By RENEE STOVSKY
Executives managing senior housing regularly face weighty questions involving residents that defy easy answers. Among the more common dilemmas, says Kathy Garbarino, vice president, mission and community benefit for Trinity Senior Living Communities, are these:
- A resident in independent housing becomes forgetful and confused. Should she remain in her apartment with extra support or does she need to move to an assisted living facility?
- A resident's financial situation changes, and he can no longer afford to pay market rate rent for his current living quarters, but has no plans to move. Is eviction warranted? What is the best way to facilitate a move and preserve the resident's dignity?
- At a monthly meeting, residents complain about dining hours, bathing schedules, transportation services and so on. How much influence should they have in decisions that directly impact their quality of life, but may also impact staffing requirements?
- A resident's struggle with mental health issues has begun to negatively impact neighboring seniors. Can she be successfully integrated into her current surroundings? Would a different living arrangement be more appropriate?
Kathy Garbarino
Send in the ethicists
Such circumstances confront care providers on a regular, if not daily, basis, but straightforward solutions are often hard to find.
"At Trinity, we are committed to a holistic, individual-first brand of health care. We like to say we provide seniors with freedom, independence and privacy when they choose it, and security, companionship and support when they need it," says Garbarino. "But deciding how to balance that equation, while treating someone with honor and respect, often presents ethical dilemmas."
Three years ago, to help guide leaders at Trinity Senior Living's 37 senior communities — which serve more than 35,000 people in independent living, assisted living, memory care, nursing care and rehabilitation and wellness settings across six states — Garbarino began providing continuing education in Catholic identity and its sacred values on a regular basis. Ethics committee members from various senior communities meet with an interdisciplinary team on a quarterly basis in Livonia, Mich. —Trinity Senior Living's home base — to build knowledge that will help them bring Catholic social teaching to bear in the individual situations they confront.
"Of course, there are no rules to govern everything, but we are striving to bring empathy and compassion to the decisions we have to make to support our residents and their families, rather than just looking at issues from a clinical or financial point of view," she says.
Human context
So, for example, in the case of a senior resident in independent living who is becoming forgetful and confused, Trinity Senior Living encourages its leaders to consider the person, instead of a particular incident, in making a decision about whether a change in community living is necessary.
"In this case we first would want to know how the confusion manifests itself in the context of the person's life. Does she just have trouble finding the dining room, or is she wandering at night? Does she misplace belongings or is she leaving the stove on?" Garbarino says. "Then we would want to consult with both the resident and her family. Does she want to age in place in the current venue? Are they concerned about her safety in that environment?"
After that, Garbarino hopes community leaders would address the issue with "their hearts as well as their heads." If the resident wishes to remain in her apartment, is it possible to manage the situation with additional support from a loving neighbor or with staff assistance? Or is the decline severe enough that assisted living or memory care is a better option?
"We need to identify what is best for the senior while offering the least amount of harm to her life," Garbarino says.
Ask a senior
Similarly, in the case of a resident's challenging financial situation, Trinity Senior Living would consider eviction a last option. If the senior no longer could afford market rate rent, could a less expensive apartment — say a studio rather than a one-bedroom — in the same community be made available? Or could a lower rate be negotiated, or a subsidy offered? If a resident lives in a U.S. Department of Housing and Urban Development financed or owned development on parish property, where that is not an option, Garbarino would encourage ethics council leaders to help the resident find another, more affordable, place to reside.
When residents in independent living want more input into their daily routines — be it dining room menus, transportation schedules or whatever — Garbarino suggests a culture change among management and staff.
"We need to stop being paternalistic with our seniors and create an atmosphere in which they can flourish," she says. "That involves conversing with them rather than assuming we know what they need. Why shouldn't lunch be from 11:30 a.m. until 1:30 p.m. instead of promptly at noon? Why bingo games instead of book clubs or Wii bowling? Instead of running a community like an institution, we need to allow our residents some decision-making capacity."
Common good
As for the example of the resident struggling with mental health or impulse control issues who is disrupting the peace of her neighbors, Garbarino concedes decision makers must balance the common good against the autonomy a person desires. "Community leaders might have to work with the resident and assist her in integrating into the community in a more peaceful way. If that isn't possible — if the person is becoming violent, for example — a more appropriate living situation should be found."
There is no particular approach to fit each problem, Garbarino insists. Rather, there are many different lenses that can be used to look at every issue.
"In fact, we encourage people to consider over time whether a correct decision was made in regards to a particular situation," she says. "In hindsight, was a broad enough perspective taken? Would the same solution have been reached today? If not, what should have been considered that wasn't originally thought out?"
Though ethical decisions are multifaceted and complex, Garbarino says Catholic ministries have clear approaches to such conversations.
"In the end, we need to remain true to our core values — our belief in the reverence and dignity of each person, and in our care for the poor and underserved — in making our decisions regarding senior housing issues," she says.
Copyright © 2014 by the Catholic Health Association
of the United States
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