How is this day unlike any other day?
Those famous words were applicable to us as we celebrated Shrove Tuesday in our neighbourhood. The menu at lunch was, of course, pancakes, with sausage, bacon, peach and/or strawberry sauce and maple syrup. Resident’s eyes widened as this amazing plateful of goodies was brought to them. If for some reason, that didn’t appeal to them, we had an assortment of sandwiches, but for the most part, that was the menu.
There wasn’t a lot of choices.
As the meal progressed and I was loading the dishwasher, I had a revelation.
Choice is hard.
I realized that serving residents when the choices were limited was quicker. It used less dishes and took less time. Our normal lunch menu consists of two kinds of soup, four entrees (one vegetarian, one bland, two or sometimes three salads) and a whole cart full of assorted desserts. You don’t fancy the soup options? We always have clear chicken broth. Don’t like any of the entree choices? We can give you one of five different kinds of sandwiches. Nothing on the dessert cart appeals to you? Let’s break out the ice cream. We are kings of choice in the dining room.
Choice extends to so many areas. This morning, our first customer for breakfast was at her place by 6:30. She had a cup of coffee while she waited for me to cook the waffles for Valentine’s breakfast. The bulk of the crowd came between 8:00-9:00, but our last customer wandered in at almost 11:00. There is a choice about when you get up in the morning.
Choice extends to every other part of a resident’s day. What they wear, how they like their days to run, whether they like to attend activities or crawl back into bed between meals. Residents choose whether they would like a shower in the morning or the evening, and a few who absolutely hate showers, have a thorough bed bath. I have a resident who doesn’t say much but generally likes to be in her room, looking out the window between meals. The other day she was sitting in the dining area, and I asked her if she’d like me to take her to her room. To my surprise, she said, “No.” She was enjoying watching the bustle around the kitchen. Choices can change.
The thing with choice is, it’s inconvenient and expensive. You can bet that with this kind of morning flexibility our kitchen is cleaned up for a millisecond before it’s time to start lunch. Offering all those choices obviously costs more, and with thirty residents each keeping their own schedules, the logistics are enormous.
Why offer so much choice?
Because choice is essential to our personhood. Taking away our choices sends a message that who we are is less important than the schedule or the rules.
The Eden Alternative identifies autonomy–choice–as one of the Seven Domains of Well-Being. “Simply put, to be autonomous is to be one’s own person, to be respected for one’s ability to decide for one’s self, control one’s life and absorb the cost of one’s own choices. Lacking autonomy is a condition which allows or invites sympathy, pity or invasive paternalism.”1
There are always choices. It just depends on who is making them.
Because it is easier, cheaper and less confusing, many care partners and most institutions decide to make the choices. It’s easier if everyone gets up at 7:00 so that breakfast can be between 8:00-9:00. It’s safer if I choose whether you can go outside or not because I’m more equipped to make that choice. It’s faster if I dress you in whatever my hand grabs from the wardrobe because you take a long time to decide.
And the person, who may be dealing with cognitive and physical changes and losses of all kinds, begins to die inside. The message is clear. You don’t matter. What matters to you, however small, doesn’t matter. Either their eyes glass over and they cease to care, or they fight. And if they fight, we may drug them.
Choice is hard. But it’s the very essence of all we believe in. You are a person of value, and therefore you have a choice. I will honour you as I honour your choices.
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1. http://www.edenalt.org/wordpress/wp-content/uploads/2014/02/EdenAltWellBeingWhitePaperv5.pdf