Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

Appendix 1

CAReTOGRAPHY…APPLYING THE MODEL, ONE CONSUMER AT A TIME

Let's apply the model to you, the reader. Begin by taking an inventory of the people, resources, supports and other factors that make up the fabric of your life using the following domains:

Intimate community. These are the people you interact with most frequently. Think about them in terms of the level of intimacy they have in your life. Some people just naturally come to mind like your friends, your family, maybe your close colleagues; while others are more formal, such as your employer, you co-workers, or your minister. Don't forget to consider groups or clubs such as your monthly card game, your jogging companions, or your book club. This is also the place to identify your cultural or religious norms and preferences.

Economic/legal community. While the American way of life affords us incredible freedom, there are expectations that we adhere to legal and societal norms. Most of us live with responsibilities associated with financial and legal commitments, such as mortgages, rent, and other related expenses. Maybe you need to function with a tight budget to make ends meet; maybe you're financially secure but have college expenses looming ahead for your children. Are your options and decisions influenced by legal circumstances, such as child custody?

Health care community. When we are well, the health care community plays a relatively minor role in our day-to-day lives. Our sophisticated 911 response system for trauma and emergencies is almost invisible to us until we need it. Yet, when living with illness or caring for an ill or aging loved one, the health care system can take on monumental proportions. Navigating a system of fragmented services is cumbersome and can be quite intimidating. Health care consumers are often the common thread that ties the pieces of the system together. This can be an exhausting experience for a healthy individual; imagine the challenge when you are ill or vulnerable. Especially consider how well or poorly the health care and human service providers in your life might communicate with each other if your needs or the needs of your loved ones changed.

Governance community. The government, like it or not, is a presence in our daily lives. Public services provide structure and order at many levels of our society without which we could not function. In addition, we are all living with a new reality since the 9/11 attacks brought terrorism home. Our national and world economies are struggling and we are facing international uncertainty regarding peace and war. It is difficult to disassociate ourselves from these realities.

Connecting the Pieces

CAReTOGRAPHY provides a visual perspective on how different communities shape our lives and influence our options and choices. It is also useful to imagine how the balance might shift as the circumstances of our lives change. As you take inventory of the resources across the various communities in your life, you might find that you use supports from other places such as national, regional, state, or local sources that don't fall into the other areas. Be sure to add these into the mix.

As you create your personal puzzle, are you beginning to get a feel for the complexity of your own life? Can you see where certain pieces connect or overlap? Now consider a sudden shift in the balance of your puzzle—an added financial responsibility, change in your health status or of someone close to you, for example. How prepared are you to accommodate such changes? Depending on your formal and informal support systems and resources, even something as benign as a broken leg could seriously impact your ability to carry out your daily activities and responsibilities. Take a moment to consider how the CAReTOGRAPHY model is useful not only for identifying your resources, but also where there may be gaps or even redundancies—and most importantly—where collaboration across these communities would improve your chances for living as well and as fully as possible with limitations and change.

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