Wednesday, 12 October 2016

Care Partner Wednesday--The Domain of Security

Imagine George.

He moved to senior’s facility with his wife several years ago, and they enjoyed their lovely apartment, the many activities and their friends among the community. It was a good life.

Then Betty died. George felt like his right arm and half his brain was missing. And all of his heart. His family arranged housekeeping services, and for all meals to be provided, but George sat in his chair day after day, staring at the TV. In his mind, things couldn’t get worse.

Then they did. He fell, and broke his hip. Now he needed help just to get dressed in the morning, and he couldn’t go to the bathroom independently, a fact that horrified him. His children talked to the facility, and it was decided George be moved to the care section.

Today George moved to my neighbourhood. He’s lonely, grieving, depressed, and angry every time he needs help in the washroom. How do I fill George’s severely depleted domain of security?

It’s not going to happen overnight, but there are a few things that can help right away. As George’s family sets up his room, I encourage them to put up pictures and bring furniture that is comfortable and familiar. As George looks around his new room, the things that matter to him are there. Also, I introduce him to his care partners. There are six people who look after him over the course of the next weeks, but they are all regular staff, and they take the time to get to know him. They find out that he used to work for the railroad and loves trains, and that is the conversation they have whenever he needs help in the washroom. He and the physio assistant talk sports as they work through his exercises. The music therapist heard him whistle and invites him to join a group that is singing. His warbling whistle adds a new dimension and soon he is a celebrity in the group and making connections with others. A few months down the road, George realizes that the fears and anxiety that dogged him when he first arrived have dissipated. His domain of security is full.

I’ve condensed the process of several months into one paragraph, but you can see that there are practical steps to fill the domain of security. Familiar objects and familiar staff are important. So are respect and privacy. Do I knock and identify myself every time I go in a room? Is personal care kept private? Am I treated with dignity, even when I make social faux pas? All of these work together to make the George’s of the world feel secure.

There’s another, controversial aspect to security. Risk. We who work among the elderly hate risk. We want to “keep them safe,” but safety can become a prison.

What if George, after his hip healed, wanted to go walking outside the building? Perhaps he loved to sit in the nearby park and feed the birds. However, getting to the park meant crossing a road and going up a curb. Can you hear it?

“He’s still quite slow. How can he safely cross that road?”
“What if he trips over that curb?”
“What if…?”
George’s simple pleasure of making his way over to the park and feeding the birds is restricted to the rare times his family could go with him. His safety has become a prison.

Let’s try a different “what if…” What if his family recognized that the trip to the park was important to his well-being? What if they signed a negotiated risk agreement, acknowledging the risks and allowing the park trips anyway?

“To take away all risk and the chance to make mistakes is to take away the right to be human. Maximizing safety actually creates insecurity. While safety is important, there is a range of risk tolerance. Optimizing safety with the individual, based on their risk tolerance, creates security.”1

I’ll never forget Margaret and her salads. Margaret loved salads, but as she aged, she had more and more difficulty swallowing. The dietitian recommended minced diet, which meant the end of salads for Margaret. We talked with her family, and together came up with a plan. Margaret’s meat was minced, but she still had salad. She knew enough to take her time, chew well and take every precaution. She enjoyed her meals, but all was not perfect. Occasionally, she choked. When that happened, we responded immediately. Until the day she could no longer swallow at all, Margaret ate and enjoyed her salads.

For Georges and Margarets and all elders, security is foundational to well-being.


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