The podcast for the Eden Alternative / Green House interview Bill and I did for WXXI radio on May 15th can be found at the following link:
I am trying to wrap up my book manuscript this weekend, and came across a gem of an article that I had to add to the mix. The article is by Athena McLean, PhD, and is called “Dementia Care as a Moral Enterprise: A call for a return to the sanctity of lived time” (Alzheimer’s Care Today 2007; 8(4):360-372).
There’s a lot in there, but among the highlights is a discussion of how our institutional approach to care has become “a cult of clock time and task”. Because of our staffing needs, we break the day into shifts, and then break those shifts into schedules of tasks, to be sure that all get done. This destroys the natural flow of “lived time” that we seek in life and puts the task before the person.
The tyranny of the clock also has its effects on the direct care staff, who always feel like they are “coming up short”, because they cannot complete all the tasks as the clock dictates. Regulators tend to look at quality of tasks rather than quality of interpersonal interactions.
For people with dementia, the loss of ability to experience a natural flow is particularly disruptive. Time and task pressure is a major contributor to our tendency to view their expressions of need as “problems” that must be rapidly controlled, in order to get back to the tasks at hand. McLean shows how the institutional approach results in “completing the task, not rendering care”.
McLean is right. This is a moral issue for all of us, no matter what the care setting. There is much more than I can summarize here, but I love her quote that even when there is no possibility of cure, we must continue “validating the person, thereby allowing healing to take place”.