Carole lived for many years in a beautiful home with a large garden; at 5am every morning before work she would lovingly tend to it. Her vegetable plot backed onto The Lawns Care Home next door. When Carole retired she had more time to spend in the garden, and she began sharing her love and expertise with the home’s residents as a volunteer. Indeed, two of the beautiful trees that flank the Home’s driveway were planted by Carole a few years ago.
When Carole showed signs of frailing in older age, her relationship with the Home evolved from volunteer gardener to visiting most days for her own respite care. Carole enjoyed having meals with the residents, and staff were able to subtly ensure Carole’s basic (nutrition, hydration, personal hygiene, mobility) needs were being monitored. Her pride and sense of independence was easily maintained by the fact that she went back home, across the garden path, each afternoon. Eventually, Carole’s dementia meant that she was no longer taking good care of herself, and reluctantly agreed that she needed full time care. The move was heart-wrenching for her. Now her home and the garden that she tended to for so many years, was someone else’s property. Yet there it was, tantalising her, just a few metres away. Carole’s shift to a ‘permanent resident’ status, impacted her emotional wellbeing significantly. She struggled to build relationships with the staff and other residents, and at the time I met her, she spent most of her day either in her room, or in the communal lounge watching a large telly. Rarely was she reported to be in a good mood.
Having no next of kin, it was Carole’s Attorney that brought in Plan with Care, several months after her moving in, there were no signs of Carole ‘settling’. If anything, there were signs of deterioration with low mood, poor hygiene and regular infections.
One of the assessment tools used by the Care & Wellbeing Consultants at Plan with Care draws upon Tom Kitwood’s Five Psychological Needs model: Occupation, Identity, Comfort, Inclusion and Attachment. In Carole’s case, it was clear that her need for Identity and Occupation were largely unmet. Despite the staff’s efforts to try and connect with Carole she kept herself to herself, and even the best care homes in the world do not offer bespoke one-to-one care as standard, which we felt was needed to break through Carole’s depression-like symptoms.
A person’s sense of ‘identity’ comes from a vast, complex web of elements from your life experiences and your personality. Something as simple as your name, through to the variety of roles we all have. For example, one person might identify as a wife, mother, daughter, GP, gardener, runner, and pianist. And so on.
Separate, but certainly connected to this, is our need for Occupation. This is not simply about keeping busy taking part in any activity, or our ‘job’ – although work can play an important role – but a deeper, existential sense of purpose, the answer to ‘Why do I get up in the morning’? To satisfy this need, we must take part in meaningful activity. Carole got up in the morning for her garden, both in a philosophical and a literal sense; yet the closest she now got to gardening was watching Alan Titchmarsh!
Plan with Care introduced Carole to a new ‘Creative Companion’ called Sarah, a florist and landscape gardener. (For more details on the introduction approach, which included a recreation of the Sound of Music, please see our blog “The Sound of Music” sparks harmony and happiness
Following the introduction, it was arranged that Sarah would visit Carole twice a week for a couple of hours each session. Building upon their musical experience, Sarah then used her knowledge of Carole’s love of gardening (and fashion) to further develop a real friendship. Carole never asks Sarah about how and why she began befriending her, and while it seems clear that Carole is aware that Sarah is ‘paid’ or there on some level, in a professional capacity, their mutual love of gardens means that there’s plenty of genuine connection between them.
If they’re not planting seeds and flicking through gardening magazines together, they’re out visiting garden centres and sampling the array of excellent tea shops in the local area!
As always, psychological needs and physical health needs are interlinked, and as important as each other. There is little point in being physically healthy, but miserable!
Now that Carole’s psychological wellbeing has improved, so has her personal hygiene, fitness levels, along with a radical decrease in the number of infections she was experiencing. In short, Carole now has something to live for.
Do you know someone receiving care that may benefit from an enhanced approach to care, beyond the basics? It might be that they’re well cared for in terms of their hygiene, nourishment and medications, but do they have a sense of purpose, a source of joy in their day-to-day existence? Plan with Care has the resources and expertise to provide a holistic assessment of an Individual’s emotional, physical and environmental wellbeing (along with financial and legal if you wish), including a list of interventions that will improve the person’s quality of life. The report you’ll receive will enable you to implement these suggestions yourself, or arrange for our support, as preferred.
Do get in touch if you think we can help.