In understanding what it is that makes life living - perhaps answering a big part of "Who Are We? and Why Are We Here? the topic of Well-Being comes up.. I helped create and coordinate a Study Group back in 2005 that looked deeply into this definition. Given the continued increase in the amount of Elders ("Sages") in the U.S. and in developed countries around the world, and given my current "Soap Box" priority relating to turning around the way our Sages are viewed and treated from Objects to Untapped Resources, the results of this Task Force seem even more relevant today. Here it is:
A Measure of Well-Being
“When we love a woman we don’t start measuring her limbs.” Pablo Picasso
So, Picasso, what do we measure? What is quality of life, and what is true caring?
A task force was put together in 2015 (with funding help from the Centers for Medicare and Medicaid) by the Jefferson Area Board for Aging (JABA) in Charlottesville, VA, represented by Arthur Rashap and the Eden Alternative (founded and lead by William (Bill) Thomas, M.D. The full roster of the task force is listed at the end of this memo.
Eschewing the declinist’s view of aging, the task force worked from the perspective of ‘old age’ as another stage of human growth and development. The ultimate outcome agreed upon was WELL-BEING. For Elders to fully achieve all aspects of well-being, it is contended that their families, friends, organizations, and ultimately the communities they engage with need also to be experiencing it.
Well-being (n.) a contented state of being
Well-being is the path to a life worth living. It is what we all desire. It is the ultimate outcome of human life. So what are the components of well-being? What do we need to experience contentment? The task force identified seven primary domains of well-being: identity; growth; autonomy; security; connectedness; meaning and joy.
The Domains of Well-Being:
Idenity: being well-known; having personhood; individuality; wholeness; having a history.
Nothing exists without an identity. The objectification of elders strips them of their identities, leaving them virtually unknown and vulnerable. When an Elder is ‘sentenced’ to long-term care, when she is no longer in her home or is there without a support system and is lonely they face
non-personhood. Identity becomes murky because she no longer has a special bond with a place that held a significant personal meaning. There can be a pervasive sense of uprootedness and non-belonging as well as confused feelings about self and identity. This sense and feelings has a end result of finality as one’s roots, the objects relating thereto, and memories attached are actually severed. One’s own identity, history, life and feelings of self are essential components of well-being. Without this, our Elders ‘cease to exist.”
· Growth: development; enrichment; unfolding; expanding; evolving.
Conventional wisdom in our modern, industrial society regards aging as a process of decline. The prevailing attitude centers on mitigating that decline. As Barry Barkan, the cofounder of Live Oak put forth:
An Elder is a person who is still growing; still a learner; still with potential and whose life continues to have within it promise for and connection to the future.
Longevity gives forth its own promise and potential. Our Elders should be regarded as “Sages.” That is the learning that history gives us – that for centuries Elders were regarded as ‘wise,” as respected, as ones who have been formed into councils where advice could be sought and directions pointed out. Acknowledging this wisdom and the continued growth that these millions can and should have can open the door and the treasure chest that this untapped resource can provide.
· Autonomy: liberty; self-governance; self-determination; immunity from the arbitrary exercise of authority; choice; freedom.
Simply put, to be autonomous is to be one’s own person. It is to be respected for one’s ability to decide for oneself; to control one’s life; and to absorb the costs and benefits of one’s own choices. Lacking autonomy, as children do, is a condition which allows or invites sympathy, pity, or invasive paternalism. When decision-making is surrendered to another – in whatever setting it may be, and particularly in a long-term care situation – and for the sake of ‘efficiency’ or economics – when personal choices of what, when , where, how much, and in what order are controlled by others, the life is squeezed out of autonomy.
· Security: Freedom from doubt, anxiety or fear – safe, certain, assured, having privacy, dignity and respect.
Abraham Maslow theorized that human being are motivated by a hierarchy of needs and that certain lower needs must be satisfied before higher needs can be fulfilled. For example, safety needs – the security of home and family freedom from fear and anxiety – must be satisfied before we can grow toward self-actualization.
When an Elder is ‘objectified’ – whether in long-term care or when she is subject to situations that create fear or uncertainty in her own home situation – security in this sense expands beyond the basic need for safety to also include a right to privacy, dignity and respect. Being in a community where she is known and knows the others who she will be involved with, creates a sense of peace, eliminates fear, doubt and anxiety, and leads to the ability to move on and grow.
· Connectedness: State of being connected; alive; belonging; engaged; involved; not detached; connected to the past, present and future; connected to personal possessions; connected to place; connected to nature.
Studies show physical and emotional benefits to staying connected with loved ones and with one’s environment. As we age, many connections can be lost – we retire, spouses and friends die, children move away, we don’t get out as much – all of these place us at high risk for feeling disconnected. The risk increases dramatically for those in long-term care or those alone in a home setting. Separated from family, having no or few friends, unable or unwilling to participate and enjoy what filled her life in the past, the present reality becomes endless days of boredom, helplessness and loneliness. As this state creeps into her spirits, she may disconnect eompletely from the physical and social environment, leaving a shell of a human slumped over in her chair.
Meaning: Significance; heart; hope; import; value; purpose; reflections; sacred.
The search for meaning is the primary human motivation according to Logotherapy and Existential Analysis, the “Third Viennese School of Psychotherapy,” developed by Viktor Frankl and first published in 1938. Even in the degradation and object misery of a concentration camp, Frankl was able to exercises the most important freedom of all – the freedom to determine one’s own attitude and spiritual well-being. No sadistic Nazi SS guard was able to take that away from him, or to control the inner-life of Frankl’s soul. He found the strength to stay alive and not lose hope by thinking about his wife. Frankl saw those in the concentration camp who had nothing to live for were the first to die. He found meaning even in the depths of horror, and with it, a reason to live.
In the institutional long-term care facility, whose activities (or lack thereof) are often mirrored in the home of a lonely/alone Elder, where meaning is stripped away in many ways. Meaningful activity is absent or withered into mind-numbing unchallenging events. The sacred interconnectedness of human to human is too often reduced to a series of tasks and procedures delineated in manuals prescribed by those ‘in charge,”
When the goal is to infuse meaning into every corner, every act and every relationship, then Elders will find life worth living rather than waiting for the moment when they no longer will be a burden.
Joy: Happiness; pleasure; delight; contentment; enjoyment.
“Joy seems to me a step beyond happiness– happiness is a sort of atmosphere you can live in sometimes when you’re lucky. Joy is a light that fills you with hope and faith and love.” Adela Rogers St. Johns.
Joy is a short, simple word describing the highest possibility of human life. Joy is not a feeling in response to a fortunate event. That is happiness, and it fades away as quickly as the happy situation passes. Joy is not a momentary response to love or sky or water. That, too, is happiness, and it disappears when love is gone or the sky turns gray or the water hardens into ice. Joy is a condition of spirit that so fills a being that no amount of unhappiness can cast it out.
Joy can be found in long-term care or in the house that was once a home. It can only be found where the world of the Elder, her family and friends can experience identity, security, growth, autonomy, cnnectedness and meaning. That is true community, marked by deep homesty and caring.
LaVrene Norton, Action Pact
Nancy Fox, The Eden Alternative
Sandy Ransom, Texas Long-Term Care Institute, Texas State University
Leslie Grant, Center for Aging Services Management, University of Minnesota
Arthur Rashap, Jefferson Area Board on Aging
Vivian Tellis-Nayak, My Innerview
Dawn Brostsoki, Beverly Enterprises
Susan Dean, The Eden Alternative
Joseph Angelelli, Penn State University
Mary Tellis-Nayak, American College of Health Care Administrators
William Thomas, MD, The Eden Alternative
In this life I am named Arthur William Rashap. I have lived 79 years with a myriad of experiences that have enabled me to enjoy many worlds and to have met and worked with some special people. I want to share this and have the opportunity to interact with you.