Being in Place: Toward a Situational Perspective on Care

Abstract

An optimum focus in any care situation is creating and sustaining environments that facilitate an ongoing sense of “being in place” for all involved. Using this rationale, we propose a Situational Model of Care (SMC) for exploring dynamic relationships among aging persons receiving care, the convoy of persons offering this care and support, and the place where this occurs, as evolving situations throughout the course of a disease. The model is grounded in extant literature and illustrated through a case study derived from in-home observations and interviews. Emphasizing an underlying goal of fostering a sense of being in place as a desirable outcome facilitates situationally nuanced directions in research and clinical care.

Feasibility of Telehealth Occupational Therapy for Behavioral Symptoms of Adults With Dementia: Randomized Controlled Trial

“…The COPM identified tasks with low performance by the person with AD. This allowed the interventionist to integrate an individualized, person-centered approach and tailor the intervention to the needs of the situation ( Rhodus & Rowles, 2022 ). Delivery of the intervention was tailored through a lens of mediated learning using guided discovery principles ( Overholser, 2013 ).…”

“…However, although this study combined several clinical assessments, the operationalization of individualized approach was complex. The development of assessments that consider a situational perspective ( Rhodus & Rowles, 2022 ) by integrating PEOP and sensory approaches will dramatically advance the utility and clinical reproducibility of the intervention in real-world settings.…”

“…Four key components should be considered in environmental, situationally focused intervention development for older adults with cognitive impairment ( Rhodus & Rowles, 2022 ): tailored sensory-based environmental cueing; a person-centered approach emphasizing strengths, personal preferences, and autonomy while acknowledging the cognitive and physiological capacities of the person; individualized goal selection with occupational gradation; and care partners’ capacity to support function and behavior. These concepts are integrated into a newly designed intervention program, HARMONY: Helping older Adults cReate & Manage OccupatioNs successfullY.…”

Dementia care and prevention in community settings: a built environment framework for cognitive health promotion

“…Whereas loneliness is a negative appraisal of one's relationships, at-homeness helps us take action for full and fruitful living despite cognitive ill-health [131]. By achieving a sense of "being in place" [132], at-homeness unlocks "a better sense of self for psycho-sociability" [133,136]. In the face of adversity, fulfilling these basic psychological needs enables self-determination [134].…”