Tag Archives: Person centered care

Senior Care Professionals

Quality of Life in Nursing Homes—What Matters Most?

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Individual preferences determine if one feels they have a high or low quality of life.

Nursing homes often stress that they strive to maximize the quality of life for those elders who reside there. Over the years I’ve heard the term quality of life so many times that it seems rather vague now. Has it become an overused phrase that lacks a meaningful context? What is it anyway and how do we know when we’ve achieved it for anyone other than ourselves?

Quality of life is hard to define, therefore we all have our ideas about it. For one it may be associated with physical function or being pain-free. Yet the next person may stress having regular connections with family or friends. And still a third will say it’s having a clear mind and being able to engage in spiritual practice. The most basic definition I found states says that quality of life is “how good or bad a person’s life is.” I find that sufficiently vague to be meaningless.

So if the quality of life is subjective, then what matters most to individual residents in long-term care? One research article tells us that “The majority of the elderly people evaluate their quality of life positively on the basis of social contacts, dependency, health, material circumstances, and social comparisons.”  Other researchers found that “dignity, spiritual well-being, and food enjoyment remained predictors of overall nursing home satisfaction.”

An especially exciting publication called Quality of Life: The Priorities of Older People with Cognitive Impairment reports that nursing home residents most value:

  • Frequent contact with family
  • Privacy and being able to spend time alone
  • Socializing with others, including staff and visitors
  • Being active
  • Having meaningful activity
  • Engagement in religious or spiritual practices
  • The staff treats them with respect
  • Feeling like staff members see them as individuals

In conclusion, there are many layers of daily existence to take into account when trying to measure if a person’s quality of life is at a high level or is lacking. The bottom line is that we really can’t judge it through our lens; however any attempt to know the person is in the right direction.

If you work in long term care, what’s something you do to help ensure each resident’s quality of life?

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and serves as a Master Trainer and training consultant.

Hospital Professionals, Senior Care Professionals

How to Prevent People in Nursing Homes from Becoming Invisible?

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People in care can often feel invisible.

People living in nursing homes become “invisible” when they are regarded as feeble-minded and lacking in the ability to contribute to society in a meaningful way.

I once met a man named Frank, who lived in a skilled nursing facility, and his memory still haunts me. I noticed him because he wasn’t particularly old, and he was tall and muscular. He was sitting in a corner in the hallway near the nurses’ station. By his appearance, it seemed he had suffered a stroke.   The following day I noticed Frank sitting in the same spot– for hours, just sitting there.  He had no real interaction with anyone and pushed restlessly on the wheelchair footrests. He couldn’t propel the wheelchair himself. Lots of people passed by, but no one paid him much mind. To me, he seemed lonely, frustrated, and, yes, invisible.

I felt drawn to offer him a Compassionate Touch. I pulled up a chair introducing myself. He immediately looked me in the eye. He had trouble with language, but he could, with effort, carry on a conversation. A Vietnam veteran, Frank grew up in Illinois. He believed his age to be 37, moreover, other signs of confusion were there, too.  I held his stroke-affected hand. He was receptive to the touch. I gently rubbed his shoulders and back, and he told me it felt good.

At the end of our time together I asked him if he would like to sit somewhere else. He pointed to a spot about six feet away that was near a table, so, I maneuvered his wheelchair around so he could reach the table with his hands. He reached out took hold of a newspaper, and proceeded to read it. He engaged in something purposeful.  The restlessness stopped.   As I left, he said, “thank you for stopping.”

Frank still haunts me. He likely sat in that same corner spot the next day, invisible again. So, how do we prevent people like Frank from becoming “invisible”? In closing, Alisoun Milne, a gerontology academic in the UK, tells us, “There is evidence that well-trained staff can build up relationships with residents that help to reduce reliance on medication and the need for acute medical care. Because the more you know about the person in that chair, the more likely you are to see them as rounded human beings, and the less risk there is of neglect.”

Ann Catlin, OTR, LMT: For twenty years, Ann led in the field of skilled touch in eldercare and hospice. She has nearly forty years’ clinical experience as an occupational and massage therapist. She created Age-u-cate’s Compassionate Touch program and serves as a Master Trainer and training consultant.

Faith Community, Family Caregiver, Senior Care Professionals

Personhood and it’s Value in Dementia Care

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Quite simply, the definition of personhood is the quality or condition of being an individual person.  At the core of personhood is the self- who we are are, our values and beliefs.  It’s who makes us who we are.  Being able to recognize the “self” of personhood is key to understanding and practicing person-centered care for persons living with dementia.

Professor Thomas Kitwood was a pioneer in the philosophy of person-centered care from the University of Bradford in England and in the 1990s, connected the beliefs and values of person-centered care specifically to dementia care. His work and research gave voice and credence to the need to realign dementia care practices to a model oriented to the “personhood” of the individual living with dementia.  Although he passed away before his research was complete, his valuable work, and has been built upon throughout the world as the basis and model for providers of dementia care services, advocates and certainly the continued research on this topic.

Personhood doesn’t go away as dementia progresses.  The individual within is what makes up who we are.  In many ways, dementia does change one’s judgment, memory, sensory abilities, language, mood, and behaviors.  But what makes them who they are doesn’t change – it’s their personhood.  Unfortunately, too often our society, families and even professional caregivers treat someone living with dementia as if they have lost who they are.  When we ‘discount’ that person’s selfhood (or personhood), it alters how they think of themselves in the world, their relationships, security, and purpose.

Humans are born to relate, connect and bond.  These needs remain for a lifetime, yet far too often when someone has even mild dementia, others treat them as if those inner needs that keep them whole, are simply not important.  Sadly, those who are often the most vulnerable to this reaction are families.  The root cause of not respecting one’s personhood is often fear,  denial or the need to suddenly take control.  Losing one’s personhood robs them of the ability to hang on those basic human needs – to related, connect and bond.

Respecting one’s personhood in dementia care means that we must move into their world.  Join them where they are, in the moment, with no expectations other than to connect with the individual within.  When doing so, we are practicing person-centered care and their personhood.

Pam Brandon is President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and their caregivers.  Pam is the creator of the internationally acclaimed Dementia Live awareness and training program and worked with recognized expert, Ann Catlin in developing the Compassionate Touch program.  

 

 

 

Hospital Professionals, Senior Care Professionals, The Family Caregiver

Are we Confusing Life Enrichment with Activities in Dementia Care?

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What exactly is the meaning of Life Enrichment?  

Quite simply, Life Enrichment it is the act of bringing purpose and joy to persons living with memory loss. As dementia progresses, engaging in a life skill or routine task becomes increasingly challenging, and seniors need the support of someone who can adapt activities so they can still feel a sense of accomplishment, success and enjoyment.

How do Activities differ?

In senior care,  Activities are the entertainment, planned events, exercise classes etc. that are posted on weekly and monthly charts for anyone who is able to join in.

So, the question then is, are we too often confusing Life Enrichment with Activities?   

Too often, the answer is yes.  These are not the same, although they often intersect.  Person-centered or resident-centered care models must focus on the individual (life enrichment), as opposed to the whole (activities).    While activities are important to everyone living with dementia, those activities must bring purpose and joy to the individual, giving them a feeling of accomplishment.

When we fulfill the purpose, joy, accomplishment needs of an individual, we have a life enrichment model.  For each person, that may or may not coincide with the activities that are offered to all the residents.

Digging Deeper into Life Enrichment

The needs of persons living with dementia change, sometimes daily or even hourly.  Resident-centered care starts with understanding who they are now,  and their life story, allowing us to capture the who, what, why, when and how of their life.  Why is this so critical? Those long-ago snapshots allow us opportunities to engage with that person’s memories that are still intact.  Persons with Alzheimer’s disease and other forms of dementia will most likely retain those distant memories of their younger years while short-term memories fade.

When we take the time to dig deeper,  we discover the person they once were – and still are!  Let’s look at an example:

Kate came into memory care with mid-stage dementia.  She was listless and had no interest in taking part in the Activities that were offered daily.  On the surface, you would think Kate was depressed and had no interest at all.  After a life history assessment and talking with her family, the staff learned that Kate was a landscape architect, master gardener, and avid hiker!  No one would have guessed coming in that Kate had such an interesting career and such knowledge and passion for gardening.

What might life enrichment look like for Kate?  Spending time in the community’s outdoor garden, possibly taking part in garden activities with assistance, certainly photos of projects that she designed as a young architect would capture memories and spark conversation.  How about finding out where some of her hiking adventures were and finding  National Geographic and Travel shows that she might engage with?  Perhaps your community hasVirtual Reality programming in place.  There are tremendous products now that literally transform life experiences for persons with dementia. A memory basket of gardening items, tools that she used in her career and personal photos of her gardens, hiking adventures and certainly her projects could all be kept in a place where staff and families can access easily to engage in quality time together.

Kate may not find any interest in the Activities offered, but that doesn’t mean Life Enrichment has been sacrificed.  For Kate, what gives her purpose, joy, and feelings of accomplishment are not found in the activities area.  That’s okay!  We’ve found the sparks with Kate, and maybe our activities can incorporate some of her needs, but we are certainly not relying on our Activities program to provide Life Enrichment to her as an individual.

For more information on reminiscence training and other innovative dementia programs, please visit http://www.AGEucate.com

Pam Brandon is President/Founder of AGE-u-cate® Training Institute, the creator of the Dementia Live® simulation experience, and Flashback™️ Reminiscence Training.  She is a passionate advocate for aging adults and those who serve them.  Pam may be contacted at pam@AGEucate.com