When family wishes conflict with resident preferences, what is best practice?

• A. Prioritize family wishes over resident autonomy at all times.
• B. Always follow resident autonomy only when possible; otherwise defer to family.
• C. Prioritize resident autonomy when capable, engage families through mediation, document decisions, and involve surrogates if needed.
• D. Avoid documenting decisions to prevent conflict.

Answer: (C)

Respecting a resident's autonomy is essential. When the resident has decision-making capacity, their preferences should guide care, even if family members disagree. If the resident cannot make choices, decisions should reflect what they would have wanted based on known wishes or advance directives; if those aren’t available, a legally authorized surrogate makes decisions in line with the resident’s values and best interests.

Best practice also involves engaging families in the discussion, using mediation or facilitated conversations when conflicts arise, to reach a plan that honors the resident’s preferences while addressing legitimate family concerns. Every decision, along with its rationale, should be clearly documented in the resident’s records to ensure continuity of care and accountability. Surrogates play a key role when capacity is lacking, advocating for the resident’s known wishes or best interests. If disagreements persist, consulting ethics resources or care teams can help resolve the issue.

So, prioritizing resident autonomy when capable, engaging families through mediation, documenting decisions, and involving surrogates as needed aligns with ethical and practical best practice.