Embracing a model of elder living in religious communities: Medical or social?

Is the residence where your elder members live a home? Or is it an institution where they receive care?

Historically, as elders in religious communities have required support or assistance to accommodate their changing physical or cognitive needs, they have been institutionalized. The primary purpose or objective of the long-term “care” facility (infirmary) or healthcare center has been to attend to the physical healthcare needs of those who are frail and infirm.

What has been overlooked, in many instances, is that the facility is first and foremost a home to those elder, frail, and infirm members. In many communities, the facility is where members entered and were formed; it is where they return for celebrations and gatherings; it is where they come to visit friends living there; it is where they return to live (often reluctantly) when they need support.

A question asked with greater frequency today is, “How can our facility or the residence of our senior sisters be a place that is focused on enhancing the quality of life and well-being of those members who live there?” The answer lies at the heart of the distinction between the medical and social models of support.

The medical model of care

You know that you have a medical model if…

• Assessments focus primarily on medical needs and fail to consider the whole person
• A plan of care is developed without the involvement of the individual
• Showers are determined by room number or the available time slot open on the assignment sheet, staffing levels, or staffing schedules
• Shower or bathroom design does not promote independent use (requiring the assistance of an aide) when with another design this assistance would not be necessary
• Meals and snacks are served at specific times, with limited choice and access to refreshments throughout the day

The medical model can be described as one in which we can accurately assess, diagnose, and provide appropriate clinical treatments. It is the fundamental teaching in medical schools and nursing programs throughout this country.

For many years, this model alone was used to address the needs of the frail elderly in long-term care settings. It still plays an integral part of care; however, the philosophy related to elderhood and the systems of support and care delivery has evolved to recognize how this approach may limit the dignity and very essence of personhood for individuals residing in senior housing rather than enhancing their life and well-being.

The social model of care

You know that you have a social model if…

• Decisions regarding how living will be supported are initiated by and developed with the individual, maximizing self-determination and sharing responsibility
• Assessments are focused on promoting strengths and abilities that are still evident in consideration of the unique social, spiritual, emotional, and medical needs and preferences of the individual
• Specific life patterns and preferences are honored by ensuring flexibility in staffing and programming that is focused on meeting the needs of the residents rather than being primarily task-oriented
• Environmental design throughout the residence promotes independence through adequate adaptions, just as it allows for privacy

The social model engages the individual as a valued member of the community who maintains purposefulness and connection to mission and community life. It is consistent with the understanding that religious sisters live in support of the mission throughout their lives with whatever strengths and abilities they have. It is consistent with religious life: a life lived in community and in support of one another. It is consistent in engaging all members so that they may remain an integral part of the life and mission of the community.

Adopting the social model to improve well-being and quality of life

In order to foster this approach, it is necessary for a relationship to be nurtured between the individual member and the support staff assisting with and attending to the individuals’ personal care needs. This is the foundation for supporting the individual holistically.

Through ongoing education and development, staff and residents develop a mutually valued and respectful environment, promoting self-determination and dignity. Staff achieve this through getting to know and understanding the individual beyond what her physical care needs are. Staff should continuously create the opportunity for meaningful interaction and connections. The social model recognizes the limitless value of honoring the person and those who support them.

A comprehensive approach to integrating psychosocial, spiritual, and medical services — as reflected in the social model — enhances the quality of life for members and enables them to continue to participate in the life and mission of the community. Successful implementation of this model will result from viewing residential life, facility operations, and the physical environment through the eyes of the individuals in the residences and then serving accordingly.

Our Religious Institutes team has helped many religious communities elder care and member well-being initiatives. We would be glad to help your community as well. Please reach out to us with questions.