Yes, and. . .Embracing the Spirit-Centered Care Approach

by Sandy Sabersky & Ruth Neuwald Falcon, authors of The Elderwise Way: A Different Approach to Life with Dementia

Yes, and… does not require giving up anything. The Spirit-Centered Care approach is not an instead of all the traditional, and very valuable, ways of working with people with memory loss—it’s an add-on. When you add it to other approaches, the sum total is greater than the parts. 

In the months and years before she passed away, I got to experience this “Yes, and…” approach with my mother-in-law. Despite her no longer knowing exactly who I was, I visited her every week and, when we sat together and held hands, we could feel each other’s presence.   

Her physical and mental tools didn’t work the way they used to, which, of course, was a loss. But our time together was no less valuable because she didn’t remember it after I’d gone. Sometimes, at the end of our visit, when I was heading home, I realized that I was happier than when I arrived. This is the gift of connecting on a heart level and not being troubled by the brain’s limitations. 

Spirit-Centered Care

At Elderwise, the adult day program that I co-founded in Seattle in 1997, we call this way of being with a person who has dementia, Spirit-Centered Care. The concept that all people are whole—and that the diagnosis of dementia does not change that fact—is the foundation of what we have come to call The Elderwise Way.

We have a general societal understanding that if someone has had an amputation of a body part, the personhood, the Who are you? of that individual, their essence, remains intact. But when a disease state affects the brain, such as in Parkinson’s or schizophrenia, the question hits closer to home and we may not be as clear in our answers. Even more so with dementia. As brain function— the ability to think and remember—progressively declines, how then do we answer the question, Is this person whole? 

The Elderwise answer is a resounding Yes! Each of us is whole as we are. I am not saying that problems with the body or brain are not losses. A broken leg is a loss; an amputation is a loss; and dementia is an even bigger loss because it gets closer to one’s essence, or what one identifies as I/me/myself. 

Our essence: Our own deepest part

Part of my life’s work is to foster a broader acceptance of what happens to our minds as well as our bodies as we age. We are used to thinking of cognitive losses as being destructive of a person’s essence, but in my experience, this has nothing to do with who anyone is as a person, any more than losing a limb or an organ changes the essence of who we are. 

What I have learned over these past decades of working with people with dementia is that they are more than their bodies and more than their brains. The core or essence of who they are remains whole, always. And, with support, a person can continue to develop the heart-sense qualities of kindness, joy, and love. This has certainly been my experience at Elderwise.

Everyone has an essence—the caregiver, the person with dementia, and everyone else, for that matter. When a caregiver and a care receiver relate to one another, the idea is to do so on a heart-level. This creates a kind of deep respect and leveling of the field: No one’s essence is better than anyone else’s essence.  

We have made so much progress in the past two or three decades in recognizing that “patients” are people. Person-centered care, which makes the individual and their preferences of primary concern, is now the common approach in the long-term care community. As much as possible, people are given choices about their daily lifestyle, activities, and social opportunities. It recognizes the importance of tying the existence of a person, who currently resides in a supported living environment, to their former life, by keeping the fabric of their lives as intact as possible.

We are all whole

The Elderwise Way takes this one step further by adding the concept that we are all whole and recognizing the value of working consciously from our own essence while being aware of the essence of others. Having this kind of approach informs and enriches everything we do. 

When we do our work from a place of being in touch with our essence, we are working from our own deepest part. Whether you are serving tea, helping someone in the restroom, or communicating with another staff member, you always have the potential to be working and moving from your own center, your own core. When working in this manner, your actions are in alignment with your thoughts, values, beliefs, and your own deepest truth. Work becomes a life-affirming way of being. This awareness makes for a positive and enriching experience in which one can practice and progress in one’s personal growth, while caring for another. 

While one’s actions may differ only slightly when one carries this attitude, I believe this respect is felt in all interactions in subtle and important ways. Experience supports this belief; it is what I have witnessed in the Elderwise environment. We help participants understand that, in their core, they aren’t less than, whatever their intellectual losses. Some are aware that those losses are impacting them yet being valued in this way causes them to sit up a little straighter and express themselves with more confidence as they share their opinions, paint or joke around.

The Elderwise philosophy aims to counteract the everyday reality that often those with declining senses or reduced cognition isolate themselves. They feel that it’s safer and more comfortable to stay home, maybe even to sleep or to shut down by watching endless hours of television. This isolating experience is self-perpetuating: it can make one more closed, fearful, and unwilling to try new things. Instead, by acknowledging the essence of each person and treating them with a deep respect, people are drawn out of their isolation and feel free to express themselves as fully as possible. It’s amazing what happens when folks don’t feel limited by the judgments of others! 

I have heard people say, about a person in the later stages of dementia, “There is no one left inside. There’s nobody home.” But, in my opinion, while there’s life in the body, that essence is never gone. 

Co-authors of The Elderwise Way: A Different Approach to Life with Dementia, Sandy Sabersky and Ruth Neuwald Falcon, along with Educational Specialist Elisabeth Mitchell, are currently producing a series of video training modules for caregivers based on the book. Learn more about Elderwise at www.elderwise.org. To receive notification about when the modules will be available, send an email to info@elderwise.org. The book is available on Amazon or through local booksellers.