Sep 20, 2016 • Provision Living at West County • By: Katy Rice
What does it mean to transition to an assisted living environment? Is assisted living a response to the changing needs of an elder? We don’t think it is.
At Provision Living, we believe that the essential human needs don’t change. New challenges arise as we attempt to meet those needs, but people of all ages need the same things. This distinction—between our needs and how they are met—shapes our relationship with every elder who joins us. It defines the scope of the care we provide. A brief look at the domains of well-being that we recognize will illustrate why we believe our community should adapt to each elder, and not the other way around.
The seven domains of well-being are listed below. They make up components of a rewarding life—the things we need to experience contentment—and they guide our relationship with each elder we serve.
When we consider each of the domains individually, it’s difficult to imagine how life could be complete without all of them. And yet for decades, the prevailing model of elder care has been built on the assumption that people somehow outlive these basic needs and reach a stage of life where the management of physical frailty is paramount and all other concerns are secondary. Nothing could be further from the truth, as will be clear when we look at how each domain connects with the others.
It’s fitting to begin by discussing security, because it encompasses physical safety—and concerns about safety are often what lead families to consider an assisted living arrangement. Security stands apart from the other domains of well-being because of how intensely we react when it is threatened. That reaction is natural and healthy, but it’s important to remember that safety is only one aspect of security, and security is only one domain of well-being. As we look at the other domains, we need to understand how they are affected by our attempts to maximize safety. At Provision Living, we believe that this requires an understanding of the complicated role that risk plays in a rich and fulfilling life.
In an assisted living environment there is a natural tension between security and autonomy. Families come to us prepared (perhaps too prepared) to accept that living in our community means giving up a certain amount of control over one’s daily routine. We understand that family members have often been preoccupied with the safety of a loved one in the months prior to coming to us. Safety is naturally foremost in their minds. On the other hand, the elder they want so much to protect has a broader set of concerns. She wants to set her own schedule, to eat the food she enjoys (and prepare it the way she likes it), to maintain her relationships with family and friends, and to continue doing the things that have brought her happiness throughout her life.
We can’t ignore the physical and cognitive challenges that come with age and dementia, or the risk they can introduce to activities such as cooking or even going for a walk. But we can look at that risk in proper perspective: We can ask how much of it we are willing to accept in exchange for the happiness that comes with a healthy sense of autonomy. Most importantly, we can involve the elder as much as possible in decisions about how to balance risk and choice. An elder might, for example, want a steadying hand when walking on a garden path but feel perfectly capable of walking by herself when indoors. Perhaps instead of making an elder’s meal for him, simply keeping him company in the kitchen while he prepares his own breakfast is all a care partner needs to do.
Autonomy allows us to thrive in all of the other domains. Consider identity, and how much of it comes from exercising autonomy. We define ourselves by the choices we make—to spend time in the community garden, or to cook meals in the kitchen and feed friends and relatives when they visit. That identity is what we bring to our interactions with others and allows for connectedness, which is much more than simply having others nearby. Connectedness requires engagement and participation in the social activities—things like gardening and cooking—that are vital not just to individuals but to our communities, where each person benefits from the contributions of those around them.
Our care partners work to evaluate risk and to manage it, but not to avoid it altogether. Our approach to care is person-directed and not driven by a fixed set of procedures, and our goal is to give each elder as much control over his or her life as possible. This includes the freedom to seek out new experiences and relationships, both of which are necessary for growth. We reject the idea that there is an age at which personal growth stops and decline begins. The onset of physical and cognitive challenges doesn’t mean that an elder should—or would want to—stop seeking novelty and settle into a routine determined by someone else.
Opportunities for growth lead us toward others, to learn from them and to teach them what we know. And in a community designed to build relationships among elders and care partners, each elder can have a positive impact on those around him. That experience—of having a part to play, and contributing to the well-being of those around us—gives meaning to our lives.
Meaning and growth, which so often arise from daily experiences, might seem to be the domains most affected by dementia. But the challenges of memory loss don’t change the universal human desire for
moments when we experience or accomplish something new.
In addition to the identities we build for ourselves throughout our lives, we also need the kind of happiness that occurs spontaneously—what we refer to as the domain of joy. This isn’t something we can achieve by reflecting on our past, but instead requires constant exposure to new experiences.
When we see how tightly bound together all of the domains are, we realize that a care model that doesn’t address each domain can’t succeed—not according to how we define success. What’s more, we begin to see that risk can’t be defined simply as something to be eliminated in response to the demands of security. Risk, and the right to accept it in some circumstances, is essential for all of the other domains of well-being.
Managing risk will always be an essential responsibility in an elder care environment. But when concern about risk crowds out other vital aspects of care, we have a responsibility to step back and reassess our priorities. We have done just that, and person-directed care is the result.
If you’d like to learn more about our approach to elder care, please call us today at 314-384-3654 to schedule a Family Connect consultation.
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