For a long time, January has been my tidying month. A month where instinctively I feel the need to tidy cupboards and remove the nagging guilt of messy drawers and overfilled space. It’s also a time when I try to get rid of so many of the virtual and physical papers and notes I seem to build up over the year. It’s a cathartic process which is achieved in fits and starts and doesn’t always work as well as it should.
In the middle of going through one of my many notebooks this past week I came across this quote which was relating to a phone call a couple of months ago:
“I worry that in all the pressure to save resources that we are being pushed to cut time spent with people to the barest minimum.” Beside it I had written – ‘stealing time robs presence.’
I’ve often reflected in this blog about the nature of social care and support as being a dynamic which is centred around the forming of real, meaningful, and authentic human relationships. Intrinsic to that is the truth that relationships don’t just happen, but they have to be nurtured and attended to, like plants in a garden they require to be nourished and supported. Fundamental to this is time, that most precious of human commodities which gives space for encounter to occur and exchange to grow. The flourishing of social care is the depth to which a relationship enables real communication and sharing to take place.
Presence is critical to social care. It was one of the bywords of the disability civil rights movement a few decades ago as it campaigned to close long stay asylums and institutions that without people being physically present, without folks being there in the midst of community then they would inevitably be excluded and at risk of harm. Out of sight, out of mind. But on its own presence is not sufficient – being there is pointless unless it results in the person feeling that that presence makes a difference.
Recently the Scottish academic nurse/theologian John Swinton has been undertaking work with the social care sector in Australia. He has published some of the findings in a paper entitled ‘Being Present and Meaningful Engagement for Aged Care Residents Living With Dementia.’ The paper describes the findings of a project which sought to ‘understand care workers’ experiences of providing care to residents, the challenges they face in being present with residents and [the] support that enable them to be more present and provide person-centred care.’
The study of care workers across three care settings showed the critical importance of presence for residents living with dementia, it highlighted the value staff saw in being present whilst at the same time acknowledging the barriers which prevented this from happening at real depth including ‘staff shortages, competing demands of the role, and time-related impediments.’
The research recognises that there is no shared understanding of how we define presence in a care and support relationship but that two commonly held elements seem to be meaningful engagement and person-centred care. The research has two key findings, namely that the establishment of trust is key to the maintaining of relationships and that presence does not just happen but has to be organised, supported and structured as a priority with adequate supporting resources and adequate staffing levels so that individuals and the wider community can be sufficiently cared for. Importantly the research concluded that:
‘Our findings suggest that care worker presence has the potential to contribute to both the physical and emotional health and well-being of residents living with dementia, and to the well-being of the staff that care for them.’
In wider society there is a growing emphasis on the importance of ‘being present’, of recognising the key contribution to relationships which results from time being spent with another. But time has to be rich in focus and attention rather than overfull with distraction and avoidance. We are encouraged to cease or limit the distractions which get in the way of our being with other people. Coincidentally in the United States this day is one which is being celebrated and recognised as #NoPhonesAt HomeDay – a day when people are asked to set aside the distractions of their mobile phone and engage simply in ‘doing things’ or ‘being’ with family. I can sense the tremors out there!
We need presence to enable us to tell our story, to be listened to and to be heard. That is not just important in dementia care and support or in our closest relationships, but rather it is fundamental to all engagement and togetherness. There is a massive difference between listening to someone and enabling them to feel that they are heard, of worth and value through your presence.
I fear just like my note at the start of this blog that stealing time will indeed rob presence, that we will starve our encounters of paid care of the sufficiency of time because we consider that simply being present is unnecessary or not a priority. But as we all know time is an essential ingredient for people to open up and form a relationship with us, and it is also the essential prerequisite for preventative, watchful care and support. If we crowd out our presence by care activism, then we give no space to enable our presence to bring forth real support and compassion.
The beautiful nature poetry of Nan Shepherd reminds us that we are all charged with the responsibility of incarnating presence. Social carers in care home or homecare do that every day – it ill fits our humanity if we seek by contract and cost constraint to limit the encounter of our humanity by reducing the ability of staff simply to ‘be present.’
In her poem ‘Real Presence’ Nan Shepherd writes:
Clear as the endless ecstasy of stars
That mount for ever on an intense air;
Or running pools, of water cold and rare,
In chiselled gorges deep amid the scaurs,
So still, the bright dawn were their best device,
Yet like a thought that has no end they flow;
Or Venus, when her white unearthly glow
Sharpens like awe on skies as green as ice:
To such a clearness love is come at last,
Not disembodied, transubstantiate,
But substance and its essence now are one;
And love informs, yet is the form create.
No false gods now, the images o’ercast,
We are love’s body, or we are undone.
from In the Cairngorms (Edinburgh: The Moray Press, 1934).
Photo by Brett Jordan on Unsplash