The 6 Sense of Relationship-Centered Care

Again, from a presentation by Dr. Jennifer Carson -"Bravo Zulu", I have selected information to share on relationship-centered care. One of the main ideas of this care is that all parties are involved: the elder, family members, and other care partners such as physicians or a physical therapist. The elder involved needs to:
* have a sense of security knowing that the relationship is safe
* experience a sense of continuity with links to the past and the present
* form a sense of meaningful relationships and a sense of belonging
* develop a sense of a personally designed set of goals that add a sense of purpose
* feel a sense of achievement toward reaching desired goals
* possess a sense of significance - that the individual matters and is of value
This sense framework builds strong bonds and brings success for attaining goals that provide safety and unity for the individual as well as others who are a part of the relationship-centered care.

Personal Relationships

As humans we live through and with our relationships with others. Whether we like it or not, there are connections and interdependence with others throughout our lives. We rely on others, just as they rely on us - we are partners.
Who are some of the individuals who are the lost important and valuable in your relationships? Some of these people are supportive and friendly; others are on-again/off-again. And a third group brings peace and tranquility with an occasional upheaval. I guess that latter pretty well describes family. Family members are most likely there when you need them and supportive in many ways, but often these same people can be overbearing and bossy. They believe they know best even though the ultimate decision is really outside of their realm and within the grasp of the person of concern. An individual with dementia is frequently left out of the decision-making process, primarily because of a belief that since s/he cannot make every choice with wisdom, this same person is incapable of making any decision. This simply is not true.
Even within forgetfulness, a person with dementia is still a person, a viable human being with feelings and thoughts and concerns. Including each individual in conversations and activities is right. Yes, forethought and planning are essential such as one-on-one chatting in a quiet locale as opposed to a crowd of blathering in a noisy venue or a slow stroll around the park rather than a stomp through the mall. This, I believe, is just common sense.

Person-Centered Care

Person-centered care is respectful of an individual's values and fundamental beliefs. These are the principles that guide a person's life through attitudes and actions. These help a person determine right from wrong and are influenced by many sources including one's culture, religion, group affiliations, and the family.
Every person is unique and though it may be difficult to uncover the inner thoughts and feelings, these are vital to know, or at least to be aware of, for assisting in making important decisions. And I really should not say "assisting" but rather supporting a loved one's decisions. We each have our own ways of completing tasks, following routines, and celebrating traditions. Each aspect of these is part of our identity and deserves respect, even if understanding some of these is elusive. All of our quirks and individualism help explain why we act or react in certain ways and why we respond to certain people and situations as we do.
As caregivers support a loved one, they sometimes have to learn more about individual preferences and in some cases, they must "unlearn" preconceived notions about what we have decided that another person knows or thinks or understands. By doing this respect for personhood and person-centered care develops.

Personhood versus Institutional Care

In the past most care plans for people as they age came from the medical field or institution with little input from the individual concerned. While the individual may have been consulted about surgery, medications, and living situations, the ultimate decisions were left to those "in charge" of care. So maybe Grandma had chemotherapy at 95 when she really would have preferred some peace. Perhaps Great Uncle John had a hip replacement when he was completely content to use his walker and wheelchair as the thought of surgery and recovery filled him with fear.
The choices made by others are most often well-meaning, but do they truly reflect well-being? Some doctors recommend and perform surgery not based so much on what is best for the patient but rather what makes sense to them as a surgeon. After all, surgery is what they do. I am not dissing on doctors, but rather stating a reality that I have recently confronted. Doctors do what they do: prescribe and perform surgery.
And it is not just doctors. Long-term care facilities do what they do: care for clients in an institutionalized setting. While customized care is always the best in suitability, care facilities often are under-staffed and over-stressed and thus fail to meet all of an individual's needs. Instead of allowing Grandpa to sleep until 10am after a long night of wandering, it is simply easier and often safer to send him the bed at 8pm so he can be dragged from sleep at 6am when showers preface breakfast.
But what if we changed our thinking and adjusted care? What if we made a paradigm shift from "one-size-fits-all" to streamlined, person-centered care? Are we up to the challenge? I believe that we are.

Treating People Like VIPs

We all liked to feel valued - important - knowledgeable - a part of something - a voice with family and friends. This value carries over to those with Alzheimer's disease or other dementias. I know it is easy to chat over and around someone who does not appear to understand or to be actively involved in the conversation, but I also recognize that this is absolutely wrong. Inclusion is vital to good physical and mental health.
A recommendation from the Bravo Zulu presentation I attended is treating others like VIPs:
V - valuing their personhood, our relationship and their extended relationships, and their cultural identity;
I - treating people as unique individuals;
P - looking at the world from the perspective of that person;
S - providing a positive and supportive social environment. (Brooker, 2007)
In reality, shouldn't these simple steps be the way that we interact with everyone. From infancy through adulthood, it is nice to have a sense of belonging.

Relationship-Centered Dementia Care

I am currently a participant in a course offered by Jennifer Carson, PhD, who is with the Sanford Center for Aging at UNR. Called "Bravo Zulu" as it was first intended for members of the military and their families, the topic and information are applicable to everyone serving as care giver or care recipient.
A first step in relationship-centered care is knowing and understanding the loved one with dementia and above all, making him/her an active member of the caregiving planning team. Few people like decisions foisted upon them without a shred of input, and that is true of those with dementia. Understanding of culture and cultural background is key to helping understand how needs can best be met and by offering solutions that match the values and wants of each individual.
Military families as a focus helps attendees better understand culture as the military entails strict rules and protocols especially focused on being tough and never asking for help. Breaking down, or at least chipping some holes in the "no-need-for-assistance" barrier, means that a loved one in need can receive care and advice that benefit good health and healthy living.
It is important in the military culture - just as in every culture - to begin by accepting that military is a general term and that Army, Air Force, Navy, Coast Guard, and Marines are specific. Each branch has a unique creed and mission. Not all military are infantrymen or sailors, just as every person is an individual. Relationship-centered care requires that caregivers fashion care around the concerns and desires of an individualized life history made up of experiences, events, and relationships.

The Holidays Approach

With some big holidays arriving soon it is important to be prepared to make each event wonderful, safe, and satisfying for everyone, especially a loved one with Alzheimer's disease or other dementia. Even though an individual may appear lost, befuddled, and anxious, s/he still can benefit greatly from  the love and camaraderie of family and friends. A few hints include:
1. Plan events for the late morning or early afternoon. This allows plenty of wake-up time plus lots of light to avoid confusion.
2. Determine a quiet spot in your home so that your loved one can be surrounded by those who care, but just a few at a time. Even noisy little ones add joy - but in small doses with rambunctiousness at a minimum.
3. Create a menu of your loved one's favorite dishes, taking under consideration items that come in small bites. A few specialties are perfect - too  many may add to angst as decision-making may be tough.
4. Decide where a nap can occur, if necessary. This should be in a quiet area with adequate lighting to avoid potential mix-up in where your loved one is should s/he suddenly awaken. Move a chair, pillows, or soft objects next to the bed or couch in case your loved one should decide to roll. Be sure to check periodically that a peaceful rest is unfolding.
5. Select photo albums or create a slide show to share past events and memories with all of the family, especially designed with your loved one with dementia in mind.
6. Encourage all attendees to be kind and gentle, to assist but not to overwhelm, to help but not demean. Some folks will not be able to deal with this cognitive decline. Help them understand that the same person resides within but it is hard for him/her to engage as in the past.
Love makes a difference!