The Effects of Pseudopositive Attitudes
Click here to read Brian's column "Gerotalk" on the ADVANCE for Long-Term Care Management Web site.
All too often care provided to many older adults is offered in a manner that may be viewed as positive. In many long-term care facilities those that provide care are often taught to assist older adults to an extreme. After all, nursing care centers are established for the provision of care, frequently to an elderly or frail clientele that needs considerable assistance with their activities for daily living. In fact, one of the major tenets that individuals often think is essential for quality care is engaging in paternalistic intervention. A common misconception is that there can never be enough care provided. Although many of use are aware that there is numerous long-term care facilities that have failed in providing sound quality care at an optimal level, more care does not always mean better care.
I have to be careful in advancing this argument because some many take this out of context. I am not saying that nursing care facilities do not need high quality care at an optimal level. In fact, throughout the United States, most facilities still need considerably more improvement in the area. However, excessive and paternalistic intervention can be detrimental to the elderly, much like a smothering and overly protective parent who fails to allow their child to develop secure attachments and independency. Furthermore, just like a smothering parent who fails to let their child foster a level of emancipation necessary for optimal growth, a smothering caregiver can thwart the development of the elderly as well.
One of the major regulatory requirements that are found in long-term care deals with quality of care. The quality of care requirement states that,
"Each resident must receive and the facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial wellbeing, in accordance with the comprehensive assessment and plan of care."
This requirement is the hallmark for providing optimal care with the intent to enhance the wellbeing of the individual and prevent nursing care residents from avoidable regression in their physical, mental and psychosocial wellbeing. Although the word optimal is not found in the regulation, the intent for optimal care is nevertheless implicit in the regulatory requirement. Therefore, one has to understand that optimal care is also the provision of care that fosters a personal independence and avoids feelings of learned helplessness and feelings of inefficacy.
So what does all of this mean? Paramount in our understanding of providing necessary care is that intervention should be tailored to appropriately target the needs of the residents. Just as too little care can be detrimental to the wellbeing of the individual, so can too much care. It has been found that providing excessive intervention can lead to elderly regression. Providing too much assistance actually can lead to the reduction in the nursing home resident's ability to remain independence as well as establishing feelings of learned helplessness, where the resident feels that they fail to have full control over their lives. Furthermore, it has also been found that many individuals who are provided with excessive levels of care actually have lower levels of self-esteem, frequently due to lower levels of self-efficacy.
Not only is excessive physical intervention potentially problematic, but also the all to common verbal paternalism that is found in many nursing care facilities is a problem as well. Two types of verbal paternalism called "overaccommodation" and "baby talk" are frequently found in nursing care facilities. Overaccommodation happens when caretakers will speak louder or even slower, attempting to over accommodate for what are viewed as perceived deficits found among the elderly. Baby talk is a simplistic speech pattern that is often used toward the elderly, similar to that which is found when parents speak to their young children. Both types of speech often fail to take into account the concerns of the elderly and often inculcate into the older adult a feeling of inefficacy. Furthermore, these speech patterns are driven by stereotypes that are held by caregivers, viewing the elderly as being unable to understand what is best for them and therefore in need of paternalistic oversight.
These problems fall under what can be conceived as the caregiver's pseudopositive attitudes toward elderly care. What this means is that although many caregivers actually view this type of excessive intervention or paternalistic speech patterns as positive, in reality they may be doing more harm than good. However, this pseudopositive attitude is not only found among caregivers, but the public in general, and it reflects the endemic ageism that is found among the elderly in our society. Most individuals would fail to see anything wrong with excessive care and paternalistic speech, viewing it as properties of perceived "good care." Moreover, most would agree that given the amount of negative exposure that nursing care centers have received for substandard care, excessive care and intervention should be lauded. However, as was mentioned, extremes on both sides of what is optimum is potentially problematic and can have negative consequences for the quality of care that is rendered to the elderly resident.
Therefore, it is necessary to look at the provision of optimal care. Care that is optimal should not only focus its support to fulfill the needs that elderly cannot provide for themselves, but also nurture the independence and control that currently exists in their lives. Furthermore, caregivers have to be aware of their pseudopositive attitudes toward caring. They have to be aware that what they perceive as being positive may in fact hold negative consequences for the elderly. Although paternalistic attitudes and interventions are often viewed by caregivers and society as positive, being sensitive toward the negative consequences that these behaviors and attitudes may hold, as well as being sensitive to how ageism drives many of the perceived positive attributions of pseudopositive care will enhance quality care in the future.