Will increased staffing fix care?


There are many staff working in today’s care homes who experience moral distress because they do not have the time to provide the kind of care they know in their hearts the people they support need in order to have a good life. There is much in the media about person-centred care and the need for increased staffing levels in order to achieve this, however, adding more staff alone will not change things. We need to do more than give lip-service to person-centred care, we have to DO it! Increasing staff ratios in order to achieve this doesn’t necessarily mean increasing the number of care aides, although that would be very welcomed. It can mean training all levels of existing staff to be part of person-centred care, so everyone participates in improving the lives of those living in our homes. There’s more to care than taking care of the physical needs. The person needs to come before the task and there’s much “non-care” staff can help with. There’s no reason why they can’t all be trained to assist someone with meals; with engaging residents in conversation and reminiscence; in providing moments of joy with a smile and a hug, or an opportunity to have purpose (i.e. ask the former auto mechanic advice on maintaining your vehicle, have the avid gardener help plant flowers and pull weeds), etc.

Emotionally intelligent, person-centred leaders who hire emotionally intelligent, person-centred staff are necessary. We need to understand that “responsive behaviours” are actually expressions of feelings, often brought on by neutral, controlling, or abusive care. It is a normal human response to being denied dignity, choice, and purpose. It is also a normal human response to a perceived threat, or a life of intolerable boredom. Once we uncover the feelings behind these expressions, we will better understand how to meet the needs. In doing so we enable a sense of well-being for those in our care and those “responsive behaviours” dissipate. It’s a win/win for everyone involved.

It is high time for a huge shift in the culture of care, from a biomedical model to a feelings-based, person-centred model. I am an avid believer in the Dementia Care Matters Butterfly Household® Model of Care, but there are other models that are also based on similar principals. These include, among others, the Eden Alternative®, the DAWN MethodLantern Assisted Living , Silverado Memory Care, and the Hogeweyk Dementia Village  in Holland. All of these providers believe that the emotional well-being of those in their care is paramount. They all believe that the best way to care for someone is to create “home” for them, and in being an attached carer, not a detached one. They also believe in meeting the person in their reality.

The focus needs to shift from the task to the person. The task can almost always wait, it will eventually get done. In the big picture, does it really matter if the bed doesn’t get made until just before you get in it? Has anyone died because they didn’t get a bath today? If the person is refusing their bath and becoming agitated, or possibly aggressive, as you try to coerce them, back off and try again later. They are telling you no, and they have a right to do so. Maybe they are in pain, maybe they are embarrassed, and maybe they are frightened by the stranger forcing them to take their clothes off. How would you react if a stranger came into your home and tried to take your clothes off?

When did we decide that a sterile environment devoid of “the stuff of life” (Sheard, D) was a good idea? Why do we think it’s okay to leave someone staring at a bare ceiling tile all day long with nothing to break up the monotony? Why do some carers think it’s okay to walk past a person and completely ignore them as if they do not exist? Not a look, or smile, no acknowledgement what-so-ever. This is not okay!

It is time for us to “wake up and smell the coffee”. The old model does not work. Increasing staffing while continuing the same neutral, controlling, or abusive care will not change things. Freeing staff up to care with their heart will.

NOTE: Dementia Care Matters ceased operations in December 2019

Recommended video: Feelings Matter Most: An Introduction by David Sheard

Post updated June 25, 2021

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