Relationship-centred care as a response to changing conditions By Jenny Kartupelis MBE and Ann M. Callahan THE previous two articles in this series have reviewed the importance of building sound relationships of trust and knowledge between older people, their carers, managers, families, and friends. The need for meaningful relationships can be particularly important during times of transition, such as moving into a residential care home or increasing frailty. The creation of meaningful relationships can be supported by environmental conditions – a shared physical and emotional space that enables both giving and receiving in relationships. Those involved in the care of older people must ensure that conditions support the maintenance, if not enhancement, of life meaning. Carers can cultivate reciprocal relationships with older people by being present, attentive, reflective, empathic, and respectful; and helping them form meaningful relationships under new circumstances and possibly with new people, upon the onset of terminal or life-limiting illness. Genuine human interaction remains critical. Callahan’s work, detailed in Spirituality and Hospice Social Work, (Columbia University Press 2017), further suggests the experience of life meaning and potential for spiritual wellbeing is supported by connection with one’s self, significant others, and/or an ethereal, higher power however this may be perceived. This approach assumes spirituality is expressed and experienced through relationships that are significant and unique to each person. As conditions change, these relationships will also change and there may be a need for new ones to form, including a new
Jenny Kartupelis MBE and Ann M. Callahan sense of ‘belonging’ to maintain life meaning. Relationships take on new importance when older adults have a terminal, progressive illness. Relationships of trust enable older people to meet their changing needs on a daily basis: needs that can be influenced by diagnosis, stage of disease, and medical intervention. Carers need to be sensitive to this unique personal experience and have the skills and time to continually adjust and relate to that experience as it is lived by the older person. This further requires supervision to maintain the quality of care. In facing the end of life, older people may ask questions such as “Why is this happening to me?” “What purpose did my life serve?” or “What will happen after I am gone?” Such questions may not have answers, but they can lead to spiritual suffering, which may manifest as, for example, intractable pain, feelings of anguish, and loss of hope. Assuming this type of suffering is physical suffering can lead to medical interventions that fail to meet underlying needs that in fact
relate to biological, psychological, and social issues. This increases risk for continued suffering until death. Yet the situation also gives opportunities for spiritual growth if carers can listen, learn and facilitate new connections that are spiritually supportive. Relationships can also help older people with dementia to process and sustain life meaning, as their cognitive and functional capacity changes. Transfer to a nursing home may be needed to provide the support of a safe, stable environment; however, confusion can lead to panic and residential care evoke feelings of inadequacy. Care must be responsive to individual needs so that older people’s autonomy is respected and they can engage in community life. Family members and friends can also lend valuable insight into the significance of current and past relationships. As the symptoms of dementia progress, sensitivity to signs such as disorientation to time and place, reduced capacity for verbal expression, withdrawal from social
activities, and difficulty with visual processing must be part of the caring relationship. Seemingly small changes in the environment such a new shower schedule and who provides assistance with daily care can cause real upset but can be manageable when stable supports are in place. Consultation with specialists may be needed to assess medical and/or mental health issues as part of this process. The capacity to cultivate relationships that support life meaning requires commitment and skillful coordination between carers, managers, families, and friends. Spiritual suffering may not be prevented, but the wellbeing of all concerned can certainly be facilitated. It is human frailty that necessitates relationships in care homes, but these relationships can offer what could be the last opportunity for healing through new life meaning. Meeting challenges demands innovation. There are enterprising care homes and projects committed to seeking innovative ways of addressing loneliness and lack of hope, such as enabling contribution to and involvement in the community; intergenerational relationships; and ‘background’ technology to release caring time. Significant relationships and the right supportive environment can together help adaptation to the demands of human frailty. Life in a care home need not be without hope for the future – on the contrary, it may be filled with meaning, purpose, and mutual support if conditions enable the spiritual dimensions of care. n Jenny Kartupelis MBE MPhil is a director of Faith in Society and Ann M. Callahan, PhD, LCSW is an associate professor at Eastern Kentucky University.
Homes compete in regional flower festival SUFFOLK care home residents put their green fingers to the test when they took part in a flower festival inspired by the RHS Chelsea Flower Show, and created unique flower displays to ‘wow’ a panel of judges. The Care UK team at Hartismere Place, in Eye, welcomed residents and care teams from ten Care UK homes across Suffolk to compete in the flower show and be crowned winners of the flower-arranging competition. Residents and team members from 10 of the group’s homes in Suffolk showcased their gardening skills and presented a flower arrangement to enter into awards for six categories, including best home, best theme, and most enthusiastic team. Chloe Swarbrick, home manager at Britten Court in Lowestoft, said: “We have plenty of residents who love gardening and we encourage
everyone to enjoy the outdoors as much as possible. “Taking part in flower arranging not only encourages social interaction and creativity, but can also improve wellbeing, and what better way to test out our skills than with a bit of friendly competition.” The flower show participants enjoyed afternoon tea while the judges Anne Gregory, HR manager at Care UK, Phillip Steyn, regional director at Care UK, and Ian Patterson, from Suffolk County Council, decided on the winning creations. After much deliberation, prizes were awarded to: Vera Harrison, for Best Resident Entry; Britten Court for Best Resident Group Entry, Best Home Entry, and Best Theme and Presentation; Asterbury Place for Most Enthusiastic, and Glastonbury Court were awarded the People’s Choice Award.
Representatives of Britten Court in Lowestoft receive their trophy and certificate for Best Resident Group Display.
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