Evolution
One of my favorite quotes comes from Maya Angelou, although, truth be told, I am not certain she would be happy with the paraphrasing I so often do with her words. Her actual quote is “Do the best you can until you know better. Then, when you know better, do better.” Clearly, those words apply in many contexts, but I can think of few places they are more apt than in the world of elder care services.
In the not-so-distant past, elder care, particularly in long-term care settings, was built on the premise that elders required care in which others made all of the choices. Staff told them when to get up, when to eat, what to do and the like. Elders were treated like children or, at worst, like objects. The priority was keeping people safe, and the prevailing assumption was that age and infirmity rendered them incapable of making choices or decisions.
With the growing number of older adults, and a growing understanding that nursing home care, in some settings, was substandard, more significant governmental involvement began in the late 1980’s. A few years later, the concept of “person-centered” that had entered the world of psychology in the 1940’s, was adopted into elder care and the term elder-centered became commonplace. Elder-centered was the recognition that care and services had to be focused on the specific needs of the individual, that no one elder was like another and their healthcare needed to be planned, and managed, with that understanding in mind. While that was a huge step forward, the emphasis was often on treatment and not on quality of life.
Today, enlightened providers of elder care know that truly caring for older adults must go beyond elder-centered to elder-directed. Elder directed, simply put, means that we must recognize that each person we care for is an individual, that each one has the ability to make choices and express preferences. For too long, we have assumed that individuals with cognitive impairment were not capable of self-determination. On the contrary, presented with choices even someone with significant cognitive impairment, can choose and indicate their choice. Just because someone is older and infirm does not mean that they don’t enjoy certain activities more than others. It does mean that the person they have always been is still there, just sometimes more difficult to access. The woman who likes to drink her coffee at 5 a.m. and sit quietly for half an hour, she still exists even if she can’t tell you that. The man who never went a day without walking outside still wants to walk outside. And there is no reason that their needs, preferences and individual rhythms cannot be honored.
When we look for residential support for our loved ones or when we work with older adults, we must look for settings, and people, who understand that older adults are individuals who still have much to share and much to give. Today we do “know better” and it is within our reach to “do better.” In fact, it is our obligation.