I have been spending a lot of time recently in residential aged care homes sitting watching the people who live there and those who care for them.
It struck me as I watched carers at work just how self-focused they had become. I watched a lifestyle staff member leading a group of people with dementia in an activity focused on Bastille Day and she was doing a good job of keeping people focused and enjoying it. However, as happens a few people became restless and began to walk away, one walking up close to someone else and causing some disturbance and another wanting to walk with a person who was listening. Someone else was snoring loudly and making it difficult for others to hear!
What is unusual about this was that there were two care staff nearby writing in files. This is a necessary part of the day but right at that moment they were treating their colleague as a “sitter”, someone to “mind” their people while they got on with their writing. This is not just a problem invovling care staff. It occurs with all staff groups.
What would have been more respectful of their colleague and more helpful in maintaining their residents in a good emotional state would be to assist their colleague by remaining engaged and attentive to what was happening in the group and intervening when needed.
Unfortunately this attentiveness can be rare, especially when staff are so focused on their own work that they lose sight of the bigger picture and the TEAM focus. Each different type of staff member contributes differently to the success of the day by assisting all others to achieve their own goals.
The consequence for the person in our care is they they are not the focus of our care attention – our job completion is. This becomes staff/organisation-centred care – not person-centred care. This is just one small way in which the institution and our work habits can get in the way of person-centred care.
What is your experience? Does this happen where you work? How can we organise our workplaces better so we have better cooperation among colleagues and more person-centred work practices?
This week we are attending the Alzheimer’s Australia 14th National Conference in Brisbane. The theme this year is “Take a different view” of this condition that will affect an increasing number of older Australians in the years ahead.
Bernie McCarthy is presenting a workshop on “Sexuality and dementia: What are your needs“, a concurrent paper on “Pre-employment screening: Pre-employment screening: Predicting person-centredness in care staff” and a poster on “Successful e-learning in palliative care for rural and remote aged care homes“.
The keynote speaker this year is Prof. Steven Sabat, a psychologist whose books (The Experience of Alzheimers Disease: Life Through a Tangled Veil (Blackwell, 2001), and in his co-edited book, Dementia: Mind, Meaning, and the Person (Oxford University Press, 2006)) have opened up the subjective experience of the person with dementia and helped us consider how the person experiences dementia. We are looking forward to listening to him speak.
Also keynote is Prof. Raymond Tallis whose career as a clinician and scientist has explored human consciousness, and what it is to be a human being. His over 200 publications include textbooks: The Clinical Neurology of Old Age (Wiley, 1988) and Brocklehurst’s Textbook of Geriatric Medicine and Gerontology (Harcourt Brace, co-edited with Howard Fillitt, 6th edition, 2003.
If you are attending this years conference please call in and say hello at our exhibition booth No. 20 where we will be selling Bernie McCarthy’s new book “Hearing the person with dementia: Person centred approaches to communication for families and caregivers”.
We look forward to seeing you at the Brisbane Convention and Exhibition Centre.
to all our readers and customers who have supported the work we do.
Our goal is to create opportunities for older people in care to experience wellbeing and to support those who care for them. You have contributed to that work and we thank you.
We look forward to working with you and stimulating reflection on the person-centred approach to care practice in 2011.
Our office is closed from 24th December and reopening on Tuesday 4th January 2011.
For immediate response and for EAP enquiries we can be contacted on 0408 145 819
I have had the pleasure of listening to family members talk about their experiences of having a relative in aged care. It has been inspiring and concerning. Today was the concerning bit.
I listened today to a son talk about visiting his mother and watching a staff member ignore an old lady nearby who was in obvious distress in her fallout chair and calling out for help. He saw the same staff member walk passed twice and not offer help. He became concerned for his own mother. While she can look after her own needs now, what will happen if she becomes more incapacitated and is unable to protect her own interests. He is worried now. And rightly.
It is a small thing seemingly but it shows a lack of compassion and empathy from the staff member. I had watched earlier in the day and saw the same person doing the same thing so I knew he was right in his observation. What concerns me is that apart from the distress caused to the lady in the chair, his trust in the care offered by the facility has now been damaged and he has moved closer to making a complaint. The next time is happens he might not be so patient.
Staff, please be careful of your actions. Visitors note what you do and don’t do. They see your care and lack of it. You may be busy but not so busy you become an uncaring robot. Always be aware of the feelings of the person you are caring for. How do they feel right now. The noise they are making has a reason. Look beyond the noise and ask yourself how they are feeling and what it means that they are calling out for help.
Attachment has been studied with children and more recently with adults. However, it is only now being considered in relation to the relationship between caregivers and people living with dementia.
Whether you are a paid or unpaid caregiver for someone living with dementia you have an effect on the person, emotionally, psychologically. Because of the cognitive changes that cause such loss of confidence and increased confusion, the person with dementia often feels emotionally upset, lost, confused, angry, abandoned, forgotten. So they are more likely to sense themselves they way they did when they were younger, much younger – like 3-8 years old. They are not children but they can feel like they used to and this is where attachment comes in.
You know yourself how easy it is to be thrown back into younger emotional territory by the actions of other people or your own actions that cause you to feel the way you used to when you were younger. Its much the same for the person with dementia.
So you become their attachment figure in this emotional landscape. You are important from an emotional point of view because you become a provider of safety and security, predictability. They rely on you, look to you for guidance about what to do next, where to go, how to feel.
I some ways you are a “mother” or “father” figure to the person.
In a future blog I will talk about the ways in which disturbed behaviour can be understood as attachment behaviour.
Related articles by Zemanta
We had 32 very motivated people participate in a great day of ideas and problem solving around Working with Families in Aged Care today. They will put into practice such ideas as being proactive in working with families, using email to build trust and rapport from the waiting list time, being aware of the previous roles of family members in helping them to remain in a good emotional space and not invalidated by our taking over.
Check out of training calendar for the rest of this year and join in the fun and thinking at http://www.mccarthypsychology.com.au/
Families affect the wellbeing of the people you care for. Some are easy to have involved and others are difficult. Every one of them is doing the very best they can and in the only way they know how, to be involved in the care of their older relative.
Think about your family for a moment. It is the place where you attached to your mother and father and learned the ways of relationship and behaviour in society. How to function and feel, how to solve problems and make your way in the world. You also probably learned how to avoid some feelings. Its all part of your own attachment history with your caregivers.
Now come back to the families you have in your work. The older person is the attachment figure or caregiver for the younger people who visit them, their adult children. And you are now an attachment figure for the older person. How the wheel turns.
Some families do not cope well with being replaced by professional caregivers. They feel angry and guilty at the same time. They think they should still be the primary person to provide care for their mother or father. Some parents have instilled this guilty thinking into their children so they are caught. Others find themselves doing it naturally.
Caring for an elderly parent is not easy so we should be patient and understanding but also careful to maintain healthy boundaries for ourselves and them.
Next Thursday you may wish to come along to the latest public training day we are holding on “Working with families in aged care” at the Assisi Centre, Rosanna, Victoria on Thursday August 5th from 9.30am to 4pm.
Bookings limited by space so book soon on 03 9431 0311
Related articles by Zemanta
Aged care is rarely a sexy vote winner for political parties but as the population is ageing pollies are having to pay more attention to aged care as an important topic in the discussion.
Caregivers either at home or in paid roles are squeezed by expectations to provide high quality care with minimal support and in some cases inadequate support. Residential carers are expected to provide person-centred care when the staffing levels are clearly inadequate for them to do so. This is complicated by poor pay for nursing leaders encouraging good quality nurses to leave aged care and return to acute care where they can get more money. This leaves aged care with too few nurse leaders.
So can we get the pollies to acknowledge the need for more staff per person in residential care? Ask your local politician when next you email them!!