Read Part 1 of Abolishing the Old Age Asylum here.
Read Abolishing The Old Age Asylum, Part 2: Bulldozer Therapy here.
I worry about the Culture Change movement in long-term care.
This is a movement I’ve fought for and supported for decades. It’s a vibrant coalition of people and organizations that has brought humanity and dignity to thousands of elders living with frailty. Culture change leads us to place the needs and desires of elders at the center of all decision-making. Culture change can – in theory – radically transform modern long-term care.
It can also do harm in unexpected ways. When people and organizations who do not identify with the ideals of person-centered care use the rhetoric of culture change and emphasize the artifacts of culture change, the movement is weakened. Even more ominously, culture change becomes a tool for reinforcing the grip the institution has on our elders.
Authentic culture change represents a direct attack on the structure and function of institutional long-term care. The false (surface only) version of “culture change” is all sizzle and no steak. Worse, it offers antiquated nursing homes a second chance they don’t deserve.
It’s always the case in a human endeavor that people confuse the surface with what lies beneath. Examine any field of human endeavor– education, religion, politics – and you will see how easily people become polarized and begin to fixate on superficialities and let the deeper meaning (which is the true source of value) remain unexamined.
Culture change is no different from any other human activity. We are easily led away from the important but difficult work of changing how people treat each other and quickly find ourselves investing our time in the surface dimension of culture change. The parakeets, the salt and pepper shakers and the floor plan grab the spotlight while the work of actually changing culture remains in the shadows. This very human weakness is an important reason why I favor abolishing old age asylums.
America has more than 16,000 nursing homes. America should have ZERO nursing homes.
This is where I stand: I’m a nursing home abolitionist. Nursing homes are wrong. They are relics of a time so far along ago that we don’t even remember the roots of their founding. We know better now and we can do better now. The future belongs to those who can offer sensible, practical and cost-effective answers to the question— “What Comes Next?”
When historians look back I’d like to be part of the generation who booked no compromise with an immoral institution, who said nursing homes are wrong and must go.