By Barbara Speedling, Quality of Life Specialist
A friend and I were having dinner at a rather expensive steakhouse recently. We were both celebrating an event, so we decided to splurge. As we were enjoying our pricey steaks, I said, “You know, Judy, twenty years ago we thought the steaks at the diner were really good. Today, we would never order a steak in the diner!” We agreed that what would have passed for satisfying two or three decades ago, will no longer be satisfying since we’ve experienced something we enjoy more.
How easy is it to go backwards in your life? I can remember having no furniture beyond a mattress on the floor, some milk crates borrowed from the local grocery store that I used creatively as seats and book shelves, and eating macaroni and cheese several nights a week because it sold for 25¢ a box. I could return to that time in my life when I had nothing, if I had to, but I wouldn’t be happy or satisfied.
One of the first things I want to understand about someone I’m asked to interview is how far back he’s had to go. How he’s lived and worked, what he’s accomplished, and how strong his ego is are just the first of many things I want to know about him and his lifestyle. Understanding the level of success and independence he’s achieved will provide great insight into how he might respond now in the face of dependency.
During a recent conference for social workers in Maine, I asked my audience if they thought giving up everything you’ve worked for and everything that defines you to move into a nursing home is a traumatic experience? Many said they would consider it a difficult experience, but had not identified it as traumatic. I offered that it is likely one of the most traumatic things a person could experience – equal, perhaps, to having to declare bankruptcy or becoming homeless. Assessing behavioral health from this perspective puts an entirely different spin on person-centered care.
As a member of the Baby Boomer generation, I can speak personally about living in retrograde. Having worked in long-term care for the better part of my adult life, I am already acutely aware of what I will have to give up to live in a nursing home. I currently answer to no one. Without a doubt, I will not respond well to being directed. I love time alone and having privacy. I will not want a roommate. I am obsessive about order and symmetry. I will not want you to rearrange my things. I like variety and thrive on change and new experiences. I will not tolerate the same routine day in and day out without agitation. I have trouble sitting still and that will be the biggest adjustment.
I believe that person-centered care means that you must explore ego, lifestyle, occupation, and achievement closely as the first step to understanding someone’s behavior. How disease and disability impact the person now has to come next. Considering the move to a long-term care environment to be a traumatic event is the final step in developing an improved awareness and anticipation of where to begin a realistic plan for this person’s care.