Exercising Choice in Long-Term Residential Care /

The aim of the reflection group is to improve our knowledge and become even better at understanding and handling difficult situations in order to improve the care and make the environment more stimulating for both the residents and those working together. [...] Moreover, there is a fundamental tension between the need for routine, for evidence-informed decision-making and for safety on the one hand, and on the other, the need to respond to individual choices and deal with the events that often disrupt routines, such as an unexpected death or sexual aggression. [...] For example, in February 2017, six of the 36 nursing homes in the city of Toronto had estimated wait times of over a 1,000 days for nine out of 10 applicants.7 It is not only the number of places that matter in terms of options but also the kind of care that is provided. [...] Increasingly, they may also be places of last resort for those who work in them because pay is lower than in hospitals and the working conditions are often inferior.9 Based on our survey of those paid to work in care homes, we concluded that: The low staff levels, the hectic work pace, the low level of control and unequal pay take a toll on the workers’ bodies and in their homes. [...] It is intended to provide data on the health care needs of those in long-term care and to measure the quality of life in long-term care, as well as contribute to accountability by providing indicators of quality in homes.24 However, the focus is on standardized clinical measures instead of residents’ routines and preferences where “knowledge of individual preference, style, and vocational history