“How has Mrs. Smith handled change in the past?”

This was how we predicted how well a new resident would cope with nursing home admission in 1983, when I started my career in aging services.

For the most part, this simplistic rule of thumb seemed to work, but I look back now and see that question as but an opening to a deeper conversation, one that might help any organization understand how to best adjust its own practices and environment to support an Elder new to its services or community.

And the truth is, we didn’t know what to do when the answer was, “not well.”

In our journey of culture change, we’ve examined our own attitudes, reviewed organizational practices, and analyzed the physical environment as loci for the attack on what The Eden Alternative® refers to as the three plagues of loneliness, helplessness, and boredom.

We have challenged wider cultural ageism and ableism that keep institutional models so firmly entrenched.

We are rethinking cognitive challenges and embracing new perspectives on living with dementia.

Finally, we have created a framework for well-being, which helps us map those areas essential to deepest life satisfaction, for all members of the care partner team.

I propose that there is an area of our garden that still requires tending. There is overwhelming evidence that many Elder-, family-, and employee- care partners carry within their hearts and minds and spirits painful memories and ancient traumas that, unhealed, create additional vulnerability to the three plagues and rob them of well-being in almost every domain.

Consider the child who, through abuse or neglect, is confronted with the terror of true alone-ness, of true helpless-ness.  That terror, and a host of beliefs about herself and the world, are carried throughout life and into Elderhood. They may be dormant during adulthood, and reactivated by illness, loss, or a move into a care home.

New research also shows that multiple early losses can also change our physical health across the lifespan, predisposing us to the kind of chronic illnesses we are most likely to encounter in our work as health care providers.

We are learning that these painful experiences are much more common than was previously believed, and their impact is lifelong.

What if, no matter how thoroughly we strive to create a welcoming human habitat, where people can grow and thrive, some percentage of the people who live and work there are saying to themselves “I don’t deserve this?” and they truly believe it? 

Or, no matter how carefully we train our staff, a number of Elders in our homes are feeling “I’m not safe!” (and may even strike out while receiving care)?

These are common beliefs and reflexes that come from early traumatic or painful experiences, (such as abuse, neglect, loss, or physical injuries), and they have nothing to do with the good intentions of the care partners.

The good news is that Elderhood is a time of growth, and there are a variety of approaches to address and heal painful memories during this stage of life.  As challenging as these beliefs or responses seem, they have developed as coping skills, and folks who live with them have shown amazing strength.

We see them as survivors, and learn from them as Wise Elders.

Trauma-informed care approaches ensure that your organization is responsive and attuned to the needs of people who may be vulnerable because of painful memories, (and can support your compliance with CMS Phase 3 requirements).

All trauma-informed care is person-directed and strengths-based, and in alignment with the values of the culture change movement.  

In fact, organizations on the path of culture change are beautifully positioned to create the kind of safe havens that people living with painful memories need for true healing!

Please join me on June 27th for “Trauma Informed Care: Making Peace with the Past.” This day-long workshop is being hosted by LeadingAge Nebraska and the Nebraska Culture Change Coalition.

For more information and to register: https://leadingagene.org/education-conferences/workshop-events


This blog was adapted from one that first appeared in March of 2016 in the Eden Alternative blog.

Lisa Kendall is a social work psychotherapist and clinical gerontologist with a private counseling and consulting practice in Ithaca, NY., with a focus on Aging and Elder care, living with chronic health issues, and recovery from trauma and loss. Formerly Senior Consultant for Work and Family Services at Cornell University and now serving on the Cornell President’s Advisory Council for Work and Family Affairs, Lisa is an Educator and Mentor for The Eden Alternative®, and teaches the Fieldwork course for the Ithaca College Gerontology Institute.

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