In my previous blog, I looked at the concept of relational care – creating a network of support based on mutuality of affection, knowledge, and acceptance – and proposed that: ‘Rather than focussing on restoring ‘independence’ without looking at its implications, social care should be directed towards re-creating agency and autonomy, enabling contribution by ensuring mutuality in the care setting …. and recognising the importance of meaning and purpose in life.’
In my most recent book (1), a range of models that enable relational care are described, and their impact analysed. It is so important that evidenced theory of this type can be seen working in practice, giving ideas and inspiration, and proving what is viable and achievable in financial, operational and human terms.
To give an overview, the models presented can be broadly categorised as: (a) indicating the factors in residential settings that favour relational care; (b) adapting the concept to community/day care settings; (c) new approaches that introduce different, positive dynamics; and (d) innovative technology. Given the number of venues and providers involved in researching the book, it’s only possible to offer a small number of practical examples in this blog, but hopefully they do give some flavour of what to consider in various circumstances.
Firstly, where residential care homes are concerned, the idea of ‘family life’ in terms of the security provided by mutual knowledge between members and their easy daily interaction offers a benchmark for improving physical, mental and spiritual wellbeing of all concerned. It appears (from extensive interviews) that there are certain factors which are frequently mentioned as promoting this model. These include but are not limited to: the avoidance of purely task-based planning; recognition of and respect for individuality; regular shared meals of high quality; and the nature of the physical environment (2). When these enabling factors are present (and it should be noted that they are greatly influenced by the guiding philosophy of the management at all levels) they help create an environment based on love, in practical, definable ways.
Secondly, can these factors be taken into consideration when providing domiciliary or community-based team care? There are good examples of how this can work and the main points to note are, that ways must be found to ensure continuity of care relationships with the team while at the same time helping older people to extend their relationships into the wider community. This means that the care team should be small, closely integrated, mutually supportive, multi-skilled and embedded in the local community so that adults receiving social care are well known to the team as individuals, and can be encouraged to contribute to, for instance, clubs, interest groups and their immediate neighbourhood. A pioneering example was the Neighbourhood Cares project run as a pilot by Cambridgeshire County Council (3). Their experience is now informing future planning.
There are a number of comparatively new approaches to care provision that involve looking afresh at how people can be given increased autonomy and opportunity to be a more active member of their community or family. For example, the Montessori concept of engaging and empowering, which has a long record of success in childhood education has been adapted to dementia care with provable beneficial impact (4); and intergenerational models are now – thanks greatly to the work of United for All Ages (5) – to be found in many situations and localities. Bringing together children, younger and older people can be life-changing, but must be done with care and thought to ensure that the relationships formed have a degree of longevity and fully recognise the needs of all involved.
Finally (for now), innovative technology can be either the friend or foe of relational care. There is a plethora of technologies for later life living, from remote monitoring to robotics; from mobility assistance to telecare. It is vital that these are not just introduced to meet a single isolated problem but are considered as a suite of possibilities, trialled in their intended combination. And equally important that there are rigorous questions during the trial: are they helping the older person to communicate more effectively or undertake daily living tasks such that they gain confidence and can relate more to family and carers? Or is technology creating a barrier to relationships by providing the sort of help that should ideally be given by another human being with love and attention? Is innovation opening new doors to living more fully and relationally?
- Making Relational Care Work for Older People: Exploring innovation and practice in everyday life (Kartupelis, J, 2021, Routledge: London and New York)
- See ibid. pp 79-81 for some guidelines about creating a favourable physical environment during new build or conversion
- See ibid pp 39-44
- See ibid pp 86-93 and also the web site https://www.mariamontessori.org
- Find more about their work and get inspiration at https://www.unitedforallages.com
Jenny Kartupelis
Author of Making Relational Care Work for Older People