What happens when an older adult needs more help and care? Sometimes we bring help into the home, sometimes we move the elder in with family and sometimes the individual is placed in a residential setting, likely either an assisted living or nursing home. The decision is based on a variety of factors unique to the person and they include health needs, mobility, cognitive function, financial constraints and more.
For those of us who are devoted to the world of older adult care, we often think about, and talk about, the best ways in which to deliver services and support. Our focus has shifted from the medical model of treating a “diagnosis” to a more holistic model, recognizing that we are not working with a homogenous group of “the aged,” but rather with a diverse group of individuals. Each elder, regardless of age or disability, must be seen as an individual with needs, preferences, choices and rights. Our goal is not just to “take care of” people but to enhance quality of life.
As a result of this understanding and commitment, we see organizations changing their models, changing their physical plants and re-tooling the roles of staff. Our approach has been to embrace The Green House model which is based on creating “small homes” with consistent staffing by multi-skilled workers. I describe it as a setting that looks and feels like an extended family, with a variety of people who are all connected and supporting one another.
Green House’s three core values provide the underpinning for this structure and philosophy. These values are real home, meaningful life and empowered staff. They sound like simple words and phrases but they are not. Real home is far different than the “homelike” setting others talk about. This is the elder’s home, they make their own choices and they have control over their own lives. Meaningful life is a recognition that everyone, regardless of age or stage, still wants to have purpose and our role is to enhance the ability of each person to live a purposeful life. And empowered staff means that each member of the team is accountable for the elders they care for and for the team with which they work.
While we prepare for the renovations to begin in our Green House homes, we’ve toured others and had an opportunity to see, first hand, how they function and how the elders and the staff interact. Each time we’ve done this we’ve all had many learnings to take away and to share.
Our most recent tour led me to an “ah ha” moment that I hadn’t had before. Each Green House home has a kitchen that is used to cook the meals for that household. Despite some more commercial level appliances, the kitchen looks like the kitchen in anyone’s home. And the elders have access to the kitchen. They may not always choose to use it, or have the ability to use it, but it is there for them.
It made me think about what an important symbol the kitchen, and access to the kitchen, is for all of us. In our house, the kitchen is where so much takes place. Family gathers there, we entertain friends there, we prepare meals and spend time connecting over those meals. But more than that, it is a place where we have access and choice. If you want to make a cup of coffee, you do it. If you want to grab a snack, it is there for you. When we put older adults in a setting where they have no direct choice or access, when they have to ask someone for everything from a glass of water to a mid-afternoon cookie, we begin to erode both their independence and their sense of independence.
Sitting in a dining room waiting to be served feels like a hotel and not a home. Taking away the spontaneity of deciding that you want a cup of tea—or several—just because you feel like it, changes your sense of self and autonomy as well as diminishes your ability for self-care.
As we often say, aging is inevitable. Our bodies change, our lives change, our circumstances change. But supporting aging must be about “mind, body and spirit.” And that, to me, means real life as well as real choices and the opportunity to exercise those choices. Maybe that starts in the humblest of places—maybe it starts in the kitchen.