Ensuring delivery of care as chosen. The administrator sets the environment

The importance of developing and continuing to promote a clear, meaningful facility mission statement should be evident. Establishing written policies and procedures that are consistent with the mission statement and are made available to all active participants in the delivery of quality long term care, including the residents, is critical to providing an environment that is conducive to ethical decisionmaking. The administrator's role in this process needs to be one of active participation on many different levels and with many different persons. He or she must satisfy residents, families, volunteers, staff, board members, regulatory agents, and community advocacy groups, seven days a week, and 24 hours a day, on everything that happens within the nursing home. It is only through the kinds of activities, discussions, and involvements described in this article that the administrator can provide an environment that will support ethical decisionmaking that is responsive to the resident. The need for ethical decisionmaking by the administrator is continually present, sometimes difficult, frequently challenging, and always very rewarding when it leads to quality patient care.