Almost all of the person-centered care crowd paint a false narrative of the aging process.
By Steve Moran
Bill Thomas is a friend. I have unbounded and unbridled respect and appreciation for how he has moved the needle in how we care for seniors and yet . . .
He drives me crazy because I think he paints a false narrative about the aging process.
The picture he — and almost all of the person-centered care crowd — paints of the aging process is a false narrative.
The idea is that as people age, their bodies fail them and maybe their cognitive processes decline; yet, not to the point of them not being able to make self-determined choices about how they live their lives. A corollary to this is that when it comes to dining if all they want to eat is Oreo cookies all day — every day — for every meal, that should be okay. It is their choice.
Why It’s All Wrong
My mom had a stroke. After her stroke, she was not the same. You could still have a rational conversation with her about lots of things and — by all accounts — she understood and responded contextually. We could talk about politics, family history, and even current family happenings. There was some memory loss; yet, mostly the conversations all made sense. We even were able to have conversations about end of life issues where I was 100% comfortable that she had a decent understanding of the implications and was able to make reasoned decisions.
Except that . . .
When it came to her care, she made terrible decisions. At one point, after her husband’s heart attack, she wanted to stay in her own home, rather than move to mine, a senior community, or a nursing home. I finally got to the point where I had to offer terrible other alternatives (a nursing home, the hospital, emergency mental health all enforced by EMS and the police).
Now I know you purists are completely infatuated by what I did and are thinking . . . “you should have”, or “you could have”, or even “you should be prosecuted for elder abuse.” And I am willing to acknowledge that — if I had been smarter or something — there are other things I could do. But this is real life for people every day.
She ultimately ended up in a 6 bed assisted living community near my house and continued to make terrible choices, that had to be overruled by family and staff. She would not have taken her medications without prodding. She would have never changed her clothing no matter how filthy or taken a shower.
Getting Old Is Often Messy
There is no doubt that for some people the aging process is this nice genteel process and others are fortunate enough to go to sleep alive and wake up dead. But for many, it is a messy, difficult process, where elders don’t make good decisions. Sometimes they have to be forced and other times tricked.
It Doesn’t Matter What You Eat
I have mostly bought into this idea that when you get old, it does not matter very much what you eat. Oreos all day, no problem. Ice cream for breakfast, lunch, and dinner. I can hardly wait until I get old enough to do that.
Then I was invited to spend a couple of nights at The Hacienda at The River, a Watermark Community, located in Tucson, Arizona. (I will write more about the visit in a subsequent article). The last stop in a very fruitful day of exploring the community and Watermark philosophy of care was a very informative presentation by their chief, John Luzader. One of Watermark’s core values is a heavy commitment to healthy living, including healthy dining. There is ample evidence that diet has a big impact on energy, cognition, attitude and overall quality of life at any age. There is even some evidence that it is more important as we age than when we are young and the body can tolerate more abuse.
John told several stories about how he and his team worked with specific residents with terrible eating habits to eat more healthy. He motivated residents to eat healthier using a variety of techniques (some might call them tricks). The end result being that residents loved the new style of eating; consequently, they are less likely to fall back into bad habits.
Our Big Obligation
I 100% believe we need to give residents choice. At the end of the day, they get to choose Oreos every day, or to sit in front of the TV for 16 hours a day, or to not participate in activities. But to let self-determination be an excuse for allowing self-destructive behavior is really really bad.
Instead, we must figure out how to be smart in motivating our residents to live the very highest quality of life.