Down Under: Relationship-Centered Care – Part II

a mother, baby and older woman

a mother, baby and older womanAs promised here is Part II, sharing what I’ve learned from Daniella Greenwood’s work at Arcare located in Australia.  Since writing part one, I’ve learned quite a bit from Daniella and also Dr. Al Power who has just released the second edition of “Dementia Beyond Disease.”   It’s an excellent read and I highly recommend it to everyone – delegators, direct-care workers and families alike.

What is becoming very apparent to me from meeting Greenwood and reading Power’s book is that caring for someone is not a one-way street, i.e., the caregiver doing something to or for the care receiver.  In fact, the way person-centered care is currently being implemented really only addresses one side of the equation – the care receiver.

Kitwood(1997) who introduced the idea of “person-centered care,” had likely intended and what Dr. Power (2017) expands upon in his book is the concept that care should embrace all of the stakeholders, i.e., the care staff, the person living in the nursing home, their families, and I would like to add, the volunteers. Caring is about relationships.

It’s “relational-care” or as Power suggests, if we’re going to use these terms we should change the word “care” to “life.”  It’s “relational-life.”

Power takes it even a step further and suggests that the best term to describe this dynamic is “authentic partnerships” (DuPuis et al., 2012).  We enter into “authentic partnerships” with the people for whom we care.

Ok, I won’t go into more detail about this here, you’ll have to read Dr. Power’s book.

In addition, Arcare’s approach to care is also based on the work of Mike Nolan (Nolan, Brown, Davies, Nolan, & Keady, 2006) who identified six Senses that he believed would give the care giver a better understanding of their role while improving quality of life of the care receiver.

The six Senses embrace all the stakeholders, i.e., care giver, care receiver, family and community.  The Senses Nolan identifies are: a sense of security, a sense of continuity, a sense of belonging, a sense of purpose, a sense of fulfillment, and a sense of significance.

There really isn’t space here to unpack all of this, but suffice it to say it puts everyone involved in the nursing home in a place where they feel secure, connected, belonging and so on.  It’s a completely different feel than simply assessing and attempting to satisfy someone’s preferences. Instead it’s about relationships, buddies if you will.

We know for a fact that there is a direct link between the quality of the relationship and the quality of life and the quality of care.

picture of daniella greenwood
Daniella Greenwood

Daniella, Strategy and Innovation manager for Arcare, observes that the current implementation of “person-centered” care is the medical model of care trying to be a social model of care but retaining the posture that “We know what’s best for you.” 

As Daniella puts it: “…it’s bossing people around in a very individualized way.”  However, Arcare by created and implemented the “Buddy” program which took “person-centered” care and transformed it to “relational-life,” or as Dupuis, et. al., (2012) would say: “authentic partnerships.”

I asked Daniella if the Buddy program was her idea.  “No, it was that gorgeous manager, Karen.”  The Buddy program was the brainchild of Karen Watt, manager, of Helensvale, one of Arcare’s communities.  She implemented this program by simply saying to her staff,

One of these people is your people, you guys choose a relationship, just do something.

Well the staff did just that and the resulting stories are wonderful.  For Karen’s part, she takes her “buddy” to the movies and they even go to the beach. Daniella says there are pictures of them at the beach and they are just “gorgeous.” Other stories tell how staff are taking their “buddy” home for a “home-cooked meal” or going on an outing to get “…fish and chips…and we even ate with our fingers.”

Yet, another personal care worker observes that the relationship with her “buddy” makes her feel good inside and that it prompts her to do more things on her own so that when she is with her “buddy” they have more things to talk about.

In watching the video “It Takes a Community” a personal care aide talks about how she chose a man who no longer could speak.  Through touch she developed

“…a special kind of language, a special way of communicating, just not through words but just human touch. It’s just one human relating to another human.”

Daniella says “It was just about giving the staff permission.”  “You mean we can go to the park and just take Joan in my car to the park?” “Yes, Joan is just a human being.” 

This really speaks to what I’m hearing from a lot of different corners and that is “We [the nursing home residents] are so not interested in large group activities. We want individual relationships and to do things that are just ‘normal.’”a mother, baby and older woman

For me, it so refreshing to write articles like this one because it really brings what is important into sharp focus.  While so much emphasis is placed on giving so much energy to making sure everything is done properly and neatly, the care giver and older adult are left in a stressful void trying to survive from day to day.

It’s more than obvious that those providers who are willing to move beyond a maintenance, warehousing mode of just administering medical cares to developing a culture that emphasizes “authentic partnerships” between staff and residents, staff and staff, staff and families, and staff, residents and the community, these are the providers who are and will continue to flourish.

As for Arcare’s volunteer program, I’m going to take that on in part three of this article.  There is so much rich content, I don’t want you miss any of it.

References:

DuPuis, S. L., Gillies, J., Carson, J., Whyte, C., Genoe, R., Loiselle, L., & Sadler, L. (2012). Moving beyond “patient” and “client” approaches: Mobilising authentic partnerships in dementia care. Dementia: The International Journal of Social Research and Practice, 11(4), 427–452.

Kitwood, T. (1997). Dementia reconsiderd: The person comes first. United Kingdom: Open University Press.

Nolan, M. R., Brown, J., Davies, S., Nolan, J., & Keady, J. (2006). The Senses Framework : improving care for older people through a relationship-centred approach. Getting Research into Practice (GRIP) Report No 2.

Power, G. A. (2017). Dementia beyond disease: Enhancing well-being (second). Baltimore, MD: Health Professions Press, Inc.