In Praise of Small…

        The benefits of relationship based care

Who is on with her today?

This was always the first question my sister and I had when discussing our mothers care at her first residential memory care facility.  The degree of peace of mind I felt for each day was determined by who that staff member was, a factor I had no control over.  I still recall that familiar, anxious, dark dread I felt in the pit of my stomach.  It felt as though I were leaving my vulnerable and innocent child in a dangerous situation.

Don’t get me wrong it was a good facility but based on the size and number of patients, there were constant changes of staff, some cared and others showed only surface- level compliance and to be honest others simply did not care.  We were always cautious about complaining too much for concern that it may be taken out on mom in passive aggressive ways when we were not around.

I have heard this story repeated by so many friends who are dealing with the same issue.

After a number of repeated problems we took the plunge and moved mom to a much smaller home and now I am truly “sold on small”

a young happy woman hugs an older happy elderly women

To provide dementia sufferer with a home is far different than providing a home like environment in a larger facility.  I relate it to staying in a nice hotel, it’s attractive, and it’s comfortable, it may even be luxurious but it is not home.

What my sister Denise and I found was that the small home environment provided the opportunity for my mom’s caregivers to become like family and allowed for relationship between the caregiver and patient to become one.

Care happens when one human being connects with another. In order for healing to be maximized, residents and their loved ones must feel safe and cared for. This is only possible when caregivers are encouraged to forge authentic human relationships with those in their care, an environment where there is a regularity of staff allows for these relationships to form.

We also found my mom’s caregivers in this home environment to be much happier they seemed to work with a feeling of purpose and meaning.

Connecting empathizing and understanding is a process of learning and caring, for a caregiver to be able to do that for a manageable number in a family setting becomes much more achievable than when rotating between large numbers of patients.

See Me as a Person

Often when caregiver, family and resident relationships fall short, it’s because of a failure to make an authentic human connection with patients and families.  In a small family setting caregivers have the opportunity to interact with people with dementia right where they are. An atmosphere can be created where the person with dementia has interaction based on who they were in their finest hour

Relationship Based Care means knowing and understanding who the person with dementia was in his or her finest hour. It includes life-long interests and favorite subjects.

For instance from talking with Moms caregivers we learnt that mom was continually pulling at threads and tearing off buttons from her clothes. As a young mother our mom was constantly sewing, making and repairing clothes for us four kids.  We put our heads together and came up with the idea of a smock which Denise (The seamstress) in our family stitched with dozens of buttons and ribbons and threads.  The caregiver would put this on Mom each day and she would spend many happy hours playing with and attacking each item.

When you’re caring for residents and their families, knowing how to create therapeutic relationships can mean the difference between a residnet and family feeling held in care or feeling dropped in a time of high vulnerability and fear.

Small home environments enable caregivers to focus on caring for the whole person, body, mind and spirit, allowing everyone in the home to appreciate and honor the uniqueness of each person. This creates an environment where caregivers are able to support patients and families in making decisions about their care and thus allowing the dementia sufferer to “Be seen as a person”

With the help of mom’s caregivers at the home we learnt to connect with mom exactly where she was. We came to understand that this was vital for her because her reality was different from ours.  Her caretakers showed real curiosity and genuine interest in her, they grew to love her and she them (I must point out that mom was not the easiest patient to be around, often demonstrating difficult behaviors. To be honest she had been like this even before her dementia set in) but in some magical way they calmed her down and actually seemed to enjoy the fact that she was so feisty.

To the day she died, peacefully in this, her home, with her family by her side.  I felt that mom was in a safe place where she felt loved, accepted and held in dignity and respect.

Sometimes Small is Simply Superior..