Checking in for a new approach
The modern way to think about providing care is that we are all in the experience business rather than the service business.
Consider the hospitality industry. There are hotels that will rent out a room for a low price and the occupant simply sleeps there for as many nights as needed, with no engagement with the hotel staff or inquiry into their unique needs. Then, there are hotels that create a guest experience, where the focus is on quality customer service, and on knowing the needs and preferences of each individual. Now, shift this analogy to care, and consider the narrative that is created by the services provided, whether those services are in a private home or in a long-term care facility.
Rather than requesting a laundry list of ailments and medications, we start by asking: Who is this person? What are their simple pleasures? How do they enjoy spending their time? By getting to know the individual, we are able to structure their care uniquely, and create optimum results.
What's Your Story?
The Eden Alternative® was created in response to the three “plagues” of loneliness, helplessness and boredom. These afflictions spring from a wide range of causes but nearly always involve circumstances in which people become socially isolated due to the loss of a spouse, because of an illness or after a major life transition, such as a move.
These changes can, and too often do, give rise to depression or other recurring health problems. They can also lead to something we call an “Elder Life Crisis.” Such crises are all too common for people living at home as well as those who are living in skilled nursing or assisted living facilities. About 10years ago, we began to develop an approach that we call Eden at Home. It helps people think differently about aging and care and some of the unacknowledged gifts of caregiving. The lessons we have learned through this work have applications across a range of settings and needs, and could help alleviate the symptoms of an elder life crisis.
The signs of an elder life crisis vary from one individual to the next, and depend on a person's lifelong interests, habits and desires. Elders often experience losses, whether of loved ones, abilities or even old habits, that can cause them to lapse into feelings of helplessness, boredom or loneliness. Often, these issues are underlying and compounded by a medical issue.
For example, an elder may be cognizant of and embarrassed by their memory loss, and begin to self-censor in social settings. This can lead to an unwillingness or inability to participate in activities that they once enjoyed and thrived on. The loss of this activity can, in turn, exacerbate their memory loss or contribute to other health concerns. Of course, physical issues need to be addressed by the appropriate medical professional, but there is much to be done about the symptoms of elder life crisis with daily care in a home setting.
Care should be centered on the person and be defined by authentic relationships, not on tasks or imposed routines. Caring ‘for' a person has too often come to mean doing things to them rather than working together to meet their needs. This can lead to helplessness, which in turn can lead to boredom and loneliness if a person feels left out of participating in their daily activities.
Consider “Bob,” who was diagnosed with ALS in his 60s. Bob's family hired a professional caregiver when they realized they could not shoulder all of the responsibility for his care, as his condition had left him largely immobile. Bob's caregiver, in an effort to create a customized care plan, learned that Bob loved swimming and had done so daily before his illness. The caregiver also heard Bob talk about his love of hunting and fishing. While the caregiver could not safely take Bob swimming, he suggested that they go on a fishing expedition together. Bob was able share some of his knowledge of fishing with his caregiver, who had never been fishing before, and as a result, Bob not only participated in a treasured activity, and passed on his knowledge to the caregiver, but he also felt capable and useful.
This example illustrates one of the key questions for those in the business of providing care: “What kind of experience am I creating?” Bob's caregiver could have shown up, assessed the physical needs of a person living with ALS and checked tasks off of a list – assisted with bathing, helped with grooming and dressing, prepared a meal – as Bob sat helplessly watching and not doing or engaging, leaving Bob disempowered. With this new approach focused on well-being, it became a story about Bob and about engaging him in his life-long hobbies and interests when possible.
Aging is a team sport. While family caregivers can provide amazing support for a loved one in need of care, rarely do they have the training or credentials to take on this huge task. They may find themselves unable to truly create a meaningful experience for a loved one daily, as they aim to provide a wide range of care from companionship to helping with physical needs.
In addition, these family caregivers can experience burn out, and get to the point where they feel alienated and not a part of the team. This often creates a situation where they are merely ‘getting it done', rather than truly engaging with their loved ones and their lives, which can foster resentment.
Long-term facilities and home care can—and should—collaborate to eliminate the symptoms of an elder life crisis through partnership and teamwork. The goal of this partnership is overall well-being, with all members of the team working together to meet this goal. No single entity—the geriatrician, the adult child or even the skilled nurse—can succeed in creating these experiences independently.
Bill Thomas is the founder of The Eden Alternative®, creator of The Green House Project® and author of “Second Wind: Navigating the Passage to a Slower, Deeper, and More Connected Life. Jennifer Tucker is vice president of Homewatch CareGivers International.