There have been many conversations and discussions about change in long-term care; change to make things better, to offer choice, and support resident participation; and change that would ultimately create a human habitat as described by the Eden Alternative™.
There has been a genuine desire by many who work in long-term care to use a holistic approach to care that allows for individuality, connection, joy and normalcy in daily life. At the same time, there has been a drive for efficiency of work processes caused by financial pressures. This created a tension between what one would like to do and what is possible. The transformation needs to be accomplished within existing structures, schedules and work processes and that is frequently difficult to achieve.
At the German-Canadian Care Home, we contemplated first steps that would turn the dial towards changing the culture in our home. We created an assessment that would give us information on each resident that aligned with several domains of well-being as defined in the book Dementia Beyond Disease, by Dr. Allen Power.
“Who am I” is an assessment used by care staff that gleans information from residents and their families on each resident’s experiences about these domains of well-being. The questionnaires focused on exploring seven domains of wellbeing, identity, connectedness, security, autonomy, meaning, growth, and joy with an additional domain of environment.
Care staff initiate this conversation with residents and draw on the support of families and friends. Among the questions we ask are: What connections are important to you? What makes you feel safe? What do you still want to learn or share with us? We added the environment as the 8th domain as we are designing our new care home spaces. What is important in the environment? Care staff worked together, collaborated with families on these assessments that were completed over a period of time and then presented to the whole care team.
The responses give us valuable information about who each person is, and what is important to them. We identify what we can implement, provide or what the individual does not want. Over time, certain themes emerged for each domain of wellbeing that are then incorporated in program decisions.
For example, we realize that the move into our home is frequently preceded by life changing events like a loss of a close family member or lengthy stay in hospital. We can feel compassion and empathy because we know a bit more about this person. Of course, we complete numerous clinical assessments as well as we are required to do so and needed to develop a care plan. But the personal story is important too; we give space to the new resident to say “let me tell you who I am”.