Posted on: January 29, 2021
Written by Jenny Kartupelis
We have all become well aware of the terrible effects of Covid-19 on care homes for older people – not only the tragic loss of life, but also the way in which the necessary precautions have exacerbated the potential problems to be found in residential settings. It is all too easy for older people, and indeed their carers, to feel forgotten, isolated, kept away from loved ones and from all the ordinary small pleasures of life. My recent work has involved interviewing visitors, managers and residents, and all have the same story to tell. By talking up the vulnerability of older people, with the idea of encouraging others to protect them by changing their behaviour, politicians and advisers have unintentionally promoted the already prevalent view that most older people are decrepit, without agency, and need to be sheltered from mainstream life. This is very unfortunate and needs to be addressed. Meanwhile, if you are considering residential care for yourself or a family member, you should still take a positive view: there are many good care homes, if you know what to look for.
What makes life in a care home satisfactory, contented or even – and why not? – happy and fulfilling? Over the last five or so years, I have talked to over 150 people through in-depth interviews, asking a variety involved in the residential care sector what they feel really matters to wellbeing. As a result I have helped to develop the concept of ‘relational care’, and believe it holds many answers to the most vexed questions of how older people can flourish while those who look after them can also be better supported and recognised. When the right steps are taken in a home, the benefits to everyone fall into place, and the providers are also in a stronger position.
‘Relational care’ and why it matters
So what is relational care? In the context of supporting older people, it has developed from the better-known idea of ‘person-centred’ care, which shifts the emphasis from what best serves the system or organisation towards what best serves the individual. However, every individual occupies a unique place in relation to friends, family, carers, their community and society. Humans are born to be interdependent, and very few thrive in situations of isolation or loneliness; and we are also creatures of interaction, with a need to give as well as receive. No-one is just a collection of needs and demands to be met by others. The idea of relational care recognises this, and where it is the driver in how a care home is run, the outcomes are much more positive. Making Relational Care Work for Older People, published by Routledge this year, explores which features are most important in getting it right.
What should you look for in a care home?
Creating relational care is about looking at accepted ways of providing care through the lens of mutual support and loving relationships, rather than the lens of provision on one side and receiving on the other. When considering a care home for yourself or a loved one, the question to ask about it is therefore: does it support these types of relationship, while also providing all the practical requirements of good personal care? The points below should help, but of course during the pandemic making the essential ‘inspection’ remotely is going to be more difficult, and I’ve suggested a few ways round this. It is important to give time to the selection process – try never to get into the position of having to make decisions during a crisis, but get to know what is on offer locally while you are not rushed. Ideally – after the pandemic – you should favour homes that offer visits for lunch or short-term stays to get to know how things are run.
The tone of a home is very much set by the manager (who may also be called the ‘housekeeper’ on smaller sites, or the ‘warden’). Do they know all the residents well? Do they join in activities, have an open-door policy, make sure that the care staff can raise problems easily? You need to talk to this person, by Zoom if necessary, and gently find out more so that you can form an impression of how they run the home. Also ask if you could speak to one or two relatives of residents.
Time and staffing
There are always great time pressures on care staff, so relationships will be built not only in ‘down time’ when they sit with older people, for example over a cup of tea but also while tasks such as dressing, washing and so on are being carried out. Ask about staff turnover, as a high turnover will prevent longer term relationships forming and may suggest other problems. Ask as well, about what the manager most seeks when recruiting. The answer should be on the lines of ‘A loving attitude’.
A network of relationships
A lot is said about the importance of independence, but people are naturally interdependent. Don’t worry about staying independent but think about autonomy – the ability to make choices, feel in control, and be able to give as well as receive so that trust can be built with other residents and with carers. Ask the manager if they can ‘walk’ you round the home using their laptop if you can’t visit, and check if people are chatting to one another as they sit or move around. Are there volunteers having conversations or joining in activities? Do people seem to be living life as fully as possible? In ‘normal’ times, also see if there are young people or animals around.
The physical environment of a care home plays an enormous role in favouring or impeding the formation of relationships. Does it feel like a ‘family home’ or an institution (however grand or beautiful)? There are features that residents and care staff consistently mention as important to enabling conversation and friendship. These include: a variety of communal areas, some smaller, quieter and more intimate without a TV; good natural lighting; green views from the windows; residents’ own pictures and artefacts (if they wish) in communal areas; an all-weather summerhouse in the garden; easy access to making drinks around the premises. Look for or ask about this checklist.
Finally, does the home actively aim to build links with its local community, and help older people maintain their local friendships, for example by encouraging them to continue going to external clubs and meetings, church services and home visits if they are able to? Does it open its doors to local people, for them to help, get to know the place, perhaps use its facilities? Of course, none of this will be happening during the pandemic, but it should have a normal feature before 2020, and should be part of the ethos of the home.
1st Photo by Georg Arthur Pflueger on Unsplash.com
2nd Photo by Esther Ann on Unsplash.com