What the heck is a hierarchy of values? Why do you need it?

Apr 8, 2022 | Advance Care Planning, Australian Aged Care, Carers Advice, ExSitu News

You’ve heard us reference this wonderful thing called the Hierarchy of Values a lot on the ExSitu website and during our many presentations.

But what is the Hierarchy of Values and what can it do for you?

Here’s your five-minute guide to the Hierarchy of Values and how it can help professional or individual alike!

It centres care on values

With a name like Hierarchy of Values, values have to be in there somewhere, right? Well, they are the centrepiece and the turkey on that family table.

Australian aged care is changing. The focus is on ensuring we understand the values individuals hold dear. That way, truly customised, culturally appropriate, granular and individualised care can be given.

In knowing this information, we can create an accurate picture of what treatment looks like for the individual. It also covers off things like family, autonomy, and likes and dislikes that make up a person. This is a way of capturing all the tiny pieces and choices we automatically make each day that make us who we are without it becoming a never-ending list. One where items might get skipped because the space and the time required to extract each item is simply not available or practical.

Larger topics such as what quality of life looks like to a person, what treatment is too much or too far, what a person can and can’t live without are all part of the mix.

But this investigation of a person doesn’t take years and years of study, conversation and exchange. It doesn’t face challenges from other people’s bias, intentions or influence.

By using the Hierarchy of Values, an individual is prompted to think deeply and answer on their own terms. What starts off as a broader topic of exploring the elements that make up a person’s life becomes a gateway to greater understanding and more discussion.

It helps rank the unrankable

the hierarchy of values is a pyramid of choices to the right of a person on their laptopIt’s wonderful to understand all the values an individual holds dear. But what happens when those values contradict or intersect with others?

This is where the hierarchy part within the Hierarchy of Values starts to earn it’s keep.

In life, there are things we must, should, could, would but probably won’t prioritise. There are many nice to haves. And there are many deal breakers.

But we don’t know how all these values, deal breakers and nice to haves play in the playground of life until we have to deal with them directly. Or until we crack open the Hierarchy of Values and start to think about it in earnest.

Articulating the things that matter to us isn’t always that simple. However, if we can understand the choice we might make when faced with never seeing our pets in care and the impact that might have on our overall mental health if the doctor is concerned about infection risk and being sued, then it starts to make sense.

And by looking at the core values within that hierarchy, we don’t have to chart out every single scenario to cover all bases.

We can allow the articulation of those values and what matters most to be the core guiding light within complex and everyday care decisions.

It gets people thinking

Whenever we put the Hierarchy of Values on screen, professionals and individuals alike start to realise how powerful sorting through these choices can be.

We all have things we naturally consider. If you are an accountant, chances are you have your end-of-life, retirement funds and aged care costs figured out. Your friend who volunteers at the hospice might understand the importance of small joys in a day. Or the frustrations of not being able to enjoy a specific personal joy through losing the ability to communicate it.

Our culture sort of puts ageing, end-of-life and care planning in a basket marked “for another time”. Before we realise it, that time is well and truly upon us.

By having these conversations and looking at what individuals value while essentially gamifying the decision-making, a light bulb goes on.

It shifts from being that uncomfortable conversation we tend to delay. And it becomes a deeper, far more personalised approach to ensuring that dignity is preserved, and choices are protected.

It gets people talking

At ExSitu, we’ve done thousands of hours training and educating professionals and individuals alike on how to use our software. And every time we present the Hierarchy of Values, out comes the conversations.

We’ve heard about the most gloriously stubborn individuals seeing their experience of later in life be a true reflection of them right to their death and funeral. We’ve also heard the saddest stories about the dying who refused to acknowledge their terminal status. We’ve experienced the moments as former aged care nurses where the individual is lost between the risks and the procedures versus what we know of the person before us that hasn’t been appropriately recorded.

The conversations had after the fact belie strong emotions we have about each other and the experience of ageing and dying. They are a collage of trauma and life lessons we don’t all have to learn the hardest ways.

The Hierarchy of Values infects people in a good way. The unit manager that leads the training who begins bullet pointing out the pros and cons between residential care and care at home for themselves. The nurse receives the training at work for their clients that goes home to fix up their own advance care plan. Or the dying parent who, emboldened by putting their wishes down and sending it to their child, feels better about sharing what they know of what’s coming.  And that adult child, touched by their own experience with their parent, who decides to do something so their children are similarly informed and protected. The teenager who finds the language to talk to their soon-to-be bereaved friend.

This simple yet powerful document melts away all that stigma. And it opens the door to all kinds of people considering what ageing well and dying well looks like to them.

It helps cover the gaps

All the trees in the forest or the gigabytes in the galaxy couldn’t map every single treatment, eventuality or need an individual might have.

But gee, knowing what that person cares about and to what degree that care extends certainly makes life a lot easier.

One of the most exhausting elements of dealing with ageing, illness, disability or end-of-life is how it becomes a fulltime job. There is decision after decision, option after option. It is difficult to know exactly what might happen.

An individual receiving chemotherapy for prostate cancer may not anticipate that their white blood cell count could surge or fall through the floor to cause seizures that might have been better answered with a DNR. But their loved ones will be the ones who will feel that choice forever imprinted in their hearts and minds.

The cost of making a decision that is questioned or even regretted can have a profound influence on the person left behind.

That’s where the Hierarchy of Values can help. It goes part of the way to articulating what quality of life means to the individual. And that can be an invaluable reference point for loved ones when the hardest of all life’s choices comes calling.

The Hierarchy of Values can help you

Whether you are wrestling with the concept of care plans at your aged care facility or investigating it for your own needs, ExSitu can help.

We put the values at the centre of care planning, aged care, advance care planning and end-of-life well before it became law. And we’ve applied our simple yet effective blueprints to all kinds of care scenarios for a wide variety of people.

Designed to appeal to all age groups, cultural backgrounds and people from all walks of life, our Hierarchy of Values provides you a safe, inclusive and easy path towards articulating what matters most.

Let us help you to help the people that matter to you. Get in touch to arrange a training session for your organisation and/or get started on your own documents today.

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