Vital Living: Rethinking Elder Care

Vital Living: Rethinking How We Approach Elder Care

My research is driven by the notion that, no matter the level of disability an older person faces, they ought to have the opportunity to engage in “vital living.” This concept is the belief that every person should be able to live as good a life as possible – whatever that means to them. Whether living in an assisted living facility, residential nursing home or their own home, we must provide the elderly with the tools and freedom, and also the support and opportunities, to pursue a happy, healthy life. This begins by listening – and a commitment to focusing on what an individual can do – not their limitations.

Focusing on the Patient

Too often, elder care is thought of as the individual being in a facility where the residents’ lives are governed based on what’s easy for the facility management and staff. In many ways, this is antithetical to the concept of vital living, and its underlying principles of vital involvement. A good example of this vital involvement is a man living in a nursing home, who has been part of an elder role model study that I’ve been working on for more than 35 years. This man has multiple sclerosis and is a double amputee. Because of his condition, he’s in a powered wheelchair and requires a tremendous amount of skilled nursing care every day simply to live his daily life.

Most people in his position would be awakened every morning at the convenience of the facility. They would then be showered, dressed and fed based on the schedule of the nursing staff. Everything they did throughout the day would depend on the services offered by the facility. However, this man became politically active in statewide and national consumer advocacy for more responsive and flexible nursing home care and elder self-determination. His own vital involvement led to his leadership in advocacy and activism. By encouraging this type of personally purposeful living, we can move away from the idea that people in nursing homes are passive “passengers” in their own lives (or “burdens” on the lives of more able family and paid staff) and start seeing them as individuals with the ability to make valuable contributions to family, community, and society at large.

Shining a Light on Abilities, Not Disabilities

Empowering the elderly to be meaningfully engaged with the world outside themselves is the key to vital living, but sometimes the training of service providers can, unwittingly, get in the way. Caregivers are trained to help people in trouble. This usually means that when we encounter a patient, we deal with what is wrong with them and ignore what is right with them. In doing so, we often don’t pay attention to the strengths that are closely tied to the person’s values and identity. Even if a caregiver is able to help ease a patient’s physical pain or reduce the impact of their disability, they are not necessarily giving the same patient an opportunity to express what their personal strengths are, or to contribute to others on the basis of those strengths.

However, when we focus on an older person’s strengths, the impact for the individual and family can be profound. In the course of my research, I met a family in California that did a wonderful job of empowering their extremely disabled grandmother when she moved in with them. She was legally blind and had lost a leg, confining her to a wheelchair. Upon moving in with her youngest daughter’s family, she let them know that she intended to contribute to the household in any way she could. She started out by sorting the family’s socks and folding laundry. Over time, she added baking for the family. The kids would always have baked snacks when they came home from school and the family would have tasty desserts throughout the week.

She adored her grandchildren and was proud of their work in school. She would meet them at the door as they came home, asking what they had learned that day and inquiring about their homework. The mother of the children told me how much better her kids were doing in school because of her mother’s encouragement. Although the grandmother required toileting assistance multiple times each night, when anticipating her impending two-week absence, family members told me they would miss what she adds to the household far more than they would value being able to sleep through the night.

This story shows the importance – to elders and their families — of paying attention to what the elder is good at, what they like doing, and what kind of activities have always made them feel like themselves.

Fostering Vital Living

The most important part of vital living is fostering an environment that promotes independence and fulfillment for seniors. As important as providing care and service is, providing encouragement, support and opportunities for them to be involved and add value to the community are just as crucial. I’m currently working with a national subsidized senior housing agency for financially disadvantaged elders. We’re working with the service coordinators to help them add the promotion of vital living practices to their regular service coordination activities. Among these practices is arts programming that encourages elders to participate in wellness-promotion activities like music-making, painting and writing.

To help match seniors to activities they might be interested in, new residents are asked things like “What have you always been good at?” and “What have you always wanted to do but never had time to do before?” when they move in. These questions give residents the opportunity to identify their strengths and share positive information about themselves.

Fostering vital living is not meant to in any way diminish providing for a patient’s needs or compensate for limitations. It’s simply being conscious that their capabilities should always be considered along with disabilities. Elders shouldn’t be identified primarily by their disabilities any more than younger people want to be labelled in this way, because disabilities are just one part of who we all are, old or young. Later in life, when the body begins to decline and conditions common to old age emerge, elders still retain what has made them special, valuable and able to contribute. By using this basic principle as a guide to how we structure our care programs, we can make sure that elders can live vitally, contributing to the community now and in the future.

How Elder Care Facilities Can Encourage Vital Living

Below are a couple of common ways in which elder care facilities can change their practices to better serve their residents. These areas can be improved upon to better serve the elderly and promote vital living.

  • Function to promote resident vital involvement, not management convenience. Facility common spaces like entry areas are often structured and designed to look impressive to visitors but aren’t necessarily suited for regular use by residents. Congregating areas often have a lot of overstuffed chairs that look comfortable, but that are hard for older bodies to get in and out of. Common spaces should be designed to be visually pleasing, stimulating, and inviting for both the residents and visitors from outside.
  • Better communication. Nobody gets what they want all the time, but staff and management should take residents’ wishes seriously. In one facility I worked in, a resident asked if the dining room could serve healthy desserts a few nights of the week instead of cake and pie. The director responded, “If you want a baked apple for your dessert, you can take an apple from the dining room and bake it in your microwave.” This could have been a great opportunity to discuss the option of healthy desserts, to consider what the residents could do to offset extra dining staff work, or any number of productive conversations. Instead vital involvement was squashed all around.
Helen Kivnick

About the Author

Helen Kivnick, Ph.D.

  • Professor
  • School of Social Work
  • College of Education and Human Development

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