Dr. Béatrix Paillot, a geriatrician at Saint-Germain-en-Laye Hospital and a specialist in memory disorders, shares the fruits of her long experience caring for older adults—an experience illuminated by her Christian faith.
What is most important for quality care?
Listening is essential. American research shows that on average a doctor lets an older person speak for eighteen seconds before interrupting. We know these patients speak slowly. Eighteen seconds is far too brief.
We must commit ourselves to sit facing the person, looking them in the eye at their level, without doing other things at the same time. The older adult tends to become an object of care, to diminish themselves. Often when I ask their opinion, they answer: "I don't know, ask my daughter." I insist: "Perhaps I'll ask your daughter too, but I want to know what you think." Then suddenly they smile and begin to give me their opinion—they become a subject again. The person returns.
A dependent person is deeply sensitive to respectful contact, which tells them they remain a person. Even a simple look that conveys attention and friendly regard matters greatly. At the very least, if that is all there is, it is still much. Often older adults separate their spirit from their body: they keep a young spirit, ready to dream and hope for anything—even impossible things—while their aging, limited body becomes a genuine burden. Healthcare staff must help these people find harmony in their whole being, including through careful physical examination from head to toe.
When you touch their body with respect, it says their body still has worth. In situations of dependence, care given with respect and gentleness becomes an opportunity for friendly encounter with another human being.
What causes mistreatment in facilities for older adults?
First, I want to say that nursing homes can be places of excellent care. I have witnessed healthcare workers of real admiration in their dedication to older residents. That said, negligence and actual mistreatment do occur.
Budget constraints and difficulty covering payroll costs mean many facilities lack adequately trained staff. This leads to an assembly-line approach to care—reducing it to technical procedures without the time needed to build human relationship. Many healthcare workers also lack proper training in caring for disabled older people. After a few years, they grow weary. When they request a transfer and are refused, this is when they may become abusive, having exhausted their inner resources to give themselves to others. I believe the secularization of our society also contributes to declining quality in elder care. Recognizing the presence of Christ in suffering people and serving them after the model of the Good Samaritan is the great engine of true compassion.
Is it important to speak about the past?
We should give older adults the chance to tell stories from their past. This exercise of memory helps them find the thread of their own life and prepares them for what lies ahead, including the final passage. This revisiting works best when the older person invites someone to witness—when they speak aloud something from their life that becomes a light, able to shine forward and give meaning to their present. In the past we sometimes find regret and guilt. Among older people, false guilt is common: "I depend on others, what wrong have I done?" We must help them move beyond it, acknowledging genuine errors that might lead to reconciliation with someone. There are truly liberating forgivenesses.
Besides family and close friends, who else can help an older person?
Work on oneself is very important. We prepare for old age throughout the whole arc of our lives. Sometimes we meet people who have lost touch with reality.
If old age is not somewhat tamed, not lived as a new chapter of life bearing fruitfulness, it will always be harder to bear. That said, old age can bring real hardship: mental decline, difficulty, loss. We cannot deny this. The question is how each person confronts these challenges. I see older adults full of distress, in constant revolt, who exhaust everyone around them—the care team included, who suffer under this weight. I also see others who entrust themselves with confidence to others when needed. Older adults are very sensitive to their family's presence, which is undoubtedly their greatest asset. But they are also responsive to any visitor who comes with gentleness and warmth. Finally, faith is essential. One can be old and severely disabled and yet radiate a living, comforting faith to those around you.
What helps you most in your work?
Christian faith and prayer illuminate and give meaning to what I live through. Care is first and foremost understanding the other. We do not stand in their place, but we grasp something of their inner suffering and place ourselves beside them. That is something like the definition of compassion, which differs from pity—which is rather negative, focusing on what is lost, what the other no longer is. True compassion sees what remains and lives in the person, what they are becoming. Beyond technical gesture and skill, compassion is a balm of friendship, admittedly somewhat unequal, but one that can grow into reciprocity. This requires that the caregiver accept becoming small and entering into personal relationship with each person in their care.
C.A.D. — Home Care Assistance Center
Through local health authorities, the C.A.D. provides healthcare services in the home for people unable to visit outpatient clinics due to temporary or permanent disability.
Services provided include:
- home nursing care
- blood draws for laboratory tests at home
- wound dressing and specialist visits at home
- prescription of medical aids and prosthetics (incontinence supplies, wheelchairs, etc.)
- physical therapy at home
How to Request This Service
Submit your request to the C.A.D. of your local health authority through your primary care physician, who must complete the request form. The C.A.D. will then visit your home to assess your needs and establish with your doctor which interventions are necessary.
Protected Hospital Discharge
Protected hospital discharge is a service available in many municipalities and health authorities. It aims to organize integrated social and healthcare services during the delicate moment when older people leave the hospital, managing the recovery period as needed on a continuing basis.
This includes temporary home-based social and healthcare assistance, coordination between hospital, primary care physician and community services, medication supply, and return transport by hospital ambulance when possible.
The service is available to all older adults discharged from hospital wards and rehabilitation facilities who are unable to arrange their own return home. It ensures continuity of care and prevents unnecessary institutionalization.