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Relational care and practical issues ... By Jenny Kartupelis MBE and Ann M. Callahan CARE homes can create the conditions for relationships that support life meaning and further inspire resilience, when long-term care becomes necessary to meet needs beyond the capacity for self-care or the expertise of family members or friends. Professional carers must be able to recognise the spiritual significance of relationships and respond by helping to create them: This sensitivity can transform person-centred care into relationship-centred care. Callahan’s work, including the book Spirituality and Hospice Social Work, (Columbia University Press 2017), describes critical factors in this process as an awareness of enhanced life meaning attributed to one’s relationships and a capacity to create conditions that support life enhancing mutual relationships. Although sensitivity to the spiritual significance of relationships is desirable, it requires practical commitment for it to become a reality. The therapeutic relationship enables a caregiver to affirm meaningful relationships and help older adults develop new ones. To achieve this, caregivers need continuing professional education, practice, and supervision; as well as a personal commitment to values such as human dignity and worth, personal integrity, compassion, generosity and competence. The ethic of care further suggests that a degree of interdependence in a caregiving relationship offers the potential for mutual growth. Beyond the significance of professional preparation, relational and contextual factors contribute to the potential for spiritually sensitive care. Based on extensive research with older adults living in residential care

Jenny Kartupelis MBE and Ann M. Callahan homes as detailed in Developing a Relational Model of Care for Older People (JKP, 2018), Woodward and Kartupelis suggest critical conditions for relationship-centred care: n It is based on trust and mutual knowledge. n It has had an opportunity to develop over time, and probably through some ‘ups and downs’. n It is not ‘one way’ in that both people feel they are giving and receiving care, although the nature of the care might be different. n As a result, both people involved have a sense of purpose and value. n It is set in an environment that favours its growth. One factor relates to time: there should be significant amounts of time for interaction within the daily and weekly routine, and there should be a stretch of time over months and ideally years for understanding to develop and ‘faults’ on both sides to be either worked through or accepted as part of the human condition. Ensuring adequate interaction time need not mean more caring hours in total but encouraging the focus to be on interacting during tasks such as help with dressing or during mealtimes, rather than on the tasks themselves (though it should

be noted that where dementia is concerned, there is more need for face to face contact before and after a task). Time to build mutual knowledge argues for small teams of carers being with small groups of older people, so that there is continual contact within the same ‘family’ community, rather than a wide range of different people offering different types of care at various times. This need not be too limiting – there is always room for the stimulation of new people and activities as well, as long as it is within the ‘safety’ of a relatively stable core group. All too often, older people join this new ‘family’ as a result of domestic crisis or a sudden breakdown in health, and as a result are too frail to build the new ‘belonging’ they need. If this can be avoided, there is a much better chance of integration. Similarly, managers should make every effort to retain good staff over long periods of time by demonstrating the organisation’s commitment through training, fair pay, and treating each person as an individual who is valued and has their needs recognised. Not only is this good business practice, it also creates a virtuous

circle of support and retention. Finally, the practical measures that create an environment for the choice between privacy and company, and for relationships to flourish include: n Quiet communal areas with ‘grouped chairs and focal points such as a fireplace or piano, designed to encourage conversation between residents, carers and visitors. n Outdoor and semi-outdoor spaces, such as a heated summerhouse. n Spaces for activities that give an easy option to participate or not. n Personal artefacts such as paintings, books or ornaments in communal areas. n ‘Coffee pods’ where residents and guests can make a drink at any time. n Dining rooms that benefit from good natural light. n Meal times that create a family atmosphere. n Individual rooms (whether bedrooms or flats) that can be personally decorated and furnished. n Scrupulous cleanliness, to enable dignity to be maintained. These relational and contextual factors along with professional training and support provide the conditions for spiritually sensitive care, which is particularly important when older adults cannot fully assert their own needs or preferences due to, for example, progressive cognitive decline. As needs change, so too must their relationships change and how they function in the context of care. Carers, specialists, other staff and volunteers must work together as a community to meet needs that extend beyond a single person’s capacity so that relationships are life affirming, and, ultimately, help older adults transcend the limits of personal ability, place, and time. 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.

Music and exercise combined to get residents moving MUSIC and exercise have been combined to get elderly care home residents motivated and moving more. Fitness instructor and personal trainer Mark Turner has been running the combined sessions at Waverley Lodge, in Lemington, near Newcastle. After taking a course in physical activity for the elderly, he started running armchair exercise classes, but found that many residents did not want to get involved. Mark taught himself to play guitar and ukulele and decided to try combining his playing with his exercise sessions – which proved much more effective. He found that residents respond better and are more willing to participate, especially if the songs come from their own regions.

Mark also chooses songs based on the exercise. He plays I Do Like To Be Beside The Seaside and Yellow Submarine when residents are doing breaststroke type movements or Michael Row Your Boat Ashore for rowing. As a trained Pilates instructor, he also works on getting residents to breathe correctly during exercises. “After combining both music and exercise I had a brilliant response and the exercises were more effective,” said Mark. “I found residents really respond to singing and moving along to songs that represents their own heritage. “I love to see someone who isn’t able to mobilise get involved and start to move along to the songs.”

Resident Kenneth Sanderson and personal trainer Mark Turner.

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Caring UK July 2019  

The number one magazine for the care sector

Caring UK July 2019  

The number one magazine for the care sector