Respect for the integrity of the dependent adult means being concerned to preserve the person's autonomy, tempered with a protective attitude in the areas of functioning where the person is impaired.
Obtaining consent and assessing competency ensure that residents are given respect protecting them from unwanted intrusion.
Standards exist for appointing substitute decision-makers and for guiding their choices for individuals who are not competent to choose for themselves.
Involuntary admissions to long-term care settings are acceptable only if the decision to admit is thoroughly justified. Competent residents who express the desire to leave the nursing home are free to discharge themselves in most circumstances.
Involuntary interventions are required only to preserve life and to restrain in situations of danger. The use of physical restraint has declined dramatically. Medications are often used to control dangerous behavior and avoid the use of restraints. Institutions should have policies governing the use of restraints.
The resident's personal finances are best handled outside the institution to avoid potential conflicts of interest.
Many controversial issues arising in nursing homes are addressed at the individual level. They can also be a subject of public debate. These include lifestyle and sexual issues as well as the use of forced feeding and resuscitation.
An open dialog between those involved can resolve most disagreement. Mental health consultants can play a useful mediating role. Conflicts that cannot be otherwise resolved can and at times must be taken to a legal authority.
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