Resident Councils: The Politics of Serving Diverse Residents
While we don’t usually associate Resident Councils with politics, the reality is Resident Councils are intended to give voice to the people, a basic premise behind political democracy. A well-functioning Council not only provides an excellent platform for residents to voice their concerns, but it serves as an excellent barometer relative to resident/client satisfaction for staff and leadership within the home.
With the coordination of the Resident Council typically falling into the purview of the manager of the recreation department, it is especially important that recreation managers are fully cognizant of the challenges, and are constantly on the alert to fostering resident inclusion as an element of this important function within the home.
One of the greatest challenges facing Resident Councils, and long term care councils in particular, is adequately serving and responding to the needs of an increasingly diverse resident/client population. As in any political milieu, when the resident population becomes increasingly diverse, residents’ needs and interests also become more varied and potentially more at odds with each other.
For example, how does a council speak on behalf of those who cannot communicate their concerns, such as those who are living with dementia? Cultural, ethnic and spiritual diversity of residents may lead to very divergent needs and solutions. A resident’s sexual orientation that is seen as “different” presents challenges in terms of sensitivity and awareness. And how does one relate and connect the interests of the 30 year old resident with those of the 90 year old?
An unfortunate outcome in such situations can be the emergence of a council made of, and primarily serving, an “elite” group of residents. Such councils are typically comprised of the cognitively well residents, often coming from more professional backgrounds in terms of employment, education and/or experience (such as involvement in community-based committees and associations over their lifetime). While well-meaning, such council compositions can lead to significant skewing of issues and concerns.
When this is the case, one often sees the council focused on items such as the quality of the food (rather than the diversity of the food offerings), the need for more large group entertainment (rather than small unit-based entertainment, and sensitivity to age-specific preferences), and seeking even more outings into the community (such as trips to the theatre, shopping malls, etc.).
If these concerns and interests reflect the majority of a Resident Council’s focus, one must ask if they reflect the majority of the home’s residents. The number of residents living with dementia in today’s long term care homes can range from 70-90% of the total resident population. Affordable specialized services specifically for younger disabled persons are limited, leaving many younger people in need of extensive care with no other option than long term care. Facilities based on cultural, ethnic, spiritual or sexual orientation are typically limited to larger urban centers, and even then, often with limited availability.
While there are no easy solutions, as a professional recreationist, you must always be looking for ways to bridge any gaps in service, and this also includes representation and focus by the Resident Council. In trying to help a Council overcome such limitations of focus, there are two pitfalls to avoid:
- Moving too quickly. The members of the existing Resident Council are likely very well-intentioned. We must try to work with them.
- Inviting family members to speak on behalf of those who can’t. Family members tend to have their own agendas, and the evidence suggests they are not the ideal people to speak on behalf of resident needs and interests. Encourage them to participate on the Family Council.
Helping a Resident Council be more responsive to the entire resident/client population takes time. If an employee of the home is “dictating” or pushing an agenda or process, the Resident Council becomes ineffective in another, and wrong, direction. The key to helping the council is through education and awareness.
When meeting and working with the Resident Council, here are some strategies to consider as part of the education and awareness process relative to recreation programming in response to resident diversity:
- As part of your time at the Council meeting when you share information, in addition to focusing on upcoming programs, include a few minutes on something you might call “Our Current Resident Mix.” Present some information about the total resident population (without breaking any confidentiality rules), such as resident composition by gender, religious affiliation, cognitive levels and age. Only focus on one or two aspects at each Council meeting, then ask if people have questions, and listen for any spontaneous discussion that might result from the shared information.
- Ask permission for time at each meeting to share research findings on best practices in recreation in long term care. This is usually seen as a positive item by the Council – they want to be in a home that is looking to provide “best practices”. Do your research on best practices, and share one example at every meeting. This can include presenting an innovative program that will appeal to the Council members personally, as well as programming strategies relative to the diverse residents who are not represented on Council. You are planting the seed, and it may prompt discussion as some Council members recognize there is more that they can and should focus on in terms of serving others.
- Having provided such understanding, move to presenting a small planned change relative to better programming in response to the underserved residents/clients. Present this as being done on a trial basis, ask for feedback and welcome discussion. Also acknowledge which existing programs will be affected, and how, as a result of any new programing strategies.
- If there is ongoing and significant resistance to such changes, respond with questions. In other words, help create awareness of the negative impact of their response to the challenge, not by telling them they are wrong, but by helping them self-discover the limitation or shortcoming of their position. Asking questions at a personal level helps to emphasize the point. Consider questions such as:
- “Do you think we should be providing programs for________?
- “How do you suggest we help those who can’t speak on their own behalf then?”
- “If this was your loved one, your wife or spouse, or son or daughter, what would you want us to do?”
- “Is it fair that 65% of our programs are suited to those who are alert and aware, when 85% of our residents are living with dementia?”
Some people might argue that asking questions such as these is too sensitive, or might be upsetting for the residents. For those who might say that, we would ask the same questions of them – “If this was your loved one…” – in other words, they may be challenging questions, but not addressing the needs and interests of the underserved is an even more egregious response.
Resident Councils are an important element in the care setting, and by helping the Council become an advocate for those who can’t represent themselves, you are demonstrating your professionalism as a recreationist. And while this process can be challenging, know that you are doing the right thing!