In the case of a person living with dementia or an Alzheimer’s diagnosis, the traditional approach involves an individual living in a secured, long-term group-home-like setting that practices a ‘one-size-fits-all’ approach to resident care.
Often, meals, activities, and care are provided on a defined schedule, offering little room to accommodate an individual’s needs, wants, and desires. Care plans are developed by the service provider, possibly with some input from the resident’s family members.
Movement within the community may be limited to a specific floor or secure area of the building. Overall, the focus can often be on the limitations created by a person’s diagnosis rather than a person’s continued abilities, passions, and desire for independence.
Enter: Relationship-Centered Care
United Active Living, an older adult community in Calgary, Alberta, Canada, has revolutionized memory care with its United Minds program.
The United Minds team approaches memory care holistically — offering empathetic care that focuses on each individual’s wants, needs, and abilities — and in the process, nurturing a trust-based relationship that has an overwhelmingly positive impact on the individual’s well-being.
There are no locked floors or units in United’s communities. Nor are there restrictions on living with a partner or friend. There are no set meal times, assigned seats or required schedules, or mandatory enrichment activities.
Importantly, there are also no labels. Residents who do not wish to participate in activities or adhere to a group schedule are not associated with negative terms such as “acting out,” being “difficult,” or “aggressive.” Instead, residents are seen as having potential unmet needs; they are empowered to choose how they respond to their environment, and their choices are supported by the United Minds team — a group of specialized professionals.
The results speak for themselves. Those experiencing cognitive decline who live in an integrated community have more opportunities to connect and socialize with residents of all abilities, pursue their interests and passions, and contribute to the community in their own unique ways. Inclusion and integration in a community provide every individual with a sense of purpose and value and leads to better outcomes physically and mentally throughout an individual’s journey with memory loss.
“Balancing the risks and benefits of support options through a dementia diagnosis is just that — a balancing act,” says Amy McDonough, Executive Director of United Active Living’s Fish Creek community.
“Because every person’s journey is unique, that balancing act should likely look different for each individual. Using broad strokes to mitigate risk and focusing solely on safety issues can be a source of resistance. It can also have unintended consequences for a person’s mental and emotional well-being.”
“I have worked as a nurse for years, and previously thought assessing medications and collaborating with colleagues on a care plan was the definition of relationship-centered care,” adds Kera Redlack, RN and United Active Living’s Vice President of Wellness and Employee Engagement.
“When I came to United Active Living, I realized this traditional approach was leaving the resident themselves out of the conversation. At United, residents and their caregivers are directly involved in care decisions, empowering the people most impacted by care to have the choice and voice in their day-to-day care.”
Is Relationship-Centered Care Right For Your Loved One?
United Active Living managers Victoria Janzen, United Active Living Fish Creek, and Stephanie Herits, United Active Living Garrison Green, answer some questions about relationship-centered care to help you determine if it’s a suitable model for your loved one.
Q: What is relationship-centered care, and how is it different than other dementia care models?
Janzen:
“Many care models highlight a person-centered care offering; this often involves a team developing tailored care plans based on the care team’s knowledge and expertise. Relationship-centered care goes a step further: care developed with the individual – not just for them.
“Relationship-centered care focuses on more than just the individual by considering the entire network of relationships connected to that individual such as family, friends, and care team.
“Relationship-centered care looks like a team working closely with each individual and their families to develop customized care plans designed to nurture strengths, interests, and goals rather than limitations. It also focuses on building relationships to foster a sense of trust and respect.
“Other dementia care models focus on an individual’s medical diagnosis rather than looking at the individual from a holistic perspective, including their interests, preferences, and life experiences. Relationship-centered care aligns closely with the social model of dementia care by emphasizing an individual’s strengths and existing abilities beyond a medical diagnosis.”
Q: How does United Mind’s care model work, and what makes it innovative?
Herits:
“The United Minds care model means team members spend a great deal of time getting to know the individual closely by learning about their interests and what’s important to them. The United Minds team also works closely as a liaison with individuals and their families and care providers to ensure continuity of care. We encourage independence for residents and promote freedom of choice as much as possible.
“An example of this is promoting residents’ ability to choose when they would like to come for a meal and where they would like to sit rather than having set meal times and established seating arrangements. United Minds impacts an individual’s quality of life by providing an environment that promotes autonomy — one that is engaging, enables choice, and promotes equity.”
“United is a blended community, which means people are not separated based on their care needs. United communities are purpose-built to support integration – there is no separate area or secure floor for residents living with dementia. Experiences, programs, spaces, and social interaction are equally accessible to all, which provides continued opportunities for shared meaningful moments and social inclusion among all residents and team members.”
Q: What benefits does relationship-centered care offer people living with dementia?
Janzen:
“People living with dementia are the experts in their experience; relationship-centered care offers a distinct and intentional way for their voices to be heard so their wants and needs can be honored.”
Janzen offers a list of ways relationship-centered care benefits those living with dementia:
- Reduced stigma: “All residents are given the opportunity to participate in programming and experiences within the community reduces stigma related to cognitive impairments.”
- Enhanced dignity: “Individuals are offered a greater sense of dignity by being actively involved in certain choices and decisions involving their care.”
- More trust: “A focus on relationship-centered care means stronger, more trusting relationships can be built between the resident and their care providers.”
- Sense of individuality: “A relationship-centered care model treats individuals like community members rather than just a patient and honors the individual’s life story and experiences rather than just focusing on a medical diagnosis.”
- Opportunities for personal growth: “This type of care model recognizes that individuals living with dementia have continued capacity and interest in opportunities to learn and grow.”
Q: What benefits does relationship-centered care offer caregivers?
Herits offers a list of ways relationship-centered care benefits caregivers:
- A supportive community: “A team working together with the resident offers a sense of community and support amidst the feelings of stress, isolation, and frustration common among caregivers.”
- Trust: “Caregivers have an opportunity to build strong relationships with the care team, which means a higher degree of trust in how their loved one is cared for.”
- Better relationships: “Loved ones can more easily focus on the emotional aspects of the relationship rather than the practical tasks of caregiving.”
- Peace-of-mind: “Caregivers find comfort knowing their loved one is receiving care tailored to them.”
Q: How are family members and caregivers involved in helping build their loved one’s care plan?
Janzen:
“Yes — family members and caregivers often know their loved ones best. They provide invaluable insights into unique ways of supporting the resident. For someone to successfully transition to a United Active Living community, it’s important for the goals of the resident, family, and care providers to align to ensure the resident can live well with appropriate support in place.”
Q: How can someone find facilities that offer relationship-centered care?
Herits:
“Ask questions: How does the team establish and develop relationships with residents? What is their philosophy surrounding dementia care?
“Ask about how care plans are developed. Who is involved? What are the goals of the care plan? How does a care plan take shape? Inquire about the community’s values and what steps they take to ensure a safe and respectful environment.
“Tour the community. What do interactions look like between residents and team members? Can you observe familiarity and signals of trust? Does community design promote integration, or are residents separated by care needs? Can couples continue to live together? Observing the community residents and team members in action can be the best indicator of whether or not a community that promotes a relationship-centered model of care actually employs it day-to-day.”
Q: How can people bring elements of this care model into their own homes if they’re not in Canada or their local area doesn’t offer it?
Janzen:
“Elements of relationship-centered care can be incorporated into someone’s home by continuing to individualize the care for each person and building trusting and authentic relationships with them and their support network.
“With relationship-centered care, the individuals providing the care get to know the person and their needs and preferences, all of which can be done within the home with a shared focus on providing individualized care aimed at building trusting and authentic relationships.
“The relationship-centered model of care directly supports continuity of care by emphasizing the importance of community and trust with all involved: the individual, care partners, family, etc. Continuing to communicate effectively with individuals about their care is the best way to understand what they need and what is important to them.
“Respectful relationships will encourage autonomy for the individual living with dementia—having a choice whenever it is safe will give the individual the sense of independence and inclusion in decisions regarding their care plan.”
