One of the defining elements of ‘wellbeing’ as it is generally considered today is the focus on thriving, flourishing and living life to its fullest.
It’s no longer about simply surviving and avoiding ill health for most people (in the developed world).
This is good – we want to see people positively engaged with life, fulfilling their ambitions and dreams and contributing what they can to something greater than themselves.
Sadly, my experiences of the past week have slammed it into my attention that there is a growing population of people for whom ‘surviving’ is all that’s on offer. I’ve been visiting my mum in her (new) aged care home.
Because this is Scotland, and I’m only here for a week, I’ve been in the home for 3-4 hours per day… longer than most visitors. So I’ve had more time to experience, observe and reflect on the wellbeing of the residents.
Hopefully this is not too off track from our usual topics. I’m assuming many of you have or will have dependent parents, and are or will be making decisions about their care. And we’ll all be there ourselves one day. Spare a brief thought now for how you want your ‘last stop on the journey’ to be.
A close family member describes aged care homes as ‘God’s waiting room’. He should know – he’s worked in this sector for the past 25 years.
It was one of my first thoughts when I stopped simply transacting with the care home environment and started noticing. Everyone seems to be waiting rather than doing things or living life. It struck me that this is akin to being on a long-haul flight (as I will be shortly):
- There’s a long period of time to get through, and you’re just waiting for it to end.
- You welcome the appalling food because it breaks up the time.
- You can watch as much TV as you like but that is soon dull, you are physically uncomfortable and constrained in what activity you can undertake to get comfortable.
- Your needs are met by people who are generally quite helpful and pleasant but don’t care for you deeply.
- Sometimes one of your fellow passengers makes life difficult – they are finding the conditions unbearable and acting out.
The important difference is that the long-haul flight ends, and you get off, until the next one. Not so for the care home resident, where the ending is both unpredictable and permanent.
In my musings on this, I brought to mind our framework of wellbeing (the GLWS Framework) and tried applying this to my Mum—how does her wellbeing measure up against the framework? How does the care home environment support or detract from the wellbeing of its clients? What scope is there for changes to enhance wellbeing and at least enrich the waiting process, if not significantly shift the experience?
The two most important and relevant wellbeing domains in my review were Authentic Relationships and Meaning, Purpose and Direction.
Authentic Relationships
Clearly the most important daily relationships are with the care staff and managers in the home, and I have to say that everyone I met this week was warm and helpful. There were a lot of different faces, however, including two ‘new’ ones who Mum hadn’t seen before (but who were about to be involved very directly in her personal care). They told us their names and got straight to work.
Mum has a ‘key worker’ and I gathered this was the person with whom she would have the closest connection. I saw this person for a moment and then not again all week. She was off shift. I didn’t see anyone sit down with Mum and have a conversation with her, even for 10 minutes (maybe because I was there, but I didn’t see this happen with anyone else either).
It makes me think of the workplace, where the business of the day can take precedence over connecting to your colleagues and team—yet we all know how vital those connections are for motivation, engagement, wellbeing and performance.
Is it due to a gap in resourcing, or training, or a lack of understanding about the importance of genuine human communication in supporting health and wellbeing?
My ‘inside source’ tells me that when care homes have a higher staff-to-resident ratio, the wellbeing and morale of both increases. The staff enjoy having that extra bit of time to spend with their clients and their own sense of meaning is enhanced.
But if there is no extra money or staff, are there some simple shifts in approach that might help?
For example, the inclusion of dedicated one-to-one time with each resident for a short spell each day. New staff could be encouraged to sit down to speak to their clients for a few minutes. And, the management could legitimising simple communication with residents as part of the day’s work.
It’s like we always say—leaders have to legitimise ‘checking in’ with their team as a fundamental expectation of their role.
Meaning, Purpose & Direction
This is a biggy. Really.
Where is the sense of meaning and purpose for the average care home resident? Staying alive for another day—is that the best we can do?
I see two issues and opportunities here:
- Identity – a sense of meaning is closely related to our sense of identity in our lives and work. So can care homes do a better job at connecting with the identity of the person in front of them – as it was and as it still is?
- Purpose – there has to be some useful activity that residents in care homes can undertake that creates a sense of value and making a contribution.
Identity was a good one for me to reflect on for my Mum and one that I recommend you consider for your own parents. I thought of four important strands to her identity: being a mother; being an artist; having a love of gardening; and, being unconventional and a non-conformist (yes, you can read stubbornly independent for this one!).
These thoughts prompted me to:
- Organise a family tree to be drawn up with photos of Mum’s immediate family to say, “This is my tribe, I’ve raised this lot and contributed to their lives, this is who is important to me”. This is for Mum and also for her carers – for them to see, ‘this is who I am’.
- Look at what was staring at us: Mum has a painting on her wall above her bed. I’d like her carers to know she painted it. I’d like them to know the histories, achievements and interests of all the people they are caring for.
- Reconnect Mum with her art interests: she has a collection of art books but there isn’t room for them in her new space. So her visitors are going to bring them in from time to time and look at them with her.
- Rearrange her room so she can see out of the window when sitting in her chair (yes, seriously, she can’t at present, and as she can’t walk, she is staring at the same thing all day). Could I please ask that the architects of care homes of the future take account of the positive wellbeing benefits of engaging with nature in their designs?
- Buy a bird feeder and place it outside the window.
- Investigate something that can grow – a seed tray, a jar of sprouts – something she can watch and nurture.
- And I’m still thinking about her being an independent non-conformist! (I did explain this to the care staff as an apology for when she gets frustrated about her lack of mobility and takes it out on them).
Purpose – can we make better use of the untapped resource that’s sitting doing nothing? Some people in care homes have good cognitive capacity and/or good manual dexterity. Aren’t there some useful tasks we can seek their help on? What can they uniquely contribute to the people around them?
Perhaps charities or NFP organisations could ask for volunteer help from the residents of care homes for some aspect of their fund raising or administrative load. That would serve both parties well – the elders can do something useful with their time and the NFP gets some free labour to keep costs down.
One completely brilliant initiative I learned of in the UK is connecting aged care residents with pre-schoolers for the benefit of both groups. A recent UK TV documentary reported on an experiment in this space, finding that it “had a powerful effect on the participants. The children were seen to be more confident by the end and formed connections with new friends. And the adults were happier”.
This kind of intergenerational program has the capacity to significantly impact the loneliness epidemic and provide the younger generation with wisdom and insights they might not otherwise have access to.
There are four more wellbeing domains in the GLWS framework, and if you have a family member in care or heading that way, I recommend using them all to consider how their wellbeing needs can be met.
If your organisation is a provider of aged care services, I’d love for you to use the GLWS framework to consider how well you are fostering wellbeing for your clients (and your staff, of course).
And I’m full of other ideas I haven’t included here, so please let me know if you would like to connect.
Finally, I’d like to say that my Mum is well cared for in terms of her personal care, safety and physical needs. Her experience is thankfully not like those that will be the subject of the forthcoming Australian Royal Commission into Aged Care Quality and Safety. However, my plea is that we look beyond just making these facilities safe and strive for more—can we create environments for thriving, not merely surviving?
Be well
Karen (& Audrey)
References:
Skropeta CM., Colvin A., Sladen S. (2014) An evaluative study of the benefits of participating in intergenerational playgroups in aged care for older people. BMC Geriatrics 14:109
Teater, B (2016) Intergenerational Programs to Promote Active Aging: The Experiences and Perspectives of Older Adults. Activities, Adaptation & Aging, 40:1–19