It is easy to point at nursing homes and criticize the way that they institutionalize care. Home care, we often assume, must be warm and friendly and– person-centered.
Unfortunately, home care can drift into institutional patterns despite the care team’s best efforts.
How does this happen?
1) Gradually, the professionals begin to substitute their judgments about what is best for the person/persons being cared for in place of what the family or the person thinks is best.
2) Gradually, the convenience and customary routine of the staff take precedence over the needs and desires of the family and those receiving care. Routines overtake even the possibility of variety and spontaneity. When the people being cared for, or their families, interfere with staff routine, they are sharply criticized.
3) Gradually, conversation between and among the professional caregivers begin to function as a clearing house for an emerging “official” position on what should or should not be be done with or for the person/persons receiving care.
4) Gradually, the family begins to be caricatured in negative ways and the caregivers begin to assume that they know best and that the family should, always, accede to their wishes and routines.
5) Gradually, empathy for the distinctively different experience of the family and the unique needs of the family and those who are being care for is lost. The needs and priorities of the professional caregivers move to the forefront and direct challenges to the professionals are discouraged with judgmental statements which imply that the family no longer has a right to such objections.
In this way, the home becomes its own form of institution. Families very often feel beholden to caregivers and fear offending them. Communication is cut off and the decline accelerates.
How can this form of institutionalization be stopped?
It is important to recognize that everyone involved has the best of intentions and wants what is best for those receiving care. Second, there must be a collective recommitment to the ideals of person-centered care delivered in the home. The family’s needs and preferences are not incidental, they must form the core of the care experience. This is real care and it is, in fact, what most professionals want to deliver. We live in a world that, for now, bends toward institutionalization but that can change. How can it change? The answer can be found through conversation, respectful, open conversation that is places the person above tasks and comfortable routine.