The Value of Both a Residents’ Council and a Family Council

In this communication, we lay out more than 25 years of experience with both a Residents’ Council and Family Council at two not-for-profit nursing homes affiliated with Peace United Church of Christ and six Lutheran churches in the Rochester, Minnesota, area. Both facilities serve as the teaching nursing homes for Mayo Clinic and the Geriatric Fellowship program. The “newer” Samaritan Bethany Heights has had a continuous Residents’ Council and Family Council since the doors opened in 1981. The older Samaritan Bethany Home on Eighth has had an active Residents’ Council, while participation in the Family Council has been variable over the years. Recently, the Family Council at the Home on Eighth has become a more integral part of the life of the community.

A Residents’ Council serves many functions and responsibilities. A Residents’ Council should be the voice of the people who count most, its core value. If the facility is resident-centered, this council will determine how the facility functions in both good times and under duress. The council is usually a good barometer of how the survey process will go. Depending on the case mix, this can be active and dynamic or be represented by only a very few residents. In addition to all they can do to support, identify problems and solutions, and offer up change to the facility, they also serve as their own support group.

The Family Council can meet with the facility administrator and other key staff. They can do much more than voice grievance. They can advise with regard to areas of improvement for better patient care and improved outcomes. They can gather information and disseminate it through both formal and informal networks. They can be an informed public and receive continuing education at a variety of different levels.

In the past few years, Samaritan Bethany has been on a culture change journey to implement the household model. Person-centered care and training through Action PactTM has resulted in higher participation levels at both resident and family councils. Satisfaction measures from “My Inner View” are high for residents, family members, and staff. Both councils can serve as a buffer, or even provide support for the survey process. They can become involved with infection control and be advocates for immunization. Many arguments exist as to why there is no need for either council to exist: “Our facility is perfect.” “We have an open door policy and listen to all concerns at all times.” “There is no interest in either a Residents’ or Family Council.” “We have tried in the past, but we cannot get rid of people who still carry a grudge three years after their loved one is gone.” There are some limited research data regarding the barriers and benefits to family involvement in the skilled nursing facility setting.

Lindman Port¹ identified three key barriers to family involvement, including transportation barriers, poor relationship with staff, and a smaller network of supportive family and friends. In this study, greater access to support groups and education were frequent family requests. Pillemer and colleagues² have demonstrated that parallel training sessions on communication and conflict resolution techniques conducted with family and staff improved attitudes and reduced conflicts. In a survey of Michigan nursing homes, Friedemann et al³ found that while 55% of facilities encouraged participation in a Family Council, 31% did not have one available at all. Her data suggest that family-oriented facilities that promoted learning and gave families opportunities to be heard and be a part of the operation were less likely to be criticized by families for care or safety issues, and had fewer complaints overall.

The key offerings of these facilities as a group included: family group meetings to help solve nursing home problems; instruction in patient care for families; classes to learn about chronic illness; family support groups; advisory board to family members; education materials for families to borrow; and education about nursing home programs. The literature does support the notion that families appreciate a menu of opportunities for involvement in patient care and facility function, and that this improves outcomes important to all involved. Our experience changes over time and takes on the personalities of those involved. The issues remain relatively static; the people do not, though various roles can be identified within just about every group dynamic. We encourage you to explore and embrace both a Residents’ Council and Family Council for your facility.

Dr. Tangalos is Professor of Medicine, Chair Emeritus, Primary Care Internal Medicine, and Co-Director for Education at the Alzheimer’s Disease Research Center, and Dr. Hanson is Assistant Professor of Medicine and Director of the Geriatric Fellowship Program, Mayo Clinic, Rochester, MN; Ms. Wiesner is Administrator at Samaritan Bethany Heights, Rochester, MN; and Ms. Gustason is Administrator at Samaritan Bethany Home on Eighth, Rochester, MN.