Long-term care & the human spirit.

LONG-TERM CARE & THE HUMAN SPIRIT

THE LIVING OF the days of institutional long-term care, an experience most likely to come in the latter years of our lives, is as much a matter of the spirit as it is of the body, though the body's increasing need for assistance and care is what is most attended to. My sense of spirit, derived from clinical work and my own life experience, is that there is meant to be a wholeness to the living of our days--an interconnectedness of body and spirit in daily life, which we neglect at our peril. John Dunne's (1973) concept of spirit as each human being's relationship to "all the things that have their proper times and seasons in life" provides the inclusive framework necessary for the discussion that follows.

This discussion seeks to identify the elements of daily life that deeply affect the relationship of a person to all the things that constitute the experience of nursing home living. Redirection of philosophy and practice from the prevailing task-centered care practices to person-centered, individualized care is urgently needed if those who live and work in our long-term-care institutions, as well as families and friends who visit, are all to be sustained and nurtured in both body and spirit. Further attention must also be given to nursing home as community, and new ways must be explored for expression of community life.

The interconnectedness of body and spirit that exists throughout life's journey becomes achingly direct and clear in advanced old age in the presence of chronic disease, many personal losses, and increasing dependency. Body and spirit are then enfolded, one upon another, more closely, inextricably, than at any other time of life, and the skill and understanding--or lack thereof--with which these body-spirit needs are met either strengthen or break down the spirit. If the spirit breaks, life's savor is lost, though life continues. Conversely, the simplest action, such as a gentle back rub at day's end, may bring relaxation, peace, and a sense of being cared about. Though a woman with advanced demendtia cannot communicate verbally, her caregiver notes her stillness as her back is sponged and stroked during her bath, and the two share a quiet moment of giving and receiving that approaches the quality of sacrament. As surely as the body is eased, the spirit is lightened and lifted up.

This simple example sets the tone for inquiry into the homely details of daily life in a nursing home that communicate caring and being truly cared about, that convey respect and reinforce dignity, individuality, identity, and self-worth--all those things that gladden and …