The Role of Family Councils in Long Term Care Facilities in Nova Scotia

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Gillies, Anne E.
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Mount Saint Vincent University
The Role of Family Councils in Long Term Care Facilities in Nova Scotia ‘Family councils’ (FCs) composed of family members of people living in long-term care (LTC) facilities are meant to exist throughout Nova Scotia according to current provincial guidelines. Ideally, FCs function as voluntary, democratic and self-organized groups to bring forward the family standpoint regarding how to enhance or improve LTC systems and procedures. They also provide advocacy on behalf of those living in LTC facilities. Based on a small-scale qualitative study conducted using a critical theory framework and an institutional ethnography (IE) methodology, the primary research aim is to understand how the institutional ruling relations of the LTC system provide the context for the formation, roles and functions of FCs at the facility level. The thesis critically reviews selected disciplinary perspectives on family engagement with LTC systems and describes lived experiences of FC participation in Nova Scotia LTC. It explores intersections and tensions between LTC institutional practices and policies, and the family activities and interests underlying FCs. The research describes four main phases of family carework in relation to the LTC system. It then describes some characteristics of FCs as well as positive benefits for LTC practices resulting from the work of FCs within LTC facilities in Nova Scotia. Benefits include: sharing information regarding licensing inspections, structure and roles in facilities, LTC policies and regulations, and dementia care; helping facilities achieve LTC accreditation; suggesting improvements to facility handbooks and orientation packages; and improving practical issues such as timing of meals, resident nourishment, laundry, furniture, recreation, communication, and staff identification. However, the research reveals several underlying tensions in FC-facility dynamics, based on institutional relations in the LTC system. The complexities of the institutional setting at both the province-wide and facility levels provide the context within which FC members seek to have their viewpoints known as well as share their knowledge and insights as family careworkers. Five key disjunctures or tensions in FCfacility institutional relations are noted: attracting and maintaining consistent family participation and motivation; negotiating the balance between ‘personal’ and ‘impersonal’ perspectives on FCs; the role of facility staff on family councils; challenges of ensuring appropriate means for information sharing by and about FCs, as well as negotiating privacy-confidentiality concerns; and how best FC members can provide critical input on both system-wide and facility-based procedures and policies. Description is provided of the interplay and ambiguities of these tensions in the experiences of FC members. Analysis involves explication of how institutional ruling relations are created and maintained in on-going interactions between FCs and LTC facilities. The conclusion focuses on how to critically assess the extent of ‘embeddedness’ or ‘independence’ of existing and new FCs in relation to the LTC institutional system, combined with gauging whether they have a ‘facility-centric’ and/or ‘family-centric’ ideological orientation. Recommendations are provided to potentially strengthen FC capacities and skills as well as increase respect for the unique standpoint of FC members regarding how to improve both the Nova Scotia LTC system and individual facilities.
Family council, long-term care facility, Nova Scotia