RESEARCH TO PRACTICE
Relationship Between Residents and Staff in Person-Centered Model of Care and Challenges Associated with It
American Association of Homes and Services for the Aging (AAHSA). Audio-conference/December 14, 2006.
The hallmark of person-centered model of care is a meaningful relationship between a resident and a staff member. Close relationships have demonstrated many benefits both for residents and staff. Among the benefits most often identified are residents’ increased quality of care and quality of life, improved care and better clinical outcomes. Staff have listed improved satisfaction with their job, increased retention rate, a higher feeling of empowerment and respect, ease of job due to more accurate anticipation of residents’ needs, etc. Close relationships also create new challenges for staff, residents and their families. In December 2006, AAHSA provided an audio presentation discussing potential problems stemming from close relationships between residents and staff, and suggestions of how to deal with some of these problems.
One of the common problems that often occurs is when residents and/or their families bring a gift to a staff member they feel especially close to. It is a social norm to give a gift to a person we like or to whom we are grateful; however, in a long-term care industry one should not accept any personal gifts. It is recommended, as a good compromise, to suggest to gift-givers that they come up with a group gift, such as a pizza party for all staff. When families insist on bringing a gift, they should be encouraged to bring candies, a case of microwave popcorn or homemade goodies to share with entire staff without singling out one staff member. Resident Council should be involved in organizing a party at which consumable gifts can be shared with residents and staff. If staff are uncomfortable refusing a gift, administration should step in and explain the facility’s policy on accepting gifts. One of the potential consequences for a staff member accepting a gift is that when a relationship turns bad, a gift can be used to suggest to staff that a resident expects better care/treatment in return. Staff accepting gifts may also give the impression to other residents that only those who give gifts receive better care.
The most effective method to avoid any of the above problems is to have a well-defined policy related to gifts and consistent reinforcement of the rules. Failure to follow policy leads to inconsistent treatment of employees and also causes morale problems and employment discrimination complaints. Policies can also be used as a guideline for staff and supervisors, and provide a uniform understanding for the employer and employees. Every employee has to be treated the same, which helps avoid accusations of unfair treatment and possible litigation threats.
Another aspect discussed in the presentation was how to deal with former employees who were terminated and want to visit a resident in a facility. It was suggested that each facility evaluate the possible risk of a retaliation claim from a former employee. Some employees may claim that the Resident Right gives them the ability to visit without interference from the facility. To avoid this type of conflict the facility should include a statement in their policy stating: “Former employees need to check our facility policy before visiting residents.” Other facilities may establish a rule stating that a former employee should notify the facility where and when a visit will take place.
What if a terminated employee returns to a facility as a private duty nurse? The facility has a right to refuse his/her employment. If a staff member was fired and then permitted by a facility to serve a resident in the role of a private nurse, he/she should only get information necessary for treatment of a resident by whom they were hired. For HIPPA protection, facilities should consider authorization from that resident. The facility should always be guided by health, safety and welfare of residents.
Staff should be discouraged from moving beyond their professional relationship with residents. Staff should not be allowed to volunteer for anything that could be considered within their job description due to concerns about labor laws, liabilities and workers’ compensation.
What if a well-liked Certified Nursing Assistant, CNA, was terminated and several residents requested Human Resources (HR) to reinstate his/her employment? The facility cannot disclose information on why an employee was terminated. The facility needs to ask residents to understand that the organization must protect the privacy of staff as well as residents.
What if a CNA starts a baking business? The following example was discussed. A resident’s family orders a birthday cake for their loved one from a staff member’s business. The family intends the cake to be shared with the whole facility. The facility allows the CNA to bake a cake, but discourages her from charging the family. Facility policy should have a regulation in this regard as well. Verbal solicitation related to staff private business by staff among residents and/or families should be strongly discouraged.
Staff relationships with residents are an important part of nursing homes. However, HR and legal issues should be considered, and the welfare of both residents and staff should always be the guiding principle for any decision related to relationships.
Contact Information:
Claudia Rizzo, Human Resources Specialist, AAHSA at crizzo@aahsa.org
Jennifer Hilliard, Esq. Corporate Compliance Attorney, AAHSA at jhilliard@aaahsa.org