Abiding by a Resident’s Wishes

Jessica Luckett
Social Services and Business Office
Southern Hills Skilled Nursing & Rehab Center

When residents have a decline in their health, residents and families may disagree on how to proceed in their care. A resident might not want to continue with care and would prefer to be a DNR (do not resituate) and the family would want the resident to fight their disease or new diagnosis. A resident could even be ready for hospice but the family is not willing to accept that. Having a conversation to go over a resident’s wishes is not the easiest but by having this conversation it could help when a new diagnosis comes or when a decline in their current health status happens. This will hopefully also cause less fights within the family. Remember this is about what the resident wishes for their life. It should also be written down a living will so that the resident’s wishes are on paper for the hospital or nursing facility to abide by them.

Resident's WishesFamilies may not always agree with a resident’s wishes and they may even try to persuade resident to go against their own wishes for the sake of their family. By doing this the family is putting their own wishes before the desires of the resident. Ultimately it should be the resident’s choice. At times, someone might have to come in and be an advocate for the resident on their behalf if the resident is feeling pressure from their family members. An advocate will help the resident speak up to their family. An advocate could be someone from the nursing facility, hospital or someone from a third party. This person will help the resident voice their wishes to their family.  It is hard to disagree with family and a resident might find it easier to go against their own wishes and put their family’s wants in front of their own.

Advocates are in place to help a resident also voice their opinion against their family or even a nursing facility, physician, or hospital. The goal is to always do what is best for the resident. However, the resident might think that the best action is no action. At this point, this could mean getting hospice in place. A facility or hospital will then get those services for the resident. A resident might want to take all measures toward their disease or new diagnosis. That is their choice. Their family should stand behind the resident.

A resident can however make harmful choices toward their care. This can include wanting to leave a nursing facility or hospital when they are still getting treatment or they are not safe at home by themselves. A resident is determined not safe by different tests that a facility or hospital does, for example check their cognition to find out if they are able to make their own decision. An advocate or nursing facility will help educate the resident on the safety concerns that the facility has to help keep the resident safe. The resident still has the choice to agree or disagree with the facility. If a resident disagrees with the facility, their family or advocate might step back from the resident but continue to try and educate. If this is the case, a resident could leave the facility or hospital against medical advice.

Conversations with families and residents can help find out what the resident’s wishes. During this time, it can also help to educate the resident when there are safety concerns. By having these conversations, hopefully it will bring family and residents to be on the same page when it comes to their care. A resident has the right to choose how they want to live their life, it may not be what the family has in mind but the family should still back the resident (this excludes safety concerns). By listening to the resident, the family could figure out why a resident is wanting to do certain things or not do them. Respecting the resident’s wishes can cause less hurt to the resident and that should be the main priority to the family.