When a resident is not capable of making decisions and family wishes conflict with what is best for the resident, what approach is recommended?

• A. Always follow family wishes regardless of resident capacity.
• B. Defer to staff's personal preferences.
• C. Prioritize resident autonomy when capable; involve families through mediation; document decisions; involve surrogates if needed.
• D. Wait for a court to decide.

Answer: (C)

When a resident can’t make decisions, the approach centers on respecting the resident’s preferences and values as much as possible while using a collaborative process to handle conflicts with family. Begin with an assessment of capacity and look for any advance directives or previously stated wishes. If the resident lacks capacity, decisions should be guided by a surrogate using substituted judgment—the closest reflection of what the resident would have wanted—or, if no preferences are known, by the resident’s best interests. Involving families through mediation helps clarify goals, reduces conflict, and ensures the care plan aligns with the resident’s values. Document the decisions and the reasoning, and involve a legally authorized surrogate as needed to authorize care choices. If disagreements persist, seek ethics consultation; court involvement is a last resort when no surrogate or process can resolve the issue promptly.