Happiness the Becker way

The starting point, as well as the ultimate goal of the Humanitas care philosophy is the enhancement of human happiness for clients with a physical, or somatic handicap. Cure and care are, therefore, no longer the core business. Living arrangements and a general feeling of well-being are elements of equal importance, or probably more so. In any case, cure and care should no longer be the defining factors for the atmosphere and general outlook. Human happiness is defined by two aspects, an individual aspect (a person, though handicapped, wishes to have control over his own life) and a communal aspect (a person needs to have a sense of belonging, is in fact a herd animal). This is what the care organization needs to focus on. And if cure and care is contributing to achieve this, it would be a bonus, but in that case extra attention should be given to the possible negative side effects of a medical/hygienic approach. Should the “pain” of cure and care prove greater than the “gain”, it is probably better to abandon the cure and care, and concentrate on the well-being which causes the handicaps to be forgotten and the client to “learn to live” with a chronic handicap. In this way, well-being as an alternative for cure and care can be implemented reasonably often.

With regards to the living arrangements, Humanitas, in view of the individual wish for independency, has developed the “age-proof” apartments. These apartments (minimum 72 square metres, three rooms – the social norm for building requirements in the Netherlands), may be purchased, or hired out of one’s own income. Which allows the client to be a true resident, instead of just “staying” in a room belonging to an institution. Living arrangements and care should be strictly separate. In principle, the client should be able to choose a care provider, other than Humanitas. The landlord, in case of hire, might be Humanitas Housing, but could well be another housing corporation. Technically, the apartments should be designed in such a way that – even with a wheelchair – the sink (variable height sinks), the electricity cupboard, and the letterbox, are within reach, and barriers such as thresholds, narrow doorways, awkwardly opening French doors, etc, etc, are avoided.
 
Living arrangements, as a total living concept, do not only contribute to the individual aspect of happiness, but also to the communal aspect (the sense of “belonging”). To be a person amongst people, you need to meet people, mingle, share something: dine in the restaurant, eat apple pie, or have a drink at the bar, go to the hairdresser, the pedicure or the beauty parlour, visit the animal garden with the grandchildren, the sculpture garden, play bridge together, participate in volunteer work, go to the fitness for a daily work-out, or visit the reminiscence museum. You need sufficient space for this, a space which is created by the “indoor village square” at the so-called “skirting board”, on the lower level of the building.
 
Naturally, the old cure and care elements, such as personal care, nursing, ergo therapy, a psychologist, welfare worker, dietician, indoor physician, speech therapist, and activity training attendance, are important. These services are also to be found in the village square. But on no account should these elements dominate the scene: so, no walking around in a white coat, no jungle of sign posts, no abundance of rules and regulations, no typical institute furniture, no fluorescent lighting. For there is little to cure, and regulate about chronic deceases like Alzheimer’s, Parkinson’s, arthritis, multiple sclerosis, or total old-age asthenisation. More often than not, the attention needs to be taken away from the handicaps and it is up to the organization to focus the attention on whatever pleasantness life still has to offer, on what is in fact still possible. The ongoing pre-occupation with medical and hygienic issues, setting rules, and discussions at all levels (nurse, dietician, indoor physician, speech therapist, ergo therapist, welfare worker, psychologist etc.) on these subjects will cause a negative atmosphere into the bargain! Constant accentuation of medical issues will cause what is left of a positive image of life to disappear, and institutions for the elderly will degenerate into what Becker Sr. (96) calls: “misery islands”.
 
Regarding the management structure, Humanitas has chosen for a model which does not endorse a top-down hierarchy, but is characterized by a collective cultural operation (Prof. Karl Weick, USA), where all involved – managers, employees, clients, volunteer workers, relatives, suppliers – need to be aware of the core-values, and act accordingly. In this way some kind of empowerment is being created in the lower layers of the organization, and it will allow for bottom-up creativity and innovation. The core-values, therefore, are of the utmost importance for a properly functioning organization. They are:
 
BEING IN CONTROL. Anyone, whose brains are still functioning, can decide for himself what is important to him, even if it implies matters, which are not commonly condoned. (being drunk at the bar every day, having a shower once every three weeks, wanting to keep five cats when that is really no longer an option).
 
ACTIVE PARTICIPATION. Of the utmost importance and clearly disregarded in care-land. Once the basic functions (walking, making a cup of tea, keeping the finances in order, mending clothes, cooking) cease, these abilities will, before long, vanish in thin air. If one should stop walking for two months, regaining the ability will become almost impossible. So one needs, use it or lose it, to stay active. Becker senior set the limit: “to the pain-threshold”. This is why Humanitas uses the slogans: “Too much care is worse than too little care”, and “Do not take care of people, but take care that they take care of themselves!” Naturally, the latter has it’s limits, and the carer would do well to be watchful. One cannot possibly ask a patient with paralysis to wash his own toes.

EXTENDED FAMILY APPROACH. This implies that people should regard themselves as one big family, and not as “them”, the handicapped, dying patients who have little awareness and few abilities, and “us”, the altruistic, white-coated professionals, who after a few years of study think they know everything much better than “them”. Those “them” who, as a matter of fact, have been experiential experts for over forty years and, together with their partner or extended family, know almost all there is to know about their handicaps.
 
The fourth core-value is the driving force and indicator. It creates the positive atmosphere and activating ambiance. The YES-CULTURE means that all concerned (management, employee, relative, client, volunteer worker) will have a positive attitude towards any request concerning the wish to be in control, active participation or funny ideas, questions or demands.
If the request can not be met forthright, a dialogue will be started with the requesting client. Not to argue in order to win, but to enquire, in an open manner, which motivations prompted the request, whether there are any alternatives, and how the care organization might come to an agreement with the client in a service-rendering, positive way.
 
The abovementioned elements, such as real-life restaurants, also attracting public from outside and where everyone can place an order using their own money, the reminiscence museums providing topics of conversation for everyone, as well as the hairdresser, beauty parlour, the animal farm etc., are meant to enhance the positive and activating atmosphere even more. What matters is the totality of atmosphere and ambiance. The sum total of cure and care, well-being and living arrangements is an integral product, one cannot exist without the other.
 
On entering an establishment of the Humanitas care organization,one should as it were be taken by surprise by the exhilarating, warm, happy, activating company culture. Actually, the totality of colours, smells, sounds, artefacts, and people “going about their business”, should in no way remind us of “care”. Usually the care organizations are associated with hygiene, medication, rules, and mortality. These elements are, of course, ever present, but should be offered rather covertly. The mainstream should consist of the happy things in life.
 
One of the last on the list of elements to be mentioned, is the blending. In principle, handicaps and misery should not be clustered. Misery islands are easily created, even if it is not deliberate. Therefore, Humanitas makes an effort to blend: sick and healthy (at least one third of the residents must not have a care indication), young and old, rich and poor, native and ethnic minorities, homosexual and heterosexual. This kind of blending is extended to drawing the neighbourhood residents in from outside. The “catch” is realized by an excellent and reasonably priced restaurant, a good physiotherapist, a neighbourhood supermarket, a beauty parlour, a hairdresser, a cash point, an internet café, enough room for a large bridge club, a nursery for the whole neighbourhood, etc.
 
By creating an altogether happy picture, Humanitas is able to attract employment more easily, with less personnel falling off, and it is simpler to obtain a lower sick-leave rating, the relatives visit more often. Likewise, Humanitas has a magnetic appeal to volunteer workers, clients are less prone to depression, and are active participants, assisted by their partner. Clients are also helping each other, instead of calling upon the help of the rather scarce professional “hands at the bedside”. All available competence is employed, including all experiential expertise and activating human characteristics. In this way all (financial) capacity is being used and expensive care demands, which are often just a cry for attention in the traditional misery islands, are prevented.