The practice of dealing with existential questions in long-term elderly care

Wander Van Der Vaart,Rosanna Van Oudenaarden

doi:10.1080/17482631.2018.1508197

Abstract

ABSTRACTPurpose: Existential questions concerning life and death or meaning in life are very salient for many older people receiving long-term care. However, little is known about how long-term care organizations deal with existential issues. This study describes the practice in two long-term care organizations that took part in a Dutch pilot programme on existential questions and formulates recommendations for building a professional quality framework. Method: Starting from theoretical notions on ultimate concerns, life events and meaning in life, organization policy and care practices were explored. Existing documents, in-depth interviews and participatory observations were used as data sources. Results: The outcomes indicate that the long-term care organizations had little active policy on dealing with existential questions; also, personnel had few specific tools except listening closely. Central requirements for dealing with existential questions appeared to involve organizational framework conditions like the availability of spiritual counsellors, having facilities in the building, and clear roles for various actors. Moreover, social-communicative competence building for care personnel was found to be an important demand as well as an organization-wide attitude that puts residents at centre stage. Conclusions: A professional quality framework requires a “tiered system” that differentiates organizational roles in dealing with existential questions.

Highlights

For a number of years, existential questions have been increasingly recognized as a central issue in elderly care and, as such, have been the topic of a growing number of studies (e.g., Gijsberts, Van der Steen, Muller, Hertogh, & Deliens, 2013; Kane et al, 2003; Lee, 2002; Morgan & Farsides, 2009; Nolan, 2011; Orton, 2008; Paley, 2008; Sussman & Dupuis, 2014)
Several main themes emerged on how the longterm care organizations and their personnel dealt with existential questions
The care personnel mainly cope with existential questions by listening

Summary

Introduction

For a number of years, existential questions have been increasingly recognized as a central issue in elderly care and, as such, have been the topic of a growing number of studies (e.g., Gijsberts, Van der Steen, Muller, Hertogh, & Deliens, 2013; Kane et al, 2003; Lee, 2002; Morgan & Farsides, 2009; Nolan, 2011; Orton, 2008; Paley, 2008; Sussman & Dupuis, 2014). In spite of its practical importance, little research is available regarding the role of meaning in life in longterm care practices It can be expected, though, that especially for older people with chronic conditions, as in long-term care institutions, issues of meaning in life. The present qualitative study was designed to inform the development of this national quality framework and aimed to generate knowledge that could support long-term care institutions to deal with the existential question of their older residents. To that aim it involved collaboration with the Dutch Expertise Network Meaning in Life and Elderly and its constituting branch institutions and related long-term care organizations. We discuss what lessons can be drawn for designing a professional quality framework for this care domain

Objectives

Methods

Results

Discussion

Conclusion