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How toOrganize

and Directan Effective

ResidentCouncil

A Technical Assistance Manualof the Missouri Long-Term Care

Ombudsman Program

What is a Resident Council?History of the Resident CouncilWhy have a Resident Council?

ORGANIZATION

INTRODUCTION

MAKING IT WORK

IN CLOSING

Getting StartedStaff OrientationStructureCouncil Officers and LeadersCommitteesCouncil Bylaws

Identifying ObstaclesConducting Effective MeetingsCouncil AgendasMeeting MinutesParliamentary ProcedureEncouraging ParticipationCouncil Evaluation

ReferencesAppendixCredits

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Table of Contents

1

Since the early 1960’s, experts oninstitutional living have expressed concernabout the deterioration that results whenlong-term care residents do not haveopportunities for continuing meaningfulactivities, and when they are notencouraged to maintain independence andself-determination.

Research has shown thatmaintaining the right to self-determinationis beneficial not only to residents, but alsoto caregivers.

Elaine Brody of the University ofSouthern California Gerontology Center,found that “when residents are encouragedin maintaining a sense of autonomy andcontrol over their own life, there is lessmental confusion and physical dependencyand, hence, less need for care by others.”

Dr. P.W. Thompson of the MenningerFoundationGeriatric Centerfurther reinforcesthe beliefs ofother experts whenhe says that “themost helpfulassistance is thekind whichrecognizes theneed to experience,as much aspossible and for aslong as possible,feelings of mastery and influence. Residentsneed to use, to exercise and to demonstratewhatever talents, intelligence, knowledge, or

skills they have. They need to mix withpeople with whom they can experience thepleasure and the power which comes fromsharing, loving, discussing, and evenarguing.”

The resident council is anorganization which provides a form of self-government within the long-term caresetting. It provides a forum for residents toexercise self-determination andopportunities to use their talents andwisdom to create and help maintain thequality of environment so necessary forhealthy institutional living.

Despite the well-accepted, obviousbenefits and advantages of residentcouncils, difficulties in establishing andmaintaining effective councils occur. It isapparent that many existing residentcouncils are not being cultivated to theirfullest potential.

Working with residentcouncils requiresspecialskills andknowledge. Thepurpose of thismanual is toincreaseunderstandingof the functionsand benefits ofresidentcouncils.

The manual also includes informationand practical assistance to help residentsand staff organize and develop their

This technical assistancemanual is based on the

philosophy that residentsof long-term care facilities should be

involved to thegreatest degree possible inmaking the decisions that

affect their lives.

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Introduction

councils to be active and strong.Long-Term Care Ombudsmen are

committed to the same goals and objectives asthose of resident councils, i.e. promoting andprotecting the self-determination of residents,empowering residents to speak for themselves,providing opportunities for residents to speak onthe issues that concern them, assisting residentsin resolving problems, etc.

Throughout the history of Missouri’s LTCOmbudsman Program, volunteers have beentrained in the philosophy and function of residentcouncils. Ombudsmen are encouraged tosupport and be involved in the councils of thefacilities they serve.

The inspiration and motivation for writingthis manual came from the many years of guidingthese ombudsmen in their efforts to helpresidents and others maintain effective residentcouncils.

While training volunteer ombudsmento respond to requests for help withresident councils, the ombudsman program staffhave collected a vast amount of information andexperience.

This manual presents this knowledgein an organized and easy-to-use format forthose seeking to establish and maintainmore effective resident councils.

The manual covers the philosophy,history, functions, and current level ofacceptance of resident councils. The many waysof organizing resident councils are included witha discussion of the characteristics of each.

The manual stresses throughout thatcouncils should be individualized to reflect thespecific needs of the residents they serve.Various kinds and levels of leadership arediscussed with an emphasis on the different rolesand characteristics required of the facility staffwho work with resident councils.

Suggestions are made for conductingeffective meetings and keeping accurate recordsof the council’s actions as well as distributingminutes.

In addition to providing information forthose organizing new councils, this manual offersways to evaluate and improve existing councils.

Resident council participants are boundto encounter difficulties in establishing andmaintaining an effective council. This manualdiscusses potential problems and possiblesolutions.

Readers will not find the answers toall their questions; however, if implemented,the basic principles presented in this manual willbe helpful to persons interested in organizingand directing an effective resident council.

Emmelene W. Kerr,former CoordinatorLong-Term Care Ombudsman ProgramCentral Missouri Area Agency on AgingColumbia, Missouri

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Resident councils are organized, self-governing,decision-making groups of long-term careresidents meeting regularly tovoice their needs and concerns and to haveinput into the activities, policies, and issuesaffecting their lives in the facility. Througha resident council, residents can positivelyimpact their facility, making it a reflection oftheir preferences and values.

Because a successful council meets theneeds of the residents it serves, there is notypical resident council. Some have manymembers attending meetings on a regularbasis. Others have only a few“representatives” attending meetings.Likewise, somecouncils are highly organized, whileothers function in aninformal manner.Some are led byresidents, andothers are led byfacility staff orvolunteers.Whatever thestructure of aresident council, theprimary characteristicsmust be:

! that it provides a forum for residents toexpress themselves; and

! that it reflects and meets the needs of theresidents it serves.

Examples of how resident councils workinclude:! In one facility a full activity calendar was

displayed, but many of the activitiesnever took place. The resident councilmet and evaluated the entire program.Ideas and opinions were solicited,helping to assure that staff would befocusing on programs of interest to theresidents. To ensure that the activityprogram continued to improve and meetthe residents’ needs, an activities committeewas formed to work with the activity director.

The residents’ satisfaction andattendance increased.

! In another facility, residentswere dissatisfied with howthey were treated whenanother resident died. Theycomplained to theirombudsman that when itwas time to take a body tothe mortuary, they were all

A resident council isessential to giving residents

input into their daily life ina facility. It can giveresidents a sense of

purpose and increase lifesatisfaction.

What is a Resident Council?

4

“herded” into an area where they could notsee the process. The council was able togive residents a comfortable place todiscuss this issue. A “Time ofRemembrance” was instituted as a solution.When a resident died, those remaining in thefacility were given a chance to gather andoffer a prayer, or just have a moment ofsilence. A monthly memorial service washeld to remember all residents who had diedin that month.

! In a third facility, food complaints wereat an all time high. There were so manyproblems that the residents took theirconcerns about the food to the residentcouncil. A plan was drawn up to havethe food service director meet with a fewresidents to look for solutions. It tooksome time and patience on both sides,but the food has improved.

Residents can have a positive influence onthe way life is organized in the facility. Asthey take advantage of opportunities tohave influence, the resident council willgrow and change.

Since it is a resident council,the residents need to be asmuch in control of the planningand running of the meeting aspossible. A staff person orvolunteer would give only asmuch assistance as theresidents needed or requested.

ADVOCACY TIP:

5

Leaders and innovators in the long-termcare field have been advocating for residentself-government for over 40 years. So,while involving long-term care residents indecision making is not a new idea, residentcouncils do not have a longhistory.

The 1960’s were a time ofincreased awareness ofconditions in long-termcare facilities and theconcerns of residents wholived there. In response tothis heightened awareness,many advocacyorganizations formed toaddress long-term careissues. It was during thistime that residentcouncils started emerging and their valuewas recognized as a way to resolve someresident concerns.

As resident rights began being enactedinto law, the importance of involvingresidents in the life of the facility repeatedlyappeared on lists of rights. Advocacygroups saw resident councils a way to

improve resident involvement. In 1972, theNursing Home Residents’ Advisory Councilin Minnesota, now known as the AdvocacyCenter for Long-Term Care, became thefirst group to offer assistance in forming residentcouncils. Similar groups were established inWashington and New York.

Today, recognition ofthe importance ofresident councils hasspread to most states.Colorado, Illinois,New York, andOklahoma haveadopted lawsrequiring each facilityto have a residentcouncil. Other statesinclude the right to

have a council in their state resident rightsstatutes. Missouri supports residentcouncils through regulation 19 CSR 30-88.010(19), which states: “...Residentsshall be informed of and provided a viableformat for recommending changes in policyand services...” Although not specificallyrequired by law, the resident council canbe a tool for implementing this regulation.

During the 1960’s and1970’s, greater awareness

of the conditions insidelong-term care facilities

motivated advocacy groupsto address nursing home

issues and problems.

History of the ResidentCouncil

6

It is expected that each resident in Missouriwho wants to be involved in a residentcouncil will be allowed to do so.

Recognition of the importance of residentcouncils has also spread to providerorganizaions such as the AmericanAssociation of Homes for the Aging and theAmerican Health Care Association.Likewise, Long-Term Care Ombudsmanprograms have long been staunchsupporters of resident councils.

Although the topic of resident self-government is not dealt with specifically inthe federal nursing home reform legislation,commonly known as OBRA ‘87, residentsresiding in certified facilities are guaranteedthe right to meet together for whateverpurpose they choose. This includes havinga resident council.

ADVOCACY TIP:If you are a new council facilitator or council officer, talkwith the administrator, activity coordinator and socialservice director about the history of the resident council inyour facility. This will help you understand what has beendone in the past and allow you to avoid the pitfalls that havebeen encountered previously.

7

Why Have a ResidentCouncil?

Many of our values are deeply rooted in theprinciple of self-determination. We highly regardour right to pursue happiness, speakfor ourselves, and make the laws by whichwe are governed. These values do not changejust because we move into a long-term carefacility.

An effective resident council can do many thingsfor residents. Consider the following points:

!!!!! Involved residentsare healthier.

Professionals in manyfields recognize that afeeling of being in controlof one’s life oftentranslates into betterphysical and mentalhealth. Effectivecouncils help residentsspeak out, keeping negative emotions fromturning inward.Anger, frustration, or worry turned inwardputs residents at a greater risk fordepression, low self-esteem, lethargy, orjust giving up.

Self-expression is more than an inalienable right,it is necessary to continued good health. It is theepitome of the principles of life, liberty, and thepursuit of happiness, that are the foundation ofour republic.

!!!!! Resident Councils promoteindependence and personal growth.

When residents feel dependent on othersfor their basic needs, they may fearretaliation from their caregivers if they

criticize or offersuggestions.Councilspromoteresidentfriendshipsand mutualsupportnetworksthat provide

residents greater comfort when speaking out.

Not only do resident councils providean opportunity for new relationships, they providenew challenges and opportunities for personalgrowth and development. The

Professionals in the long-termcare

field recognize that the feeling ofbeing in control of the major areasof one’s life translates into better

physical and mental health.

8

resident who was never involved inneighborhood groups or their children’s schoolmay now be able to take a leadership role forthe first time.

!!!!! Involved residents help the facilityrun more smoothly.

Gossip and misinformation can spreadquickly through a long-term care facility.When residents are involved in a council,they can be better informed.

When asked for input on the activitiesprovided in the facility, residents are morelikely to participate. Resident involvementcan contribute to a better facilityatmosphere, as well as increasedsatisfaction for both residents and staff.

!!!!! Councils can identify and resolveproblems in the early stages.

Resident councils should be an importantpart of the facility’s grievance procedure. Infact, research by the National Citizens’Coalition for Nursing Home Reform showedthat many residents view their councils asthe ideal system in which to solve problemswithin their facility.

!!!!! The existence of a council reflectsthe facility’s philosophy of care.

The existence of a resident council in the facilitymakes a statement about the

philosophies guiding the care of peoplewho live there. By providing a residentcouncil and staff to work with it, theadministration supports the belief thatresidents have the right to speak forthemselves and influence their environment.

ADVOCACY TIP:Several states have formed a Stateresident council organization. In someareas of the country, the nursing facilitieshave joined together and schedulequarterly city wide or area wide meetingsfor all the resident council Presidents.This allows for a sharing of informationon common concerns.

9

Although not required by Missouri law, mostfacilities have some kind of resident group.Taking this into consideration, many readers ofthis book will be looking for ways to make thegroup as effective as it can be. Regardless ofwhether you are starting a new council orimproving an existing one, the same basicprinciples apply to making it successful.

A critical key to an effective resident council isthe attitude and philosophy of the caregivers.When the facility administrator recognizes theimportance of providing self-governing groups,there will likely be little resistance to theestablishment of the group. Additional supportmust come from other staff, including the nursesaides, who are convinced of the value of the

council and are committed to assisting residentsin taking part.

When you have the support necessary toestablish a council, working out the detailsand maintaining commitment from both theadministration and the residents becomesthe issue.

In developing an effective resident council, it isimportant to look at who is trying to establish thecouncil. Often, it is a staff member who initiatesthe effort. If residents are not supportive of theidea, the effectiveness of the council will belimited. If, however, the idea comes fromresidents, there will likely be more support.Whatever the source of the inspiration for thegroup, it takes only one interested andcommitted person to get the ball rolling, but ittakes many people working together to make thecouncil successful.

As the facility staff and the residents worktogether to start or improve a council, thefollowing steps should be taken:

1. Have a brainstorming session

Call a meeting of all persons interested in

It takes only oneinterested and

committed person toget the ball rolling, but it

takes many peopleworking together to make

the council successful.

Getting Started

10

organizing a resident council. This includes theadministrator, staff, families, volunteers, and mostimportantly, all interested residents.

During the brainstorming session, the groupneeds to:

! discuss the value of a resident councilfor staff, residents, and the facility;

! review the information in this manual.Consult your local Long-Term CareOmbudsman Program for furtherassistance;

! explore and analyze possible staffresistance to a council and discussstaff roles and expectations;

! secure staff and administrativecommitment to support a council;

! identify potential resident leadership;

! consider possible resident apathy orresistance and how to respond; and

! form a committee of four to six peopleto plan an exploratory meeting of allresidents to discuss the establishmentof a resident council.

Remember that during a brainstorming session,there are no bad ideas. It is important thateveryone is allowed to voice their opinion.

2. Conduct an exploratory meeting

The committee should plan a meeting for allresidents. A good strategy would be toschedule the meeting to coincide with apopular activity that a large number ofresidents would be expected to attend.

Unless there is a very capable resident, itmay be necessary for a committed staffmember to lead this meeting. The purposeof this meeting would be to:

! inform residents of the purposes andbenefits of a council;

! share staff ideas and commitment tothe project;

! give examples of how councils areeffective in other facilities. Invite amember of a resident council fromanother facility to talk about his/hercouncil;

! lead a short discussion to identify theconcerns of the residents and waysthe council could address them;

! take a vote to determine if there isinterest in organizing a council; and

! if so, select a committee of four to sixpeople (include residents, staff, andvolunteers) to organize and plan thefirst meeting.

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! determining resident needs andconcerns that are appropriate for thecouncil to address;

! selecting special projects the councilcould be involved in;

! determining when and how often tomeet; and

! planning a meeting where all residentsare invited to hear and vote on therecommendations of the committee.

After this process, the committee shouldhave the basic components for writing

bylaws by which thecouncil will operate.

4. Implementing theplan

If residents vote toestablish a residentcouncil based on the

committee’s recommendations, the onlything that remains is implementing theplans that have been made.

Creating and developing a resident council takestime. Be patient and recognize councilsuccesses, even the small ones.

While “big projects” are important andresidents gain a sense of satisfaction from

3. Conduct an organizationalcommittee meeting

The work of this committee can probably beaccomplished in two meetings. Theremainder of this book provides theinformation necessary for this committee toperform its duties.

It is important for the administrator to showhis/her support for the council at thesemeetings. This can be done either by apersonal appearance or sending a letter tothe committee. Once support is received,the organizational committee can establishsome recommendations for basic structure

fairly quickly. This includes:

! establishing the purpose and functionof the council;

! establishing the organizationalstructure and leadership;

! establishing the role of facility staff inthe council;

ADVOCACY TIP:The same committee members may be willingto continue serving at each succeeding step inthis process. The only difference at each step alongthe way is the purpose and goal of each committee.

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involvement in such endeavors, building acohesive group where people listen to eachother with interest and respect is important.This takes time, and may be difficult, butyour efforts will pay off in the end.

It will help to get your council off to a goodstart if early in the life of a council you areable to point to successes that aremeaningful to a large number of residents.Some areas where a council might besuccessful include: a change in servingprocedures assuring residents get hotcoffee; establishing a committee that sendscards and letters to residents in the hospital;or conducting a get acquainted activity fornew residents.

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Staff and administration support is one ofthe most critical and important buildingblocks of an effective resident council.Every staff member must be aware of thephilosophy and need for a resident council, howit will function in the facility, and how they can beof assistance. Staff must be committed to thecouncil if it is to operate effectively.

To accomplish these objectives, staff musthave the chance to take part in organizing

the council in their facility. The staff need to betrained so they will know how best to assist andsupport the council. Various approaches can beused to do this. Two of the more common onesare:

! information on the council is systematicallyincorporated into other staff trainings, or

! in-service trainings can be designedspecifically to equip staff to understand andsupport the resident council.

The need to orient staff on how the councilcan help assure a high quality of life in thefacility should be kept in mind whenplanning inservice programs. Residentsoften suffer from feelings of powerlessnessand lack of control over their lives. This canlead to depression. Participation in a residentcouncil can alleviate these feelings by givingback some control. Staff must understand thattheir main role in the council is support andencouragement. The residents are in charge.

If you plan on incorporating the informationon resident councils into other stafftrainings, an excellent opportunity presentsitself during the annual resident rights in-servicerequired by Missouri law. At such an in-service, itcould be pointed out how the council promotesand protects resident rights.

A key element to the success ofyour resident council is staffunderstanding, support, and

involvement.

Staff Orientation

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If the facility chooses to provide a specificstaff training on resident councils, thefollowing two in-service ideas, adapted fromthe “Resident Council Resource Kit” preparedby the Minnesota Advocacy Center forLong-Term Care, could be used.

Whatever approach is used, it is importantthat all staff have a clear understanding ofthe council and its role in the facility.

ADVOCACY TIP:Information about the residentcouncil should be included innew employee orientation, notjust at in-services.

ADVOCACY TIP:

Staff need to send out the message loud and clear that this isthe resident council and the residents are the ones in control.The only staff person who should be in attendance at eachcouncil meeting is the staff adviser. The main role of other staffmembers is to encourage resident participation by beingcheerleaders for the organization and by seeing that residentsreceive assistance if needed to get to the meeting place at thescheduled time. Staff members wishing to address the councilneed to ask to be placed on the agenda. The council can alsorequest that a specific staff member be present if they wouldhave information pertaining to an issue the council plans todiscuss.

Sample In-Service #1Sensitivity to Residents’ Situations

This exercise is designed to sensitize staff to residents’ feelings of powerlessness,loss, and lack of choice.

Ask each staff member to complete the exercise on the following page. Aftereach one has made their choices, conduct a discussion exploring how their lifewould change, what they would have to give up, and how they would feel aboutmoving into the facility. During the discussion, remind staff that residentsshould be encouraged to:

! air grievances and suggestions;

! discuss concerns with staff, i.e. discussing menu preferences with the dietitian;

! participate in care planning; and

! get involved with the resident council.

Now have staff get in groups of 2, 3, or 4 people. These are now “roommates” andeach group is to come up with one set of seven items to “keep.”

Follow exercise with discussion:! How hard was this exercise?! Did anyone have to give up something they really wanted to keep?! Would they be compatible with their new roommates?

After discussing the exercise, ask participants how they can help residents withtheir adjustment to nursing home life and how they can return power and controlto residents.

FANTASY EXERCISE

Imagine that you are an 80-year old person. Safety, social, nutrition and housekeeping needs are no

longer being met in your present residence. You have some family, some close friends, and much the

same likes and dislikes as you do at this age. You, your doctor, and others whose judgment you

respect have come to think you need the help you could get living in a nursing home.

In this fantasy situation, pretend you must move into a facility and can keep only seven of the privileges

listed here. Place a check mark in front of the seven which are most important TO YOU. If the most

important things to your happiness are not listed, you may add two choices by writing them in the

space marked “other”. These will be included in your final list of seven.

____ The privilege of doing gainful activities daily, similar to what you did in your home or apartment.

____ The privilege of taking frequent trips, and visiting friends and family outside the facility.

____ The privilege of keeping pictures of your family and small, treasured mementos.

____ The privilege of bringing favorite pieces of furniture from your home or apartment.

____ The privilege of defining your own schedule, i.e. making noise, staying up late, not getting

____ The privilege of entertaining friends in sufficient space and privacy.

____ The privilege of keeping and preparing food in any way you please.

____ The privilege of keeping a pet.

____ The privilege of monitoring your own health; to keep, take, or refuse medications.

____ The privilege of making totally independent decisions, with yourself and your close family

____ The privilege of determining how you will spend your time: leisure, rest, work, alone, with

____ The privilege of continuing relationships with friends who live in their own homes.

____ The privilege of having space and supplies to work on your hobbies.

____ The privilege of grieving for loss of home and independent living status.

____ The privilege of receiving considerate, respectful care, with your privacy and need for

____ The privilege of living in an environment where it is okay to talk about and discuss your

OTHER_________________________________________________________________________

dressed in the morning, etc.

others, etc.

independence respected.

fears and feelings about aging, life, and death.

and friends as the only people’s opinions to consider.

Sample In-Service #2Making Choices in Group Settings

An effective staff orientation should be based on exercises that help staff acquire a betterunderstanding of the ways in which residents’ lives are enhanced by involvement in groups.The following is a suggested training outline based on group involvement.

Introduction and DiscussionBegin by asking staff to list the groups or organizations they belong to and share briefly the purposesof these organizations. Continue by acquainting staff with the residents’ methodfor making decisions and choices as a group.

Discuss the basic purposes and philosophy of resident councils. Point out that councils:

! are a form of self-determination;

! allow residents to take initiative and action for themselves;

! are the residents’ own organization; and

! benefit administration and staff by providing a channel for two-way communication.

Ask your resident council president to attend and talk about the council. Ask him/her toexplain council organization; current officers; the meeting schedule; council activities;and how staff can support the council.

If you do not yet have a council, invite an officer from another facility’s council to attendor ask an interested staff person to review written material about resident councils andpresent it to the staff.

Stress the relationship between staff and the council, and discuss the importance of staff cooperationand support. Staff can show their support by:

! encouraging residents to express concerns and make suggestions at resident councilmeetings;

! attending council meetings when invited;

! assisting residents to and from meetings; and

! showing respect for the council and its work.

The resident council can be helpful to both residents and staff, by encouraging a workingrelationship between the two groups. Ask the staff, “What have residents been asking youto do differently?” and “What would you like residents to be more aware of?”

Role PlayingUse role plays to give examples of appropriate and typical exchanges between residentsand staff during resident council meetings. This will illustrate the various roles staff mayplay with the council. The following examples may help:

! Social ServicesThe residents’ rights poster has not been displayed since the last remodeling project.Resident council requests posting of resident rights.

Social services director requests resident volunteers greet new residents.

! Nursing ServicesResident council requests explanation of doctor visitation schedules.

Director of Nursing explains policies for ordering and paying for medications.

! ActivitiesResident council helps choose activities for monthly schedule.

Activity director requests volunteers to set up bowling activity.

! DietaryResident council would like more menu choices.

Dietitian discusses various menu plans that would have a broader appeal.

! AdministrationResident council asks for a change in the facility’s smoking policy.

Administrator explains current regulations and facility policy relating to smoking.

! LaundryResident council asks that a serious study be made to find ways to preventclothing from becoming lost in the laundry.

Laundry requests residents refrain from taking more towels than neededto their rooms.

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ConclusionThe group leader can conclude the training by pointing out that the resident councilprovides a forum for residents to:

! regain a sense of control and dignity;

! arrive at group priorities;

! meet their psychological need for empowerment;

! have constructive exchange of information between residents and staff; and

! encourage cooperation between staff and residents in building a fuller life in the facility.

ADVOCACY TIP:Research indicates that a sense of controland the exercising of personal choices havea definite and positive role in sustaining life.Councils allow residents greater control andmore choices in a situation where optionsare limited.

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Although the structure of any organization isimportant to its success, there is not a rightor wrong way to organize a resident council.Rather, the characteristics of the facility andits residents will affect the type of structurechosen.

The type of organization can range from ahighly structured council with bylaws,officers, and committees to a group thatmeets informally with a staff person todiscuss facility life. Regardless of thecomplexity of the organizational structure, itis crucial that the council meet the needs ofthe residents.

The followingmodels are basicideas which may beexplored andadapted as yourcouncil takes shape.

Town Meeting ModelThis type of council tends to work better insmaller facilities and usually has thefollowing traits:

! Each resident is considered a memberof the council and is encouraged to attendmeetings.

! The council is directed by a set ofelected officers, generally a president,vice-president, secretary, treasurer, andstaff adviser.

! Meetings are monthly, with a plannedagenda allowing residents a chance tomake suggestions and participate indecision making.

! Officers and the staff adviser make upan Executive Committee which plansmeetings and provides the leadership toassure the council meets the needs of

residents and fulfills its purpose.

! Committees are organized as needed to address the concerns

identified by the council.

Representative ModelThis model is often preferred in large facilitieswhere the town meeting model may beimpractical due to the large number of residentsattending meetings. The council ismade up ofelected or recruited representatives from variousareas of the facility, such as floors or wings.

No single organizationalmodel is recommended.Whatever model is used,

make sure it is flexibleenough to allow changes

when necessary.

Structure

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The representatives may be responsible for:

! participating in executive committeemeetings to plan agendas;

! knowing the concerns and wishes of theresidents they represent and speakingon their behalf at meetings;

! informing new residents of the council’sexistence and function; and

! reporting back to those they represent.

The representative model is generallycharacterized by the fact that onlydesignated representatives attend councilmeetings. However, the following ideas canencourage participation of all residents.

! Have an open meeting for allresidents every few months.

! Have a more formal agenda for openmeetings, with an educationalprogram or speaker.

! Encourage residents to discuss theirconcerns with their representative.

! Encourage participation in the electionof council officers and representatives.

! Encourage participation in variouscommittees, with electedrepresentatives acting as chairpersons.

Committee ModelFacilities using this type of organization elector appoint several residents to serve on acommittee that functions in ways similar tothe representative model.

The committee meets regularly, usually witha designated staff person to discuss ideasand concerns that have been identified.Each committee member acts as thechairperson for a standing committee, whichworks with the appropriate department headto resolve issues. The committee reports toresidents on their activities throughnewsletters, posting of the minutes, orgeneral meetings.

ADVOCACY TIP:Use elements of any of the modelslisted to design a council that meetsthe needs of your facility. The councilmay end up being totally different fromany other you have encountered andshould change over time.

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Regardless of which organizational modelis used, officers are important to theeffective operation of the council. As witheverything else, adaptations of these officersmay need to be made to meet the needs of aparticular council.

The following is a list of typical officers andtheir duties:

1. PRESIDENT/CHAIRPERSONThe president/chairperson generally workswith the other officers and staff adviser todraw up the meeting agenda and lead themeeting. He/she will direct the meeting, followalong with the agenda, and ensure that allsides are heard in an orderly manner.Following the meeting, the president/chairperson will act as a liaison with thefacility and provide follow-up on concernsbefore the next meeting.

2. VICE PRESIDENTThe traditional duty of the vice president isto fill in for the president if he/she is unableto fulfill leadership duties. This responsibility,however, could be filled by any other officer.For this reason, some councils do not have avice president, while others give the vicepresident additional duties, such aschairmanship of a significant committee.

3. SECRETARYThe structure of the council should providefor keeping a record of the meetings. It isthe responsibility of the secretary to makesuch a record, which includes taking notesat the meetings and seeing that thisinformation is distributed to the appropriatepeople. In addition, the secretary should ensureproper notice of upcoming meetings is made.

4. TREASURERThe treasurer is responsible for keeping arecord of council funds that are raised andspent. The treasurer then reports to thecouncil on the status of the treasury. Allcouncil funds should be kept separate fromother funds in the facility. The bookkeeperat the facility can provide assistance to thetreasurer.

Council Officers and Leaders

The ideal organizationalplan provides for

leadership to be in thehands of residents. The

staff adviser is anenabler, not a director of

the council.

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5. REPRESENTATIVESRepresentatives to a resident council servein much the same way as they do in stateand federal governments, and represent theconcerns of their constituents at meetings.They may be either elected or appointed.

In addition to attending regular councilmeetings, representatives may beresponsible for holding mini-town meetingswith their constituents. This gives allresidents the ability to have input into thecouncil process. If meetings are not held,representatives must devise an alternativemethod of learning resident needs andrelaying information from council meetings backto all residents.

Councils using other organizationalstructures may use representatives in otherways. They may have representatives-at-large whose responsibilities include suchactivities as visiting room-bound residentsto learn of concerns and, with permission,present them at council meetings.

6. STAFF ADVISERIdeally, council leadership would always bein the hands of residents. In some facilities,however, this may not be practical orpossible. At times, there will not beresidents who are willing or able to assumeleadership of the council. For this reason, itis important to have a staff persondesignated to serve as an adviser.

The staff person who will assist the residentcouncil must be carefully chosen. He or shemust be enthusiastic, knowledgeable,objective, persistent, and committed to thephilosophy of the council.

The staff adviser must be able to functionas an advocate for the residents while atthe same time be able to work within theadministrative procedures and constraintsof the facility.

The staff adviser should act as an enabler,not a director of the council. He or she mustbe sensitive and creative in assisting thecouncil to achieve its maximum level ofindependence, while resisting thetemptation to take over. This can only bedone by assessing and reassessing whatthe residents can do for themselves andproviding appropriate staff support.

7. VOLUNTEERSSome facilities may have volunteers whoare willing to assist with a resident council. Sucha volunteer must be specially recruited, trained,and supervised by the staff adviser.

This source of leadership has severaladvantages. A volunteer can focus on thecouncil and the needs of its members. Heor she can spend the time required to workwith the council, freeing up the time of thefacility staff. And finally, residents may feel

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more comfortable presenting complaints toa non-staff leader. It is preferable that thevolunteer not be a family member, as this mightresult in a conflict of interest.

Facilities may consult with their regional long-termcare ombudsman for assistance with training ofstaff or volunteers leading the resident council.

ADVOCACY TIP:In the event that staff or volunteerleadership is required, thisarrangement should only beused as a temporary measure.It is important that the councilalways be looking for residentswho can assume leadershiproles.

ADVOCACY TIP:Try to assure that the council has anappropriate panel of officers who willencourage others to participate in leadershiproles. Try to avoid having one or two residentswho feel they must take all the responsibility forthe council.

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Many of the objectives of the residents councilcan best be accomplished through the work oforganized groups or committees of residents.

Not only can organized committeesaccomplish more for residents, committeemembership provides opportunities formore residents to be involved and use theirtalents. This in turn leads to a sense ofaccomplishment, enhanced self-esteem,and a feeling of helping others.

Committees can either be standing(permanent) or ad hoc (temporary) and varyin size from two to six members, dependingon the work to be done. Council bylawsshould specify all standing committees andprovide for the formation of ad hoccommittees.

A committee should exist only so long as itserves a purpose. Nothing does more todiscourage resident participation thanasking them to do something that makes nodifference in their lives. Therefore,committees should exist only when theissue being addressed is of importance tothe residents and/or takes up an inordinateamount of time at resident council meetingsand needs additional effort.

This may include hanging a sign on theirdoor, giving a card, helping with a party, orsimply leading a group of residents insinging “Happy Birthday.”

A committee should existonly so long as it serves a

purpose.

The following are examples of typicalcouncil committees and theirresponsibilities. They may be standing orad hoc committees.

Food CommitteeMembers may survey residents for theirfood likes and dislikes; meet with residentsto hear complaints and suggestions; meetwith the dietitian to make menusuggestions; plan resident activitiesinvolving food; or act as a taste panel.

Birthday CommitteeMembers work with staff to providerecognition to residents on their birthdays.

Committees

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Spiritual CommitteeMembers work with clergy to plan spiritualprograms for residents. This could includereading devotions to residents who sodesire, introducing clergy at services, oracting as liaison to community churcheswho provide services to facility residents.

Grievance CommitteeThis committee can help prevent councilmeetings from becoming “gripe sessions.”It listens to concerns and provides anopportunity for discussion before the fullcouncil meets. For residents who wish toremain anonymous, a suggestion box couldbe maintained by the committee.

Personal Care CommitteeMembers observe general care forresidents who cannot speak for themselves.This committee could be very helpful inaddressing chronic complaints such as thelength of time it takes to answer call lights.

Activities CommitteeMembers work with activities staff to planand set up recreational programs. Thiscommittee could suggest new ideas or helpplan special parties; help review andevaluate programs; and lead activities attimes activity staff may not be available.

Sunshine CommitteeMembers keep track of those who are ill orhospitalized. They may send cards and

support to families who have lost a lovedone. In fulfilling their function, thesecommittee members pay special attentionto residents who have no family.

Welcoming CommitteeThis committee greets new residents whenthey are admitted. They may introducethe new residents to others, give them a tour,and encourage them to participate inactivities. They will also explain the purposeof the resident council and give an invitationto attend the next meeting. If they accept,the committee member will escort the newmember to the meeting and introduce them.

Volunteer Service CommitteeThis committee works with staff to arrangefor residents who would like to have volunteeropportunities in the facility. They may alsowork to facilitate efforts with agencies outsidethe facility such as United Way, SalvationArmy, American Cancer Society, etc.Volunteers coming into the facility, as wellas residents going outside the facility, keepresidents connected to their communities.

Resident Rights CommitteeMissouri law requires facilities to make anon going effort to help residents know andexercise their rights. This committee couldbe used to publicize, promote and monitorresident rights in the facility. The committeecould make resident rights presentationsto residents, staff and family members

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along with serving as a liaison for otherresidents when they encounter questionsabout rights.

Other InformationThese suggestions cover only a few of thecommittees that could be organized. Manyothers exist in councils and reflect theneeds and interests of the residents.

The more broad based the participation inthe council, the more successful it will be.When staffing committees, think of allresidents as potential members. Residentswho have been reluctant to take an officemay be interested in serving on acommittee. Committees may have specialappeal because they are small and focus ona specific topic.

ADVOCACY TIP:Leadership of all committeesshould be resident based.However, it may be necessary tohave a staff person involved atvarious times. The staff membermust be supportive and availableto assist when needed andrequested.

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Council Bylaws

Council bylaws are written guidelines bywhich the group operates. Whether thecouncil has a formal or informal structure, itis important to have some guidelines to givedirection. The direction should beestablished early in the organizationalprocess.

It is not necessary for the bylaws to becomplex nor take a lot of time to compose.What is most important is that they arewritten in clear, simple language with eachsection being short and containing only oneidea.

Bylaws usually contain the followingsections:

! the name of the group;

! the purpose of the group;

! when and how meetings are to beconducted;

! membership criteria;

! officers titles, responsibilities, and termof office;

! nomination and election procedures;

! criteria for replacing an officer orrepresentatives who can no longer serve;

! names and functions of standingcommittees;

! criteria for choosing residents to serveon committees;

! management of funds; and

! procedure for amending bylaws.

After proposed bylaws are written, councilmembers should have time to study themcarefully and offer suggestions beforevoting on them.

Bylaws should besimple yet complete

enough to give neededdirection to the council.

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From time to time, it will be necessary tomake changes to the bylaws. Provisionsfor amending the bylaws must be clearlyspelled out.

The amending article should indicate:

! who may originate amendments;

! how the amending may be done;

! the time required for publicizing andstudying proposed amendments;

! what kind of approval is needed to ratifyan amendment (for example, 2/3majority, simple majority, etc.); and

! when new amendments will becomeeffective.

On the following page is a sample bylaws,provided as a guide to writing your own. Add tothese, change them, and personalize them toreflect your council’s purpose and function. Besure to include whatever is appropriate for yourcouncil.

Sample Bylaws

I. NameThe name of the organization shall be __( name of council ) _.

II. PurposeThe purpose of the __( name of council )__ is to:

A. give residents greater participation in affairs within the facility;B. suggest improvements and help the administration provide

better programs, surroundings, and services;C. promote friendship and understanding among residents; andD. provide and receive necessary information for the benefit of all

residents.

III. MembershipEvery resident of __( name of facility )__ becomes a member of the council upon admissionto the facility. Every member of the council shall be given the opportunity to vote. ( If arepresentative structure is used, specify how that structure works. )

IV. Officers and Their DutiesOfficers of the council shall be elected every ( period of time, such as yearly, every sixmonths, etc. ) and include:

President - shall preside over all meetings;Vice-President - presides in the absence of the president;Secretary - records and maintains the minutes of each meeting; andTreasurer - responsible for all financial business of the council.

In the event that an officer becomes unable to fulfill his or her duties, a special electionwill be held at the next regularly scheduled council meeting.

V. CommitteesThe council shall have an Executive Committee made up of ____ members who will serve for( period of time ). The members of the executive committee will include: ( list of who willbe included ).

Other standing committees are: ( examples - grievance, welcoming, etc. ).Each standing committee will have _________ members who will serve for( period of time ).Temporary committees can be established by appointment on an as needed basis.

VI. ElectionsElections of ( officers/representatives and committee members ) shall be held every( month of elections ). The elections will be conducted using written ballots listing nominations foreach office. Nominations will be made at the meeting prior to the election.

VII. MeetingsMeetings will be held every ( specify day/month/time ). ( If a representative form of organization isused, bylaws should also include: An open meeting for all residents will beheld on __( day/month/time )__ ). Additional meetings may be called as needed and whenauthorized by the Executive Committee.

VIII. AmendmentsAmendments may be made to these bylaws at any regular or special meeting of the council, by a2/3 vote, providing suggested changes have been read at the previous meeting. Amendments willgo into effect in seven ( 7 ) days.

IX. Rules of OrderEach general meeting will follow the agenda as prepared by the Executive Committee. Robert’sRules of Order will be followed unless the council wishes to change or add to the rules to suit thewishes of the majority.

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Identifying ObstaclesRegardless of how carefully a resident council isplanned, and how well it is supported byresidents and staff, there may be obstacles toimplementing it.

The most common obstacle is low residentparticipation. This can be attributed tomany factors. Residents may be bedfast,mentally impaired, or otherwise unable orunwilling to attend meetings. If only ahandful of residents participate in thecouncil, the representative model will workbest. Address the issues that are importantto those in attendance. Those same issuesmay be of concern to other residents.Their efforts will benefit all residents andencourage participation of others.

Residents may be unaware of how thecouncil can help them. As new residentscome into the facility, and current residents

become more adjusted to their newsurroundings, they can be educated on thepurpose, functions and importance of thecouncil. A reminder prior to the council meetingmay also be necessary. Encouragement toparticipate can assist residents in gaining asense of control and possibly reduce theirvulnerability to depression and low self-esteem.

It is often difficult to find residents willing orable to take on leadership roles. There areseveral reasons for this dilemma. Residentsmay feel that they lack the skills or knowledgenecessary to perform the role they are beingasked to fulfill. Explain the duties in detailusing clear, simple language. Some may thinkthat they are not physically able to participate.Make sure that residents who use wheelchairsor gerichairs are assured of staff assistance ingetting to the meeting place on time. Otherresidents just may not be willing to commit thetime to the council, while some others mayfear retaliation from the staff if they take onthe leadership role.

Finally, an obstacle may be the perceptionof or actual lack of facility support. If theadministrator does not support the idea ofa resident council, his/her reluctance maytrickle down to other staff. This may result

See obstacles,whatever they may be,merely as challenges

to be overcome and then lookfor ways to overcome them!!

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in the staff not considering it importantenough to spend time assisting residents ingetting to the meetings; not remindingresidents of meetings, and not respectingthe work of the council. A lack of supportcan often be discouraging, thus stifling aresidents council. It is always important forthe administrator to actively and openlysupport the council.

Remember, as obstacles are identified,activities need to be planned for dealingwith them. For example, providingeducation may increase resident willingnessto participate in leadership roles.If the resident has never beeninvolved in a community groupbefore, he/she may be afraid totake on this new role out of fearthey will not know what to do.Another suggestion for improvingresident participation is redefiningofficer roles to encourageparticipation. Potential officers maybe more willing to participate if they knowthere are others who can substitute for them incase they become ill or incapacitated.

Take time to identify the real reasons behindthe council’s ineffectiveness. Obstacles canusually be addressed with some creativethinking.

ADVOCACY TIP:It may be necessary to form a familycouncil that will compliment theresident council to assure that allresidents needs and concerns arebrought to the attention of thefacility and addressed.

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Conducting Effective Meetings

Whether a small executive committeemeeting or a town meeting where allresidents in the facility are invited, “themeeting” is a very important council activity.

Many think that conducting a good meetingis the most important activity of the council.Others would consider a council’seffectiveness based on high attendance.Still others would not consider the councileffective unless significant decisions weremade at each meeting.

While council members may disagree onwhich activity is the mostimportant, all would agree thatthe council should conducteffective and productivemeetings, with properattention and time devoted toensuring this is accomplished. Goodmeetings do not just happen. They areplanned and certain details need to beaddressed in that planning.

First, formulate an agenda. Although ittakes a bit of prior planning, a well-thoughtout agenda is essential to an orderly,productive meeting. Agendas should beprepared by the Executive Committee withconsultation from the staff.

An effective agenda will use a standard,written format that is concise, wellorganized and structured to encouragediscussion. A large-print copy should beavailable to each person attending themeeting so they can easily follow along.

After developing the agenda, promote themeeting. Post the scheduled time, location,and agenda of the meeting a few daysbefore it is to occur. Take advantage ofother methods used by the facility to informresidents of activities: the activity calendar,flyers, invitations, word-of-mouth, or a

monthlynewsletter.

Meanwhile, makeadequate roomarrangements.

Every effort should be made to see thatthe surroundings are conducive to goodcommunication between those attendingthe meeting. Pay attention to the followingdetails:

! Make sure the room is a comfortabletemperature and well-ventilated.

! Assure the room is well lit.

The key to conducting aneffective meeting lies in

advance planning.

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! Make sure that the room is not so noisythat it is difficult for residents to hear. Ifnecessary, provide a microphone with along cord that allows people to movearound the room. Ask staff to avoidusing the overhead loud speaker systemduring the meeting.

! Assure the space affords residents asmuch privacy and freedom fromdistractions as possible.

! Assure there are enough comfortablechairs for all residents who need one.

Once the meeting has begun, try to keep iton schedule. As much as possible, startand end on time. The appropriate length oftime to schedule for the meeting variesdepending on the attention span, physicalcondition, and concerns of those inattendance. A good rule of thumb is to quitwhile there is still interest and energy,rather than to continue beyond the councilmembers’ attention and energy span. Tryto keep the conversation moving ahead, sothat dialogue does not get cut off justbecause time is up. In addition to keepingthe meeting on schedule, it is important tomaintain a comfortable atmosphere. Membersshould know one another, perhaps haveintroductions prior to each meeting. Membersneed to be reminded what the council is andwhat is supposed to happen at the meetings.Ask questions to encourage discussion. Be

prepared to deal with a resident who triesto monopolize the meeting with his/herpersonal concerns that are not appropriatefor the group meeting.

Plan a social time after the meeting withspecial refreshments for those whoattended. This time after the meeting canserve as an incentive to participate if avariety of special and “out of the ordinary”activities are planned.

ADVOCACY TIP:The interpretive guidelines forF243 of the federal regulationsstates that staff should onlyattend residents’ councilmeetings if requested.Uninvited staff attendance maybe intimidating to residentsand inhibit them fromexpressing their concerns.

Remind staff not to bedisrespectful of residents’autonomy by interrupting the meetingfor blood pressures, medications,baths, naps, etc. Residents shouldonly be taken out of the meetingif they request it.

ADVOCACY TIP:

36

Planning and preparing an agenda is anessential first step in conducting aneffective meeting. The staff adviser mayassist, but the executive committee orcouncil officers should provide the majorityof input into what is included on theagenda. Filling in the time is generally not adifficulty. Rather, the problem may bedeciding which of the many items needingto be discussed will fit into the allotted time.In the decision making process, it isimportant not to include more items on theagenda than can be realistically dealt within the time available.

Some items should be routine in everyagenda. These items include reviewing theminutes of the previous meeting, oldbusiness, requests from the suggestionbox, and any new business the council mayhave.

The agenda needs to be completed a fewdays ahead of time to assure all necessaryindividuals can be invited.

Generally, agendas follow this pattern:

1. OPENING ACTIVITYAll participants should receive a warmwelcome. Introductions should be made,especially for new residents. Some

councils do a roll call or wear name tags tohelp residents become acquainted. Thepurpose of the council and the reasons forthe meeting are reviewed.

2. READ THE MINUTES OF THE LASTMEETING

This helps to remind residents of whathappened at the last meeting.

3. RECEIVE REPORTSIf the council has representatives, eachshould have a few minutes to discuss theneeds, concerns, and activities of the residentsthey represent.

If the council has committees that deal withsome of the more in-depth concerns, theyshould also have a few minutes to review theiractivities. Present a treasurer’s report, ifavailable.

A written agenda isimportant because it

helps to keep theparticipants organizedand focused during the

meeting.

Council Agendas

37

4. UNFINISHED/OLD BUSINESSReview the business that was unfinished atthe previous meeting. Discuss actions thathave been taken since the meeting andwhether the issue has been resolved.Publicize successes, but be honest aboutcases where the issue cannot be resolved.Perhaps the appropriate staff could beinvited to give a thorough explanation.

5. NEW BUSINESSThe council should be an activeorganization with new concerns and ideasbeing brought up on a regular basis.

6. GUEST SPEAKERSSome councils regularly invite guestspeakers to their meetings. The speakercan come from inside or outside the facility.If a speaker is invited, he/she takes timefrom the other items on the agenda. Thismay limit the time available to discuss otherissues. It may be necessary to alternatebetween meetings with speakers andmeetings with the focus on resident input.

7. RESIDENT CONCERNSIn order for the meeting to be concluded ina reasonable time frame, it may benecessary to discuss only general concernsat the meeting. If residents have concernsthat are specific only to them, eachindividual may need to be referred to thegrievance committee, the social servicesdepartment, the Long-Term Care Ombudsman,or others with responsibility for responding toresident concerns.

8. FACILITY NEWSDepartment heads should ask to be put onthe agenda if they have any information ornews to share. It would be a nice gesture tointroduce new staff members to the group.

9. SOCIAL TIMEAlways plan for refreshments and a socialactivity following the meetings. This allowsresidents time to wind down after themeeting and serves as a thank you forattending.

10. PROGRAM IDEASIdeas for meaningful speakers, education,or special programs should be no problemfor those planning the council agenda. Togenerate ideas, look at the purpose of thecouncil. This should suggest several topicswhich can be explored. Ideas may include:

!!!!! Involving Residents More Fully in theLife of the Facility

Use the council as a place to get anaccurate view of all aspects of life in thefacility. Programs could include topics likethe function of each department and how itcontributes to the facility. Invite eachdepartment head to present a program.Have them explain to residents about staffresponsibilities, define reasonableexplanations, and what residents can do tohelp the staff provide better service.

38

ADVOCACY TIP:Posting an agenda several days in advanceof the council meeting could help to increaseattendance. A resident would know when atopic of particular interest to him or her wasgoing to be discussed. Staff members couldalso encourage those residents to attend.

!!!!! Self-Advocacy EducationIdentify problems that residents mightexperience. Provide information andpossible solutions. These may behypothetical problems or real ones from thesuggestion box, the grievance committee,or previous council minutes.

Identify resource people who can help withthe issues being discussed. This could bethe ombudsman, a department head, aDepartment of Health and Senior Servicesrepresentative, etc. Teach residents how touse these resources as they work throughthe facility’s grievance procedure to solvetheir own problems or concerns.

!!!!! Informing Residents of Their RightsThe long-term care facility is responsibleunder Missouri law for informing residentsof their rights and assuring theirimplementation. The council can be aplace where residents learn about theirrights. This can be done throughpresentations by staff, ombudsmen, orothers. Be sure to have copies of ResidentRights available to distribute at the meeting.

!!!!! Informing Residents of Facility IssuesIf there are to be any major changes infacility procedures, residents should beinformed and their cooperation sought.The council is a good forum for this.The council is also a good forum foroutside agencies to inform residents aboutthe services they provide to the facility.This could include the ombudsman,pharmacist, dentist, therapist, surveyors,etc.

!!!!! Keeping Residents Involved in theCommunity

Before an election, local candidates couldbe invited to share their position on issues.The council might ask an attorney to speakon “Advance Directives” and invite thepublic to attend. The council could alsoplan a holiday party for the staff’s children.

!!!!! Setting a Council AgendaResidents should be surveyed to see whattopics or issues they would like the councilto address, as well as any activities theywould like to see the council undertake.

39

An accurate record should be made of allhappenings at each council meeting. Theynot only serve as a record of who attended,but also the business transacted. Minutesprovide a record for those who did notattend so they can know what took place.Minutes can also act as a record of thefacility’s actions in response to theconcerns of the council.

The secretary takes the minutes or designatessomeone to do it in his or her place.

TIPS FOR THE PERSON TAKING THEMINUTES

! Minutes should be brief, while giving acomplete description of activity.

! Minutes must be legible andunderstandable enough for anyone toread.

! Minutes should contain:! the name of the person presiding;! members present;! who took the minutes;! date and time of the meeting;! all items discussed, actions taken; and! date and time of next meeting.

A standard form could be devised that wouldmake the collection of all necessary informationeasier.

Minutes should be typed and copies made fordistribution. The typing can be done byresidents, a volunteer, or facility staff.

Distribution can become expensive if notdone with some thought. It would be ideal ifevery resident and staff person in thefacility received a copy. In the event this isnot reasonable, minutes could be posted inseveral locations within the facility:employee break room, reception area andbulletin boards, for example. For residentswho are unable to read independently,someone should offer to read the minutesto them if they so desire.

It is important that the administrator and alldepartment heads receive their own copies ofthe minutes. They can then share the informationwith the staff they supervise.

Families and other interested partiesshould also be informed about what goeson in the council. A complete copy of the minutescan be mailed out or a synopsis of the minutescould be included in a facility newsletter. Anewsletter format would allow the minutes to bepresented in a more attractive and readableformat.

For residents who usewheelchairs for mobility, a bulletinboard hung lower on the wall allowseasier access than one hung ateyelevel for individuals who canstand.

ADVOCACY TIP:

Meeting Minutes

and all

40

Basic parliamentary procedure should beused in conducting resident council meetings.Parliamentary procedures are a set of rules thathelps a group run meetings in an organized,efficient manner. These rules provide a structurefor including everyone’s opinion in order toproduce decisions based on majority opinion.

Parliamentary procedure is based on thepremise that:

! meetings should be conducted in anorderly way with one question beingconsidered at a time;

! everyone is equal and all who wishshould have an equal opportunity tospeak; and

! an open atmosphere exists for theexpression of minority opinions but thatmajority opinion, once voted on, prevails.

Basic parliamentary procedure providesfour steps to determining the majorityopinion:

1. Making a MotionDuring meetings, issues may arise thatdraw comments from several persons.When a subject sparks sufficient interestfrom participants, either the leader willask if the group wishes to take any actionor some member of the group willvoluntarily make a motion.

A motion is usually made by simply stating,“I move that....” The leader should thenrestate the motion clearly so that allunderstand what is being proposed.

2. Seconding the MotionIn order for the council to consider themotion, someone must second the motion.This can be done by simply stating,“I second the motion.”

3. Discussing the MotionA discussion of the motion should beconducted. All who wish to have inputshould be allowed to do so. When theissue has been thoroughly discussed, theleader will call for a vote to be taken.

Parliamentary Procedure

41

4. Voting on the MotionThe vote can be taken orally, through a showof hands, or by secret ballot. The vote iscounted and the leader announces theoutcome to the group. The vote is thenrecorded in the minutes.

Voting is important and should be usedoften. It emphasizes the active participationof residents in the activities of the council.

Generally, the leader participates in thediscussion, but does not vote unless thereis a tie. In such an event, the leader willvote to break the tie.

Council meetings should be conducted inan orderly way, but care must be taken toassure that adherence to parliamentaryprocedure does not stifle the atmosphere ofthe meeting. Residents must feel free toexpress themselves.

If residents stray off the subject, gently leadthem back to the discussion at hand.Suggest that they address the topic later inthe meeting if time allows or put it on theagenda for the next meeting.

A simple training for council officers andmembers will assure that all have a basicunderstanding of parliamentary procedure.This helps them to feel comfortable duringthe meeting and increases verbalcontributions.

Create a “parking lot” forissues that need to be broughtup at a later time. Thisensures that ideas are notdropped.

ADVOCACY TIP:

42

An assessment to determine whatmotivates your residents is thestarting point to encouraginggreater council participation.

Getting residents to participate will topalmost any list of problems encountered inproviding an effective resident council.This difficulty has been identified byeveryone involved - staff, volunteers, andresidents.

Many reasons are given for this problem.Some are easily addressed and eliminated,while others are rooted in the characteristicsof residents living in the facility - facts of lifewhich must be accepted.

Some reasons for low participation havealready been identified in this manual. Intrying to identify other factors affectingparticipation, staff and council leadersshould examine their own attitude. Lowparticipation may be the result of leadersassuming that residents cannot participateand therefore do not appropriately assist ormake provisions for participation.

If many residents in the facility do not havethe mental or physical ability to participate,perhaps the structure of the resident councilcould be modified to better meet the needs ofthe residents. Make sure the council is based ona realistic philosophy, has attainable goals, anda workable organizational format.

When a proper foundation has been laid,there are many things that can be done toencourage participation. The most basicthing leaders can do is understand whatmotivates residents to participate. Threemotives are identified in the book,Resident Councils in Action by theAdvocacy Center for Long-Term Care,as being necessary before there will beany resident action. These are:

1. SELF-INTERESTResident council attendance may besparked by self-interest. One resident has aproblem she hopes can be solved: it is toocrowded in the lounge outside the diningroom just before dinner. Another isconcerned that there is no railing near thesidewalk to help residents keep theirfooting. Yet another resident would like tosee a cart that moves from room to roomselling affordable goodies and toiletries.

Encouraging Participation

43

These are the residents’ own reasons forcoming to the council, not the administrator’snor staff adviser’s reasons. Self-interest isstronger than any poke, prod, or push.

2. RESULTSLuring residents to their first councilmeeting is one thing, getting them to returnis another. Results keep a person comingback to council meetings. To put it simply,residents will not come to meeting aftermeeting just to have a cup of coffee.They will return if they view the council as aforum for resolving concerns, implementingnew ideas, and sharing suggestions.Residents are more likely to return if they feeltheir ideas and suggestions are given seriousconsideration.

3. RECOGNITIONPeople thirst for recognition. It is notenough to be accepted for who we are orappreciated for what we do. We need to bepraised and made to feel important.

Few people in a facility get recognition fortheir activities or work. Numerous thingsoccur in a council as a direct result of oneindividual’s efforts or a committee’s efforts.These people deserve public recognitionand receiving it will serve as an inducementfor continued participation in the council.If we expect residents to keep coming backto council meetings, those who organizeand plan for the meetings must keep these

motivators in mind as they plan.

Some techniques which council leadersmay find helpful in encouraging andmotivating residents to become involved inthe council include:

!!!!! INFORM NEW RESIDENTSNew residents should be informed aboutthe council when they first move in. Manyfacilities provide new residents with anorientation packet. Make sure a descriptionof the council is included.

A good council project might be to developa short, simply written brochure thatexplains the purpose, gives meeting date,time, and place and lists some pastachievements of the group.

!!!!! INVITE NEW RESIDENTSMake a special effort to invite new residentsto participate in the council. Each newresident should be visited by an active,knowledgeable member of the council.During this visit, the council member canexplain the purpose of the council andinvite and encourage the new resident tobecome involved. The council member willalso be learning about the new resident’sinterests and past experiences. Thisinformation could establish possiblecontributions the resident might make tothe council. It would be helpful if the councilmember offered to accompany the newresident to the next council meeting.

44

These visits might also be made by acouncil committee. If there are no residentsavailable to make the visits, the staffadviser or ombudsman volunteer shouldtake the responsibility for contacting newresidents.

!!!!! HAVE A WELL-ESTABLISHEDMEETING TIME AND PLACE

Establish a meeting schedule and follow it.Continually moving the council meeting timeor place suggests that the council is not apriority, it just has to fit in when and if thereis time.

The council should be flexible enough to fitinto the regular routine of the facility, butevery effort should be made to maintain aregular meeting time and place, asspecified in the bylaws.

!!!!! PUBLICIZE ACTIVITIESIf the council is organized on the townmeeting model, every resident in the facilityshould receive notice of meetings. A visitmay be appropriate to extend a personalinvitation to new residents, or residents whohave not attended for awhile.

The resident council should have its ownbulletin board where information about thecouncil can be posted. Ideally, materialson the bulletin board should be in largeprint and at eye-level both for those inwheelchairs and those who are ambulatory.Announcements over the facility public

address system, perhaps the day beforeand the day of the meeting, can remindresidents of the meeting time and place, aswell as publicize the program.

!!!!! PROVIDE WELL-RUN MEETINGSSee that meetings start on time and follow awritten agenda. Plan for the visual andauditory limitations of the residents by providinga microphone with a long cord. Encourage allresidents to contribute to the discussion. Ithelps to develop a procedure for dealing withpersonal concerns that are not related to thecouncil’s purpose.

!!!!! PROVIDE APPROPRIATE FOLLOW-UP ON COUNCIL ACTIONS

Make sure that all suggestions orcomplaints made to the council are taken tothe administration for action. All issuesshould be taken seriously and all actiontaken or not taken should be reported to thecouncil with an appropriate explanation.

!!!!! RECOGNIZE RESIDENTS WHOPARTICIPATE IN THE COUNCIL

Residents can be recognized by providingthem with special name badges, plaques, or“spot light” articles in facility publications.Arranging for publicity in local newspapersduring National Nursing Home Week orResident Rights Week helps to spread theword outside the facility.Perhaps no greater compliment can be paidto a resident than to use his or her individualtalents and experiences in council activities.

45

A resident who is a retired English teachermay be very willing to take and prepareminutes in a clear and concise manner.Knowing about residents will allow leadersto take advantage of their talents. And finally,residents can be recognized during the socialtime following the meeting.

!!!!! INVOLVE AS MANY RESIDENTS ASPOSSIBLE

If the council is organized so that allresidents in the facility are members,encourage everyone to attend meetings.If a representative model is used, set upcommittees and ad hoc groups to involvemore residents.

!!!!! PROVIDE ASSISTANCE TO THOSEWHO NEED HELP

Staff or trained council members andvolunteers may be willing to assist chair-bound residents to attend meetings.

Devise some way for bed or room-boundresidents to be informed on councilactivities, and to have input into meetings.

!!!!! IDENTIFY ISSUES OF INTEREST TORESIDENTS

Residents are more likely to be involved whenthe council is considering issues that areimportant to them. From time to time, surveyresidents to determine what topics they wouldlike the council to consider.

!!!!! ENCOURAGE RESIDENTS TO SEETHEMSELVES AS PARTNERS WITHFACILITY ADMINISTRATION

Look for ways to help residents see thatrunning a good facility is a two-way street andthat they can share the responsibility with thestaff.

ADVOCACY TIP:Give council members more thanjust “token” responsibilities whileat the same time not overwhelmingthem with expectations they cannotlive up to.

ADVOCACY TIP:When promoting council activities, it iscrucial to remember that residents havea variety of physical and mentalproblems. To rely solely on one formof communication will serve to excludemany potential participants. A varietyof means of communication must beworked out for announcing meetings &reporting on council activities andsimilar matters of interest. Make surethat these various means ofcommunication reach everyone.

46

Conducting a periodic review andevaluation of the council is an importantexercise and should include not onlyresidents, but staff and volunteers as well.Each group will have a different perspectiveof what the council is doing and whether ornot it is meeting its objectives.

An honest evaluation is beneficial forcouncils regardless of the stage ofdevelopment or perceived effectiveness ofthe council.

A NEW COUNCILIf the council has been organized within thepast year, an evaluation should be made todetermine its effectiveness. Do not waituntil the council becomes ineffective beforebeginning to make necessary changes.

AN ESTABLISHED COUNCILEven if your council has been in operationfor many years and is considered to beeffective, it is a good idea to do periodicevaluations. Without periodic evaluations,effectiveness may be assumed whether thecouncil meets only minimum objectives oracts as a dynamic organization.

Even though each resident group is unique,and what is considered effective or

ineffective varies widely, there are some generalcharacteristics that are known toaffect the success of councils.

Some common areas of weakness include:1. lack of council leadership;

2. lack of resident participation;

3. the council is not seen to bemaking a difference in life at thefacility; and

4. effectiveness is overly dependenton staff leadership.

Looking closely at your council will reveal itsstrengths and weaknesses. While there aremany methods to do this, two examples follow.Whatever method is used, the results shouldprovide valuable information for makingimprovements.

Council Evaluation

EXAMPLE 1COMPARE YOUR COUNCIL WITH OTHERS

Exchanging visits with resident groups from nearby facilities is one method of evaluating yourcouncil. Much can be learned by sharing information and ideas with similar groups.

Choose a facility with about the same number of residents and level of care. Arrange for some ofyour residents and the council adviser to visit and observe the council in the other facility. Thefollowing questions can serve as a guide in comparing the two groups:

! How does the group conduct its meetings: who leads them, residents or staff?

! How does the group handle personal concerns brought up during the meetings?

! Do residents participate in discussions freely and fully?

! Is the group well structured or informal? Do you think the way they conduct the councilis effective?

! Are all residents involved in each meeting or only representatives?

! Does its form of organization fit the facility and its residents? Why or why not?

! What projects have been undertaken? Would those projects be suitable in your facility?

! If the group has written bylaws, compare them with yours.

! Does the group or staff recognize those who participate regularly in the meetings? Howis it done?

! What would you change or adapt for your group?

EXAMPLE 2RESIDENT COUNCIL SELF-EVALUATION

Another effective way to evaluate your council is by answering questions related to councileffectiveness. This form was adapted from one devised by the Advocacy Center for Long-Term Care. For best results, two distinct groups should complete the survey - a group ofresidents and a group of staff. To find an average score, total the scores of all evaluationscompleted and divide by the number of evaluations completed.

Circle the answer that most reflects yourhonest opinion.

A. How is your council organized?

1. Do you hold meetings at least oncea month?

Yes No2. Are your leaders chosen by residents?

Yes No3. Do you have written purposes and

bylaws?Yes No

4. Do your meetings have plannedagendas?

Yes No5. Do all participants know what is on the

agenda?Yes No

6. Is a written record of meetings kept?Yes No

7. Are the meeting minutes consistentlyposted or published?

Yes No

B. How do residents participate?

8. Are most of the alert residents in yourfacility aware of the council and itspurposes?

Yes No9. Is information about the council easily

available?Yes No

10. Are residents involved as much asthey are able in leading or planningcouncil meetings?

Yes No11. Is there a core group of residents who

attend the meetings?Yes No

12. Do most residents who attend appearinterested?

Yes No13. Do residents who are willing to be

involved receive recognition?Yes No

14. Do residents feel they can speak upwithout fear of retaliation?

Yes No

C. How does staff participate?

15. Are all staff members aware of theexistence and purpose of the council?

Yes No16. Is information about the council given

to staff?Yes No

17. Has a specific staff person beenassigned to work with the council?

Yes No18. Would your council continue at its

present level of activity if there were achange in staff?

Yes No

D. How does the administrationparticipate?

19. Is the administration supportive of thecouncil?

Yes No20. Does the administration stay in close

contact with the council?Yes No

21. Are the council’s recommendationsgiven serious consideration by theadministration?

Yes No22. Does the administration seek the

council’s opinion before changingpolicies?

Yes No23. Does the administration keep the

council informed of changes in policiesor regulations?

Yes No

E. How does the council encourageresident rights?

24. Does your facility have a written grievanceprocedure which involves the council?

Yes No25. Is information about the council in your

facility’s handbook?Yes No

26. Are problems or questions brought up atcouncil meetings answered fairly withprompt follow-up?

Yes No27. Are resident rights regularly discussed?

Yes No

F. How does your council provideopportunities for constructiveinvolvement?

28. Is the council allowed to assist in choosingthe types of activities and programspresented at the facility?

Yes No29. Is the council involved in welcoming

and/or orienting new residents andvisitors?

Yes No30. Does the council express concerns for

residents at times such as birthdays orillness?

Yes No31. Has the council been informed about the

responsibilities of the various departmentsin the facility?

Yes No

32. Has the council had opportunities forinput into menu planning for daily mealsor special events?

Yes No33. Has your council expressed an opinion

to a source outside the facility, such as apublic official or newspaper?

Yes No34. Has your council been involved in

sponsoring or planning a special event oractivity for the facility?

Yes No35. Is the council asked to participate in

solving problems within the facility?Yes No

G. Bonus Question (10 points)

36. Does your council have a positive effecton residents and staff in your facility?

Yes No

Give each YES answer 2 points. Give yourself a bonus of 10 points if youanswered YES to question No. 36. There are a possible 80 points. A score over58, indicates that your council is probably effective. A lower score may indicateproblems or dissatisfaction, which the council would need to address.

Totals ______ ______ ______Yes No Bonus

TOTAL POINTS ________

51

Advocacy for Quality Nursing Home Care, NationalCitizens’ Coalition for Nursing Home Reform, Washington,DC 20036. http://www.nccnhr.org

McCreary, H.A. and Davis, B.W. Help and Ideas forResident Councils in Long-Term Care Facilities,Pennsylvania State University, University Park, PA 16802.

Raper, Ann Trueblood. Resident Decision-Making inHomes for the Aging, American Association of Homes forthe Aging, Washington, DC.

Robert, H.M. Robert’s Rules of Order, Scott, Foresmanand Company, Chicago, IL.

Sollinger, Mary Ellen. How to Establish a Nursing HomeResident Council, Maryland Office on Aging, Baltimore,MD.

Vernon, Jane Ellen. Resident Councils in Action, theAdvocacy Center for Long-Term Care, Minneapolis, MN.

Available from the Missouri Long-Term CareOmbudsman Program:

Family Guide to Effective Family CouncilsCall 1-800-309-3282

or visitwww.dhss.mo.gov/Ombudsman

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References

52

Resident/Family Councils in MissouriSurvey Results - 1995

(based on percentage of total respondents)

Issues Discussed and Number of Times Discussed

Resident Councils Family Councils

Food IssuesResident RightsLaundry IssuesProgrammingFacility DepartmentsQuality of LifePolicy ChangesSmokingFund RaisersGuest SpeakersRoommates/Living IssuesEmployee/Resident of MonthSafety IssuesDeathsTransportation

141158

31133

812527

7116

1712

212

Medicaid/Medicare IssuesFeelings of GuiltChanges at FacilityQuestions and ConcernsAlzheimers/DementiaQuality of LifeRights and Legal IssuesActivities

105

163422

78

19

Staff Member Responsible for Oversight of Councils

Resident Councils Family Councils

Activity DirectorSocial Service DirectorActivity & Social ServiceOther

55%20%18%

7%

Activity DirectorSocial Service DirectorAdministratorSocial Service & AdministratorNursingActivity & Administrator

10%55%18%12%

4%1%

Appendix

53

Written byEmmelene W. Kerr (1992)

About the author....The author served as Coordinator of the CentralMissouri Area Agency on Aging (CMAAA) Long-Term Care Ombudsman Program from August1984 to August 1992. She received a Bachelor ofScience Degree in Education from SoutheastMissouri State University and a Master of EducationDegree from the University of Missouri-Columbia,with special emphasis in counseling andgerontology. She taught in Missouri secondaryschools for five years before entering the field ofaging. In addition to her experience as a long-termcare advocate, she served for four years as acounselor working with the elderly and their families.

Designed and edited by Karen Rotts,CMAAA Public Information Coordinator

Consultation provided by Phyllis Bellamy,Assistant Coordinator of the CMAAA Long-TermCare Ombudsman Program

This manual was originally published in conjunction withthe CMAAA, the Long-Term Care Ombudsman Programof Central Missouri, the Missouri State Long-Term CareOmbudsman Office and the Missouri Department ofHealth and Senior Services.

Revised and redesigned (1998) by

Michelle BrownLong-Term Care Ombudsman Program CoordinatorMid-America Regional Council, Kansas City

and

Diana Clarke Assistant State Long-Term Care OmbudsmanJefferson City

Revised and redesigned (2005) by

Carrie EcklesAssistant State Long-Term Care Ombudsman

Special thanks for all their input...

Carol ScottState Long-Term Care OmbudsmanJefferson City

Karen CairerAssistant Long-Term Care Ombudsman CoordinatorCare Connection for Aging Services, Warrensburg

and

Becky BenderDirector of Social ServicesMaranatha Village, Springfield

Consultation provided by all of the Missouri State Long-Term Care Ombudsman staff,Regional Long-Term Care Ombudsman staff and the Missouri Social Service Directors Association.

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Credits

This manual is published by theMissouri State Long-Term Care Ombudsman Office

and the Missouri Department of Health and Senior Services

Copies are available by contacting:

State LTC Ombudsman OfficeDepartment of Health and Senior Services

P.O. Box 570Jefferson City, MO 65102

573-526-07271-800-309-3282

or by going tohttp://www.dhss.mo.gov/Ombudsman

by Emmelene W. Kerr (First published in 1992)Revised 1998 by Diana Clarke and Michelle BrownRevised 2005 by Carrie Eckles, Assistant State LTC Ombudsman

This booklet was made possible in part by the Older Americans Act.This publication may be provided in alternative formats such as Braille, large print or audiotape

by contacting 1-800-309-3282 or visit: http://www.dhss.mo.gov/Ombudsman

For more information or to secure the services of an OmbudsmanWRITE OR CALL:

Department of Health and Senior ServicesState Office of Long-Term Care Ombudsman

P.O. Box 570Jefferson City, MO 65102

1-800-309-3282

For hearing impaired, call RELAY MISSOURIText telephone: 1-800-735-2966

Voice: 1-800-735-2466An Equal Opportunity/Affirmative Action Employer

Services Provided on a nondiscriminatory basis.

April 2005, 500 #11518