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

ABSTRACT

Purpose: 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.

KEYWORDS:

• Elderly care
• existential questions
• meaning in life
• spiritual counsellor
• care home
• care practice
• professional quality framework

Acknowledgements

The authors thank CW, MA (spiritual counsellor elderly care and PhD student) and MvE, Ma (junior researcher) for their contribution to the fieldwork and data processing.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. In Dutch only: https://www.zorginzicht.nl/bibliotheek/levensvraag/Paginas/Home.aspx.

2. Quotations of interviewees refer to respondent number (like R1) and health care organization A or B.

Additional information

Funding

This work was supported by Vilans, Dutch Centre of Expertise for Long-term Care.

Notes on contributors

Wander van der Vaart

Dr Wander van der Vaart is associate professor at the University of Humanistic Studies, Department of Foundations and Methods, in Utrecht (The Netherlands). He has a background in qualitative and quantitative social research methodology, political science and psychology. His main research interests are in “meaning in life” studies and methods of data collection. In 1996 he obtained his PhD at VU University Amsterdam with a methodological thesis on the quality of retrospective data in life course interviews. His current research is embedded in the departmental research programme on “Humanist Traditions, Meaning in Life and Aging Well”. Since 2014, he has been a board member of RC33-ISA, the Research Committee on Logic and Methodology of the International Sociological Association.

Rosanna van Oudenaarden

Rosanna van Oudenaarden (MA) is policy advisor concerning quality assurance at the University of Humanistic Studies and a former spiritual counsellor at a long-term care organization. Prior to this, she was a vision and policy advisor concerning humanist counselling at the Dutch Humanist Association. In 2011 she obtained her master’s degree at University of Humanistic Studies (Utrecht, The Netherlands) with a thesis on the “shelter” of humanist counselling in a Dutch penitentiary. Her main research and professional interests are (humanist) counselling, meaning in life and ageing well.