman program 18.Regard for people’s physical and emotional well-being. 19.Ability to offer alternatives. 20.Readiness to give praise whenever appropriate.

33 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) Stress to members of handling common concerns, not individual problems, ombudsman let family/ resident know you are available for problems not shared by others. Encourage members to prioritize their concerns Negotiation-(Family Guide to Effective Family Councils page 65) New administrator

LACK OF INFORMATION LACK OF SUPPORT FROM THE FACILITY DISCOURAGED EASILY LOW PARTICIPATION NOT WANT LEADERSHIP ROLE What to do on chart (page 51 Family Guide to Effective Family Council) Time- Begin and end meetings on time Share leadership responsibilities and delegate small tasks to Members Schedule meetings at times that are convenient Interest-Family members will respond to a personal invitation more readily than a letter or flier. Explain the rights of family councils concept of a family council in a positive way Retaliation- meeting off-site Presented as group Information- unaware how council works or how they can help them Not willing to commit time to the meeting Staff not considering important and respecting Officers, others can substitute for them use ombudsman Ask facility about guest speakers Consumer voice Support- few members meet with management, introduce council Communicate constantly and with positive attitude Know rights Seek assistance from outside agencies Get follow up in writing also with verbal communication Staff not run council, but offer tools, and ombudsman available to assist with training Low participation-resident bedfast, mentally impaired, unable or unwilling to attend (make sure residents with wheelchairs have staff available for assistance) People die Address crisis issues, things ok not as concerned Family barely has time to see residents

35 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 (Family Guide to Effective Family Councils page 61) Example of other councils changes Increase staff satisfaction- concerns expressed to whichever staff member available and may or may not get acted upon with council concerns can be addressed more efficiently concerns communicated to advisor to address staff reducing burden on direct care staff.

36 Resources How 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. 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 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 Parliamentary Charts and Handouts

37 Image References Image 1: Retrieved from Image 2: Retrieved from Image3: Retrieved from Image 4: Retrieved from Image 5: Retrieved from Image 6 Retrieved from Image 7: Retrieved from Image 8 Retrieved from Image 9: Retrieved from

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