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 Fault Lines And Frontiers In Person-Centered, Long Term Care

 Part 3

 

​Robert Murray sat at the desk with three octogenarian fellow residents; they had an air of authority. Across the desk, the young, shy, but confident Angelica Riviera took her seat.

At the Bethel Health and Rehabilitation Center, a meeting of the ages was about to begin: knowledge developed over 300 cumulative years, arrayed against the untested idealism of the 19-year-old Angelica. This was the final meeting where this team of seniors would declare whether Angelica measured up to the certified nurse assistant (CNA) job she was seeking.

Elders in skilled nursing centers recruiting their own caregivers is something you would expect Diane Judson, director of nursing, to initiate. She has a cultivated way of relating to residents. She connects with the person concealed within an aging body; she recognizes the human spirit yearning to be whole, to reach its potential, and to rise above selfishness and to serve others.

The four residents who interviewed Angelica are the Recruiting Council Judson installed over a year ago. As recruiters, they take over after the routine preliminaries and paperwork. They have the final say in CNA hiring. Robert Murray, a victim of Lou Gehrig’s disease, is an active member. He led the interview with Angelica. His amplifier headset muffled his labored words, but Angelica sensed the pathos in the question Murray directed toward her.

Compassion Over Competence

Murray asked her, “Angelica, you see, I am only 42, but I am not a whole person anymore. ALS has crippled me. I can barely move around. I cannot talk with you without this amplifier headset. I was a full person once. I am not anymore. Angelica, as my caregiver, what can you do to make me feel whole again?”

Angelica could not stop the gush of tears. “That is not what I had expected,” Angelica says. “I thought they would ask me about my training, my skills, and my experience. Bob’s question cut through all that I anticipated, it went deep inside me. It told me that what they were looking for was not a CNA. They wanted a caregiver that made them feel like a whole person. I cried.”

Angelica is now a caregiver at Bethel—a happy one. She has a special bond with Murray.

The recruiting elders are uncanny in detecting the kindness an applicant brings to the job. Not all applicants pass the test. Of the 40 or so prospective students or CNAs thus screened by the residents and recruited in the past year, only two have left Bethel: One was hired by Judson against the team’s recommendation—she soon discovered they were right—and the other, although big in heart, fell short on competence.

The “Residents Recruit CNAs” story is as much a tribute to Judson as it is a warning about the gaping lacuna in the person-centered approach in long term care. Not all well-regarded programs that preach or practice humanistic principles capture all the essential elements that make the human person.

Service Is Joy

A history written in blood, sweat, and tears finally brought the world to agree on a lofty vision of the human person; it is now shared by nations, religions, and cultures. That model posits that five innate yearnings define our goals, endow us our inalienable rights, and confer on us our humanity. We have distilled these primal needs and birthright as: to be, to become, to belong, to be your best, to reach beyond.

To reach beyond selfishness and to lift those in need are tendencies to be compassionate etched in our DNA. Adam Smith, the widely misquoted godfather of economists, refers to compassion as a “principle of human nature, the most exquisite sensibility to feel for others.”

Compassion is the most divine of human virtues. It brings blessings not only to the receiver and the giver, but also to the bystanding observer. The science of compassion has documented the beneficial changes in brain, body, mind, and soul.

As a Nobel Prize laureate put it,

“I slept and dreamt that life was joy.

I awoke and saw that life was service.

I acted and behold, service was joy.”

—Rabindranath Tagore

Compassion Spreads Its Blessings

The residents in nursing centers know much about the rewards of selfless sacrifice. They were parents, teachers, doctors, lawyers; they volunteered and were good neighbors; they gave. Why should we presume that in their ripe years they desire to disregard life’s lesson, to become self-absorbed and egocentric?

It is rare that the person-centered agenda specifically caters to the noblest human instinct that yearns to transcend, to serve, and to give. Ironically, this is a glaring deficiency in many well-funded programs. However, compassion thrives in innovative practices at many nursing centers.

At Bethel, Judson opened one route to attain fulfillment via compassion. Other people like Judson at other sites have opened different pathways to compassion:

Residents partner with hospice staff; they bring comfort and peace to their dying friends and co-residents.

Residents serve on advisory groups that plan menus and improve layout, décor, and furnishings.

They serve as ambassadors-at-large that facilitate communication, troubleshoot, and spread cheer and smiles.

One nursing center in New Jersey reinstated a resident’s past career role as a judge. She arbitrates disputes and grievances that residents and staff bring to her.

At another Eastern site, a resident with a distinguished career on the stage was helped to turn residents and staff into actors; they put on stage shows for their families, friends, and neighbors.

In a California nursing center, residents make fancy colored soap, market it at fairs and online, and spend the profit feeding the homeless.

Many nursing centers across the nation connect with churches and schools. They host children; encourage intergenerational play; do foster-grandparenting and baby-sitting; and help with homework, writing letters, and so on.

At other sites, residents pass on their skills and wisdom to the younger generation. They teach, mentor, and counsel.

Kindness and compassion are deeply felt urges that seek fulfilment even as our body ages. Compassion spreads its blessings all around. As Judson says, “Seeing residents hire their caregivers is rewarding enough. Sitting on the sidelines, I listen to residents, I understand what they really want. At each session, I learn something new. It has made me a better leader. It has blessed us all, made each of us a better person.”

V. Tellis-Nayak, PhD, is senior research advisor at NRC Health, Lincoln, Neb. He has been a university professor, whose scholarly work has been published in national and international professional journals. He and his wife, Mary Tellis-Nayak, have co-authored a book, “Return of Compassion to Healthcare,” which upholds humanity as the ultimate measure of success. He can be contacted at vtellisn@gmail.com.

COMMENTS (1)
JAMS
2:50 AM
April 27, 2017
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