Wednesday, 30 July 2014

Carepartner Wednesday--The Domain of Security

"To take away all risk and chances to make mistakes is to take away the chances to be human." 1

That's a radical statement.
(I love radical statements!)

Isn't taking away risk what care of the elderly is all about?

Think of all the equipment we use to do this. Wheelchairs (with seat belts), walkers, bed rails, restraints, bibs, incontinent products, locked doors, chair alarms, bed alarms. Some of these are necessary and useful, and many of them invade privacy and destroy rather than enhance the domain of security.

Let's talk about negotiated risk.

Negotiated risk says, "I know there is some risk involved, but the risk to my quality of life is greater if I am not able to do this. Therefore, I (or my power of attorney) will sign an agreement absolving you of all liability. If the worst happens, I can't sue you."

Mabel loved to be outside, and would often walk around the building of the long term care home where she lived. She had a walker, but refused to use it. She "didn't need that thing." One day, she stepped off a curb and fell, painfully twisting her ankle. Her family knew she had dementia, and could also get lost on one of these walks, although she'd never ventured out of sight of the building. They wanted to keep her safe, and asked if she could be moved within the locked unit.

A trial stay, involving being in the locked unit during the day and going back to her own room at night, was a disaster. Quiet, pleasant Mabel became aggressive and angry. She lashed out at staff, and was nasty to other residents. She lost interest in the activities she always enjoyed, and withdrew.

Fortunately, her family realised this wasn't working, and reversed their decision. Mabel was again allowed to walk around the building, and they signed a negotiated risk agreement, absolving the home of all responsibility.

What was happening? The family, because they loved Mabel, wanted her to be safe. Secure. They knew, within the locked unit, there was little chance for her to hurt herself, and an infinitely greater chance when she was outside. Mabel was kept where she was safe.

But Mabel's reaction showed all involved that her domain of security was severely damaged by their actions. Security, for her, was having the freedom to walk around the building, admiring the flowers and watching the children play. When that was taken away, Mabel felt insecure and violated, which led to anger and aggression.

We can be so safe, we aren't secure. Interesting paradox, isn't it?

Security also involves respect.

"Security also expands beyond the basic need for safety to include right to privacy, dignity and respect. A person receiving support services often finds their space becoming public space, forcing her into involuntary, intimate situations with strangers." 1

Respect means I work at becoming a friend rather than a stranger. I know you, so that we can talk about things that are familiar to you, and allow you to know me. When we are friends, my security isn't threatened when you care for me. When the elderly become frail, and their care needs involve the most personal of activities, this is incredibly important. In order for the domain of security to be intact, caregivers need to be familiar, trusted and people with whom they are comfortable.

Safety, respect, security.
The balance is both incredibly difficult and absolutely essential in order for this domain to flourish.


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