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Imaginative anticipation: Towards a theology of care for those with dementiaGraham, Elaine L.; Goodall, Margaret A. (University of Chester, 2011-10)Dementia is a degenerative disease which appears to take away personhood and identity and calls into question how we understand what it means to be a person. My argument is that how people with dementia are seen and imagined is key both to the understanding of their value and the care that is offered. The aim of this study is to determine how the Christian ethos of Methodist Homes (MHA) influences the care of people with dementia in order to develop a general theology of care from within practical theology. The thesis explores the ways in which the Methodist emphases of social justice and prevenient grace offer a basis for dementia care, and how MHA has drawn on its origins within the Methodist Church to develop an ethos of care that places respect for the person with dementia at the centre. This concern for those with dementia is then surveyed and the themes of respect and relationality emerge offering the potential for human becoming. Within MHA the care offered is based on a person-centred model. In order to discover how the Christian ethos of the organisation influences care this thesis explores patterns of delivering care in three homes of each of three types; well-established, recently-acquired and new-build. In each home the views of the staff were surveyed. Three in-depth interviews were conducted when questions were asked in order to understand their perception of the person with dementia. The interviews uncovered what carers regarded as good care and when care did not meet the needs, and why they believed that happened. Browning’s ‘strategic practical theology’ was used to evaluate these findings from within a Christian context to examine the influence of MHA’s ethos on the care offered. The core value chosen as the most important for care was ‘respect’; and while the care offered across all types was ‘person-centred’ the way it was delivered varied. The culture of MHA that gave rise to the values is investigated, along with the challenge of retaining ‘mutuality’ as an ideal as the needs of older people changed. The themes that emerged were those around quality of life and the things that enable the change in thinking from basic ‘caring’ to ‘caring for the person’ as the person is seen in a different way. Dementia is sometimes called the ‘theological disease’, and this understanding of dementia and the person is explored to discern what can be offered from theology to the best ideals of care in order to provide true person-centred care that is respectful of the person. I argue from within practical theology that a new way of seeing the person with dementia is needed in order to anticipate the possibility for human flourishing that is possible in a person, even in dementia. And that, offered with respect, good person-centred dementia-care can be a sign of the Kingdom. Part 1 of the D.Prof. comprises four sections in which I explore dementia from within practical theology; how it impacts on personhood, how I, as a practitioner within Methodist Homes (MHA), could enable others to offer care of the whole person; and how the carers’ understanding of the person makes a difference. In the first section, the literature was surveyed in order to discover the historical development of the term dementia. Until the middle of the twentieth century, there was little care as the condition was not named. But then drugs were discovered that could control unsocial behaviour, and the medical model of care developed. However, a new culture of care developed (person-centred care), because of the better understanding of the social nature of the disease. From within the context of theology, I explored how personhood can be understood within dementia and how, even in dementia, it might be possible to grow into the fullness of Christ as spirituality is enhanced. The second section was in the form of a publishable article which explored how it might be possible to evaluate spiritual care within a dementia-care setting. This took the form of a case study in which I worked with staff in a home that had difficulty evidencing spiritual care. It raised issues about the nature of care and assessment of spiritual care, as well as the rationale behind, and the delivery of, that care. What developed used the biblical concept of ‘fruits of the spirit’ as a way of recognising spiritual dis-ease as it is these qualities which enable inspiration, reverence, awe, meaning and purpose even in those who have no religious beliefs. The model used to offer this care was through the 3 R’s of reflection, relationship and restoration. Section three, reflective-practice section, emerged out of my practice as a chaplaincy adviser for MHA, in which I reflected critically on the contexts and understanding of the manager and chaplain, and how a chaplaincy manual was developed. The ability of the chaplain to work effectively and enable good spiritual care in the home, depended on the relationship between the manager and chaplain. By exploring the culture of both manager and chaplain, a way to enable good communication was discovered. The role of pastoral care and how it is seen within an organisation, that must have a professional management, was investigated and ways suggested for mutual understanding using the chaplaincy manual. The last section examined whether the Christian ethos of MHA encouraged a model of person-centred care. I suggested that a way of making sense of the data is by using types to describe personhood and how that can be made visible by their care. Considering the way that therapeutic interventions (reminiscence therapy, reality orientation, validation therapy, drug therapy) were used offered a way to enable the ethos of the home to be seen more clearly. Central to theological anthropology is the concept of the person which includes an ethical dimension. MHA has the strap line, ‘care informed by Christian concern’, so the study investigated whether this Christian ethos is lived out in the care offered. These aspects of study have led me to begin this thesis to research how care is delivered and what carers understand to be appropriate care. An appreciation of the context in which this care takes place also highlighted a need to conduct a theological exploration of the nature of the person with dementia.