Introduction
Three agencies—Disability Rights Washington (DRW), the Washington Coalition of Sexual Assault Programs (WCSAP), and Washington State Long-Term Care Ombudsman Program (LTCOP)—came together as the Alliance to End Sexual Violence in Long-Term Care. Alliance partners created this resource to develop technical assistance for advocates working with residents of long-term care facilities in Washington State. The vision of the collaboration is:
People living in long-term care settings experience safe, respectful and dignified environments over which they exert control, self-determination and independence. Long-term care environments communicate that residents are entitled to live free from violence, abuse and neglect with support to make choices about their sexuality, healing and justice pursuits. A strong system of advocacy responds to sexual violence in a trauma-informed, survivor-centered manner at every level. Care providers, organizations and public entities are self-aware of the risks of violence in long-term care settings. All are accountable to the people they serve and promote a model of non-tolerance of sexual violence (DRW, WCSAP, & LTCOP, 2013, p. 5).
This project focuses on creating networks of providers, long-term care residents, individuals with disabilities, and anti-sexual assault, long-term care and disability advocates who have the ability to foster the creation of long-term care environments that are respectful and safe. The Alliance is dedicated in restoring trust within the system through authentic long-term care system reform and transformation infused with cultural and disability humility, empowered residents and champions at every level who act against sexual violence.
Many long-term care advocates can intuitively recognize, within a few minutes of being in a facility, whether the facility is one that condones advocacy and upholds individual rights and autonomy, or if the facility is one that generally diminishes advocacy and dismisses or overlooks individual rights, emphasizing instead on running the facility. To better ascertain these indicators, residents of long-term care were asked to convey what environmental factors created a welcome environment.
The Alliance recruited six residents of long-term care facilities to assist in the development and review of materials, including this resource on what welcoming and respectful environments look like in the long-term care setting. This diverse resident group included two residents from adult family homes, two from nursing homes, and two who reside in assisted living facilities. The workgroup members represented a range of ages and experiences, and they provided valuable input on this resource as it was developed.
When welcoming environment indicators are present, it is an indicator to an advocate that the autonomy and dignity of individuals is promoted and respected, and advocacy to support these individuals is likely to supported. When these indicators are absent, it often signals to an advocate in a long-term care setting that there will be advocacy barriers present, that one will need to navigate, as the advocacy process begins.
This resource is to help advocates stay true to their focus of upholding the rights of residents in the wake of sexual violence. When long-term care facilities provide welcoming and respectful environments it, in turn, promotes the autonomy, independence and empowerment of each resident. These environments mitigate isolation, control, disempowerment and other environmental tactics abusers may use. When resident rights are respected and upheld, there is openness to an added attention and awareness to what the spectrum of sexual violence entails and what steps to take in addressing the issue. Long-term care environments directly affect the manner in which staff responds to reports of sexual violence. The stronger the facility is in promoting the belief that everyone has a voice, everyone has rights, that access to advocacy services is a benefit not an inconvenience, the stronger the facility will be on non-tolerance of sexual violence.
Residents told us the following key components were essential to a welcoming environment, and fostered an inclusive, violence-free long-term care setting.
Privacy
The long-term care residents involved in the work group indicated that when the expectation of privacy is respected by the facility, it is a strong indication of a welcoming environment. Staff and guests who view the environment as one’s home and understand the value behind providing private time and space offer a healthy environment for all. Residents living in facilities that experience this type of atmosphere are allowed to shut their room door, they are free to safely go where they choose, experience the utmost respect while bathing and staff always knock before entering their room.
Dignity
It is vital that long-term care environments treat residents with dignity. When honor and respect of each individual is already in practice, residents will have access to the support they need when they need it, before a crisis occurs. Individuals live with various disabilities, both visible and invisible. It is important to recognize that some may or may not identify with disability and this autonomy should be left up to the resident. Many times people are treated differently if it is presumed that they have any disability, and this can be incredibly alienating. Facilities that hold the dignity of residents as a priority recognize that the person comes first; the environment promotes a culture that reflects this belief.
Residents expressed that when the facility takes extra time needed to properly explain their rights in a relevant and relatable manner, they feel more empowered to advocate for themselves or others when these rights are violated. Facilities that hold the dignity of residents as a priority have information about resident rights readily accessible. This, in turn, causes residents to feel welcomed, supported, able to exercise their self-determination and feel included in community.
Autonomy
The right to autonomy and self-determination are upheld in facilities that have observed respectful environments. Residents discussed that environments that promote these ideas give freedom for them to decorate their personal space; they are free to express their diverse personalities and lifestyles. The building and rooms are not stale and institutionalized. People are given methods and opportunities to build independent life skills and are given choice over their schedule and privacy. Residents know they are able to make requests for goods and services that meet their individual needs and those needs are addressed. In this type of environment, residents are able to have confidence and hope knowing if their rights were ever violated, they have a path to assert their rights and will expect results.
Resident-centered practice
In a welcoming environment, the focus of the long-term care facility will always be resident centered rather than prioritizing what is convenient for facility administration. Long-term care staff have the opportunity to complete required tasks, comply with facility rules and state regulations while still maintaining resident-centered practice by upholding resident’s dignity and autonomy. When the environment fosters practice in this manner, the ability to serve the resident becomes flexible, creating a culture where resident-staff relationships and respect are valued above task completion. For example, staff will respect a resident’s request to wake up at a later time for bathing assistance, regardless of the staff member’s desire to complete the task early. Residents currently living in long-term care facilities stated that priorities need to re-shift to focus on people first, not on pennies, compliance, facility rules or silencing, minimizing and dismissing complaints.
Safety
The expectation of safety will be prioritized in a welcoming and respectful environment. Residents will feel a sense of safety and staff will demonstrate responsibility for providing this atmosphere. When repairs are needed within the facility, they are fixed right away; residents are not forced to live with broken appliances, etc. Money and belongings are safe and financial exploitation is not a common worry or concern of residents. People feel they can be free and comfortable in their home without a constant fear of sexual or other forms of abuse and the staff and administration’s attitudes reinforce this feeling of safety.
People are able to freely live and build healthy relationships without the fear or actual acts of harassment, intimidation or bullying. The building of these healthy relationships is not prohibited or discriminated against in any manner. There is support for diversity and civil rights in general. Same sex relationships are accepted and racial slurs and other discriminatory harassment is not tolerated. Information is provided on building healthy relationships and what that looks like for those that need it. People feel comfortable and are able to set boundaries for themselves and these boundaries are respected.
Staff that work within welcoming facility environments will acknowledge and support the need for privacy and intimacy. Couples that are married have the right to live together if they choose to do so and this right is upheld. Long-term care residents expressed that when they feel informed of their rights, it promotes feelings of safety in their residence.
Access to Advocacy
Facilities that provide a welcoming and respectful environment make sure the residents are aware of their right to obtain advocacy services. They support this right and see it as a benefit to the person and the facility. There is clear protocol on what to do when an advocate is requested.
There is a transparent process for access to an advocate. Residents know who the advocate is, what agency the advocate represents and the level of confidentiality that can be provided. Residents that reside in welcoming and respectful environments have access to advocates that are not paid directly by the same facility. The respect for dignity, autonomy and self-determination must be demonstrated immediately when providing advocacy services in long term care environments, this will support the trust building process.
“You Know When You Walk In”
Residents of long term care facilities expressed you will know if a facility promotes an environment that honors the dignity, privacy, autonomy, safety of residents from the moment you walk through the door. You will hear laughter, people will generally be happy and you will be greeted as you walk through the building. The residents are not isolated; instead they are connected to the outside community. They know of and have access to local events, recreation and shopping. The environment will be clean, inviting and colorful, reflecting the diversity of the people that live there. The staff are good at their jobs and many are long-term. The people are diverse, including members of various backgrounds, cultures and the environment is welcoming to LGBT*Q individuals. There are various activities that fit the diverse needs of the people, including various religious classes, yoga, tai-chi, exercise rooms and equipment etc. You will easily be able to find and access information provided in multiple formats on resident rights and what steps to take to file complaints. Facilities that operate in this manner make it clearly known to residents and visitors that this is not an institution, this is your home.
Acknowledgements
This resource is a service of Disability Rights Washington (DRW), Washington coalition of Sexual Assault Programs (WCSAP) and the Washington State Long-Term Care Ombuds Program (LTCOP). It provides general information as a public service only, and is not legal advice. If you need legal advice, you should contact an attorney. You do not have an attorney-client relationship with DRW, WCSAP or LTCOP. If you would like more information about this topic or would like to receive this resource in an alternative format, such as large print or Braille, call DRW at (800) 562-2702.
This document may not be used for commercial purposes. It may be reprinted with attribution of the partner agencies in the Alliance to End Sexual Violence in Long-Term Care.
Disability Rights Washington info@dr-wa.org
Washington Coalition of Sexual Assault Programs info@wcsap.org
Washington State Long-Term Care Ombudsman Program ltcop@mschelps.org
This project was supported by Grant No. 2012-FW-AX-K003 awarded by the Office on Violence Against Women, US Department of Justice. The opinions, findings, conclusions, and recommendations expressed in this publication/program/exhibition are those of the author(s) and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women.
Published 2015, Alliance to End Sexual Violence in Long-Term Care, Seattle & Olympia, Washington