Humane Care: Seeing the Person Behind the Patient-A Case Study

Article excerpt

This article is about the importance of retaining a focus on the humanity of older adults while rendering care to them through community and long-term care services. It is written from my experience as a director of a community service (Adult Day Health Care [ADHC] program), a program officer at a foundation devoted to improving health care for older Americans, a researcher who spent years conducting interviews with staff workers in long-term care services, and from the perspective of a professional and personal caregiver and friend to many elders living in the community-in their own homes and in nursing homes. From these diverse professional and personal roles and perspectives, I have learned that the formation of authentic human relationships, which go beyond the routine medical, nursing, and social work approach to care, can play a vital role in healing and addressing loneliness in elders-and transform the lives of their personal and professional caregivers as well. A focus on humanity need not cost money or place a heavy demand on the worker. In fact, it can be one of the most cost-effective approaches to improving quality in health care, attracting workers to the field of long-term care, and boosting the morale of both caregivers and care recipients.

Enrich my life! Don't just satisfy my needs-Ruth

The emotional and spiritual care of our elders is of great importance to me, especially at this time when our nation's elderly population is burgeoning, the health care system is confronting a long-term care workforce crisis (Stone & Weiner, 2001), and we are in an economic recession. It is precisely at a time when people are overworked and undercompensated, and health care organizations are trying to stay economically viable, that individuals-both health care workers and recipients-can become demoralized, depersonalized, and ultimately dehumanized, because keeping the organizations financially viable becomes the dominant priority.

At the same time, I believe that there are ways that individuals working in community care services can fight depersonalization and demoralization and work together to maintain their own humanity as well as that of their patients. The case study of a remarkable 85-year-old woman, who, in the 10 years following her husband's death lived alone in New York City's Greenwich Village, will document one person's insistence on maintaining her identity and being seen as a person not as a patient. It will also describe the impact of her humanity on those who helped her remain living in the community and the meaningful relationships she formed with her unusual case management team-comprised of professionals, health care workers, friends, and a single family member-as well as the life education they received from her as she became increasingly homebound over the following 10 years, until her death at age 95.

This article will end with recommendations for transforming traditional caregiver and care receiver relationships into relationships based on shared humanity and purposefulness.

UNDERDIAGNOSED COMMUNITY DISEASE: LONELINESS

As a society, we are struggling to find the best ways to take care of our aging population. Concern about health care for older adults is becoming increasingly prominent in the news (particularly because the "baby boomers" are hitting retirement age), and there is much discussion about community-based alternatives to institutionalized (nursing home) care (e.g., see Alderman, 2010). Most of this discussion revolves around meeting consumer demand through expanding the types of community services available (e.g., through home care, adult day health care programs, assisted living facilities, retirement communities).

It is increasingly clear, however, that these conversations about health care frequently take for granted the concept of community; they assume that the provision of services in the community, membership in a community center, or living in a retirement community will automatically create or sustain community relationships. …