Service, Support, and Care Plans
Module 2 - Lesson 3 of 4
Introduction
One aspect of person-directed care is strength-based care planning. It shifts the focus to what a person can still do and creates opportunities for a boost to self-esteem and self-efficacy. Most everyone feels better when they can show what they are able to do.
Warm Up
- Watch the video below.
- How many of Suzanne's strengths can you identify?
- When you are finished, continue reading the section below.
- Then re-watch the video using the questions suggested in the lesson. What else did you notice the second time?
Dig In
Suzanne Video
In the video you just watched, you met Suzanne, who has graciously agreed to help teach you how to see and use a person’s strengths. Suzanne is a woman in her late 40s who suffered a traumatic brain injury in a car accident. She lives in a residential care facility in another state. She and her guardian have agreed to let us use her story, her name, and this video.
Dr. Wehry, who collaborated on the Texas OASIS HCBS curriculum, was asked to see Suzanne in consultation. Suzanne was repeatedly striking staff members and other residents of her adult residential care home. This was often, but not always, triggered by a conflict over her smoking privileges. Various medications and behavioral modification programs had been tried without success. She remained impulsive and physically aggressive. She had pretty much been written off because of her brain injury and was facing eviction. Despite her disabilities—which she calls handicaps—she and Dr. Wehry were able to come up with a plan that all but eliminated her striking others simply by helping staff members to see and use her strengths.
A Word About Boredom
Boredom is one of the biggest challenges for the people we serve. Dr. Bill Thomas, who started the Eden Alternative and the Green House project, calls boredom one of the three plagues of nursing home life, which can also extend to community-based residential settings.
Boredom contributes to a poor life quality and can increase conflict. People living with dementia who are bored are more likely to call out or walk about in search of things to do.
Becoming bored is significant for persons with dementia who may have lost the ability to initiate meaningful activities on their own. They rely on us to find what interests them and brings them joy and pleasure.
Practicing Strength-Based Care Planning
- Watch the Suzanne video a second time. As you watch the video, keep the following questions in mind.
- What does she have?
- What can't she do?
- Who is she?
- What can Suzanne do?
- What are some day-to-day problems?
- What does she want?
- What makes life good for her?
These questions are part of a strength-based care plan. You can use this worksheet to help create such a plan for others in your care.
Capacity
Often, the right to choose depends on showing you have the ability (also called capacity) to make a decision about something. In other words...
Capacity is the ability to 'do' something.
It is:
- Task-specific, not global
- For example, where to live, making a will, selling a house, what treatment to have.
- Situational
- Contextual
- Changeable
Having difficulty with one kind of decision doesn't mean you lack capacity for making other decisions.
Often, when a person living with dementia begins having trouble making decisions, health professionals and families consider a guardianship. There are better alternatives to guardianships.
The spectrum of alternatives to full guardianship are as follows:
Least Restrictive
- Individual retains full independence and full decision-making power
- No court involvement
Middle Ground
- Individual retains some, but not all, decision-making power
- Limited court involvement
Most Restrictive
- Guardian has full decision-making control over all areas of a person's life
- Requires a court order
Supported decision-making is another alternative. You'll look at that in the next lesson.
Wrap Up: Lesson 3
The Right to Choose
Not only is person-directed care better care, it is also the law. Individuals have a legal right to be included in those decisions that concern them. Even a person with a guardian, or a person with dementia, has the right to have their choices considered.
The law doesn’t require that the choices are what you might call 'good' choices or 'smart' choices. It's about the right to choose.