More than 50 elderly people reside in the San José Home of Messengers of Peace, most of whom are very long-lived. There are residents who have been with us for more than a decade and some have been with us for more than two decades.
Many times we ask ourselves … what is it that keeps them alive and in good psychophysical health? We have realized that there are fundamental pillars: love, respect for their rights, freedom, laughter, singing, good humor, volunteering, frequent institutional visits and family support. Although not everyone has a family, this is compensated by the families of the residents who do, by the volunteers and by the Hogar team. The fundamental paths are hugging, close talk, holding hands, singing together, among other activities.
The elderly person is a bio-psycho-social and environmental being: mental health is also important
Physical health is important, as is mental health. We conceive health care in an integrated way. For our interdisciplinary team, the elderly person, like every human being, is a bio-psycho-social-spiritual and environmental being. We cannot separate these aspects: if we only treat one, we neglect the others. Our medical and nursing team works with great care in the care of the resident’s physical health, but it does so in absolute coordination with the other professionals of the interdisciplinary team, because each human being is one and indivisible. In this sense, mental health is also just as important as physical.
Spiritual support is also important. For this reason, we organize spaces for reflection and prayer, supported by the team and by the priest who frequently gives Masses on weekends or special occasions. Our Home is ecumenical, all beliefs are welcome as long as they do not hurt others. Why do we rescue spirituality? Because we believe that it can be of great support when facing crisis or loss situations.
The importance of the environment
And the environment? The residence is not only physical, it is also the music, the colors, the decoration, the kiss in passing, the «I love you», the painting of nails and makeup, or the ‘behave well’ of the team so that they laugh and answer that they will think about it. The atmosphere is to sing bingo and a partner saying the route of the group that corresponds to each number. And another colleague saying the dreams to which the ball that came out corresponds.
San José Home in times of pandemic
And now, we are in times of pandemic. The Home has been transformed. It moves, it changes continuously. One day is not the same as another. What we plan today for tomorrow, perhaps tomorrow will have to readjust to a new reality. In the team we say “let’s go minute by minute”. We follow protocols, which have notably modified routines. Residents have had to adapt to new spaces for circulation, reading, and recreation. Suddenly, they no longer eat together, but instead maintain a considerable distance, which in many cases represents not being able to communicate verbally, due to hearing problems.
Until recently, our team gave face-to-face courses on caring for future caregivers of the elderly. And we told them: caring is not overpowering, it is not overprotecting. Caring is respecting the history and idiosyncrasies of the other and based on it, proceed. Caring is respecting the other person’s right to choose how they want to be cared for. The caregiver does not have absolute authority, he / she has responsibility in the care, but not full decision about the other / a. If this were the case, the person cared for would remain instead of object and not subject.
Today we ask ourselves in the team: how to continue in care? Are we caring? Or are we overwhelming and overprotecting? There are many residents who tell us, will I see my family again? But not because they don’t understand the situation. They understand it very well. And they explain it to us “I am over 90 years old. Two months in my current life is not the same as two months in my past years. I’m closer to leaving ”. And from there comes the question «will I see my family again?» As a team, do we have the right to
restrict the match? However, the protocol indicates this to us and we comply with it.
So, we think about the consequences of what would be an emotional deprivation, that is, a form of psychological abuse that implies not being emotionally cared for in an adequate way, considering the age. We implement all our tools so that this does not happen. Our residents tell us: they require bonding with their affections. And we are not being able to supply the hug, so necessary at this age as at all times in the course of life. They hardly recognize us with our caps, chinstraps and masks. Our faces are blank under so much gear. To try to respond to these needs, the healthcare team carries out action plans based on virtual modality workshops, articulating with public universities, video calls to relatives, a team of volunteers who call in a scheduled way, face-to-face workshops of the professional team, activities recreational, music, etc.
The scope of the protocols
Obviously, we are not questioning the protocols; they have a purpose and are made by experts. What we are saying and questioning is its scope. Until where. Or put another way, what they leave out. In this sense, we consider that the limitations of the protocol are many from the affective level.
One of the forms of abuse is isolation. Which consists of avoiding maintaining and taking advantage of social relationship opportunities in a positive and active way. This type of abuse can lead to depression and anorexia nervosa, for example. The protocols must be adapted to the vital circumstances of the elderly. They and they claim us. The family of the elderly is their source of support, it is the most important system of effective support to face the losses that aging brings. And one of the biggest risk factors for depression in older people is the feeling of loneliness.
If they interpret it as a lack of affection, affection and love on the part of relatives or close people, the affective desire and fear of loss or being abandoned could increase. This situation, signified as affective deprivation, leads to loss of interest and pleasure, causing emotional, physical and social instability. And leading to a possible depressive condition or a conduct
disorder that are nothing more than desperate requests for help, due to the deep pain that would be experienced.
The task of residences and homes
What happens then in long-term residences? Relational spaces have changed. Physical spaces are shared, with distance. But the distance has also become emotional and bonding. This situation increases the vulnerability to develop psychological disorders.
This situation does not occur in all residents, obviously. There are those who are more resilient, have more personal resources and protective personality factors that allow them to better cope with the circumstances we are experiencing. But there is a small group that has been notoriously affected. And for them and for them we are working tirelessly to implement all the interventions that are within our reach and reverse these situations.
And beyond our continuous work, we want to express, in this writing, the relevance of contemplating a work plan that contains an integrality in the view of the emotional and social plane in complex contexts. In this sense, we consider that it is important that all areas that make up the human being can be integrated, in which the Rights of the elderly and Rights in general are respected.