The “Meaning of Me” for those in need of homecare!

“What do older people with high physical and mental support needs say they want and value in their lives?”

This question was posed by a 2011 Joseph Rowntree Association report “A Better Life – What older people with high support needs value”. It made some key observations some of which I note below and others which I provide later in this piece:

“older disabled people are generally still viewed through the ‘medical model’ (in which the focus is on the impairment) and the discourse is one of dependence, care, dignity, frailty and pity…. The focus has been on their needs in relation to services, rather than their broader aspirations in relation to their lives.”

“All of us, regardless of age, need opportunities to show others who we are and to feel good about ourselves… many older people with dementia want and are able to tell us about their views and experiences, even if they are confused about some factual details of their lives.”

To date the private and public homecare service model has largely been built around the delivery of personal support and to a lesser extent medical assistance. Clearly this is a very important base, but it fails to address personal social and emotional needs, desires and objectives of the individual.

How can firms develop a more complete model of care? Well there are a number of things they can do.

They can set out to find out more about the individual’s life history, interests, hobbies, challenges, wishes, interests, values within a framework and a medium that engages the individual, care givers and family in an ongoing conversation. This should be a journey of discovery that allows the character, vitality and contribution of the individual to shine through. This conversation can be used to highlight areas of interest around which activities can be organized and opportunities for exploration identified. For the individual, the caregiver and the family this becomes a journey of self- actualization and meaning.

“Older people want to be able to hold on to the parts of their lives that represent continuity between past, present and future and to maintain as much control as they can over their daily lives. This is vital to a continuing sense of self, and in order to promote certainty, security and self-esteem while adjusting to changing circumstances. Older people with high support needs often find themselves having to make difficult decisions to balance independence, support and risk, and the research shows that they may find it particularly hard to do this where their sense of self is threatened.”

We are not talking a long form questionnaire usually completed at the start of service that collects administrative, medical and health information and that are usually filed away for future reference. We are talking about an ongoing interactive process that occurs on a level that is outside of the “medical model” referred to in the Rowntree Foundation report.

This conversation, this build-up of the meaning of that person can be used to help engage the individual and to develop interaction with people, activities, events and opportunities that for a while may have lain outside of that person’s immediate grasp.

“To enable personal autonomy, it is necessary to consider things that can be done differently to help older people with high support needs achieve and retain the things they value in life, rather than simply assuming they no longer have the motivation or ability to participate.”

Firms need to dedicate functions within their organizations to help develop and identify opportunities for engaging with this colourful and vibrant mental and physical habitat of their members.

They can also educate their caregivers about the importance of social interaction and to get them to interact with the conversation and interactions arising from the conversation framework. Special training with respect to how to communicate effectively with older adults with complex care needs is also important.

Firms can also become more community focused and by that I mean to start to develop relationships and connections with resources in the community that can help individuals being cared for, and their families, to develop and maintain social contact and personal interests.

As a firm we have developed and have instituted a personalized conversation framework, “The Meaning of ME®, around which we deliver lifestyle services and activities. We have two community resource centres where we regularly hold educational and other fun events for people in the community and which provides information on hundreds of community resources available to our members and their families. This integration within the community helps inform us and our members of opportunities and activities for development and exploration of the self.

Providers of care to older adults with or without complex care needs have to be aware that they are taking on a human being with a much wider vista of needs and interests than that provided for under the basic care model.

We believe that the homecare services model of the future has to put the individual, their family and their community at the centre of the universe and to develop service structures that meet these very important life and lifestyle needs.

To date there is still remarkably little focus within public and private homecare delivery on the higher relationship, emotional, social, cognitive and aesthetic needs, amongst others, that drive and sustain an individual’s enjoyment and reason for being. These needs become and more important to individuals’ as they age, for a number of reasons. We believe it is important that focus on unearthing, developing and giving voice to the rich habitat of the mind and the being goes hand in hand with the delivery of basic care services.

At a very important level we are not talking about patients with disabilities and care needs but individuals with valuable, ongoing life experiences who still have much to contribute to the world we all live in.