A person-centred approach to touch in care
Improving the lived experience of care by enhancing the quality of touch.
Touch and the roots of empathy
Physical closeness speaks volumes in every culture. We tend to try and keep the people we love and care for close, remain distant from the people we care little about and push the people we dislike further away! You don’t have to be particularly intelligent or have all your cognitive faculties intact to understand the kind of messages touch conveys. It is a primitive non-verbal language that all mammals share. This form of communication relies upon the faculty of empathy; an ability to identify with and respond appropriately to the feelings and needs of others. This faculty is absolutely crucial to care-giving as well as humankind. Without it we would be lost and alone. Mammals are social animals because they are born with this seed of empathy. Loving and affectionate touch is the water that helps this seed grow strong. Touch and empathy are so closely bound that many forms of touch are actually experienced as empathy. This is because we first come to know empathy through touch, in the very first days or even moments of our life. Lessons in empathic touch start early, before words begin. Each of these tactile experiences are invaluable lessons in caregiving, enabling intuitive compassionate responses to another person’s need for comfort throughout our lives.
Touch and personhood
Whilst researching my book, Embracing Touch in Dementia Care, I observed professional carers with exceptional skills in their use of touch. These carers were not trained in any fancy massage techniques or procedures; they were merely doing what came naturally to them. It was as natural as seeing a father cuddling up on the couch with his child, children playing together, partners consoling each other, a mother soothing her baby, or friends congratulating each other. Upon discussing their use of touch I discovered that they had learnt these skills simply through living their life. Their ability to offer tender loving care largely grew from the tenderness, love and care they had received themselves. Like the faculty of empathy, this loving and comforting touch was simply part of their experience of humanity. This experiential understanding of touch is particularly valuable in dementia care; in promoting the bonds of trust and affection at the beginning of our life, these forms of touch and the kind of relationships they convey can function to secure consent to care at the end of our lives when words can fail, and logic and reason falter.
Touch and person-centered care
A person-centered culture of care empowers carers to trust in their own sense of humanity enough to convey their empathy with touch, and secure consensual caregiving through the loving affectionate relationships that such forms of touch convey. In this culture of care, carers are able to sustain people's personhood in and through the language of touch, using what I refer to in my book as, “person-centered forms of touch” to meet people’s emotional needs and enrich the quality of caregiving relationships. These experiences of touch do not take a great deal of time or effort - they are not an “activity” or specialist intervention and they certainly don't require any expensive equipment - they are simply moments in touch. The kind of moments in touch that help us know that we matter and that we belong somewhere. The kind of moments that help us feel safe, secure in the knowledge that we are in contact with people who are willing and able to help us in times of need. Most of us take these moments in touch for granted; they are so everyday and commonplace that we rarely reflect upon their significance. Take them away however, and we will start feeling more alone, anxious and insecure and are likely to become more withdrawn, aggressive or “needy”.
Concerns about touch in professional care
Given that touch is such a natural and effective way of caring and a powerful form of communication, you would think that all professional care providers would cherish this exceptional caregiving tool. Sadly this is not the case in many care settings; many of the affectionate and comforting forms of touch can be approached with suspicion, doubt and mistrust. Discussions with professional carers about their attitude towards touch, across many different care settings, often reveal a great deal of uncertainty about which kinds of touch are acceptable in care settings, and a lot of concern about how other people (peers, family members, visiting professionals, local authorities etc.) might perceive their touch. In short, there is a lot of fear about “getting too close” and a great deal of uncertainty about how close “too close” is. Unless directly addressed, this can create a confused or touch-averse culture of care.
Confident and compassionate care teams cannot exist in such cultures of care, because these tend to compel care staff to detach from the very feelings that arise from their sense of compassion and, in doing so, function to suppress empathy. Care without empathy is not only meaningless but inhumane; it’s the kind of care that one might accept from a machine but despair over when it’s from a person. In touch-averse cultures of care, touch can become confined to care tasks and procedures. This experience of touch will inevitably shape how they feel about themselves and others. This is particularly the case with the onset of a cognitive impairment; when the reliance upon representational and symbolic systems of communication decreases, people rely more upon their experiences of touch to make sense of their relationships.
The role of touch in Huntington House and Langham Court
To develop more confident and compassionate care teams, we need to secure the carers’ freedom to express this part of their humanity in professional settings and to trust in their own lived experience of touch. The “Embracing Touch” training Huntington House and Langham Court have offered their staff as part of the Butterfly Projects aims to restore trust in touch, whilst identifying and removing the obstacles that prevent people living and working in care. By establishing this approach to touch in the pioneering care service, we hope to inspire other care providers to have the confidence and compassion to embrace a person-centered approach to touch in their service.
Managing Director of Huntington and Langham Estate, Charlie Hoare, has commented on the importance of human touch for dementia patients:
“The use of touch to secure consent for care is vital, but an often overlooked skill. There is often a marked difference between the ability of two people to obtain consent for intimate personal care, such as bathing, and it’s usually a relaxed, soft delivery of question such as ‘Would you like a bath this morning?’, with a hand on the person’s shoulder that gains enough trust for consent to be given. Tailoring the delivery of the question to obtain consent is as important as the delivery of the care itself, and if a care home fails to acknowledge this in its culture of care, then it will be reliant on individual members of staff and can become something akin to a lottery for the people living there”.
A special ‘thank you’ to Luke Tanner, from Dementia Care Matters, for providing the original material for this blog post.