This post is part of a 3 part series titled “Abolishing the Old Age Asylum”:
Part 1 of Abolishing the Old Age Asylum
Part 2 of Abolishing the Old Age Asylum: Bulldozer Therapy
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.
Science and technology are majorly responsible for the problem and offer solutions as well. We live longer, stay healthier and experience life more fully and independently at all ages because of increases in productivity from such previously unavailable, but, now, regularly present items as electricity, autos, washers, phones, body parts such as hips and heart valves and “how-to” knowledge like medicine and the Internet. The weaker among us, regardless of age, have benefited mightily!
Gerontological advances, individualized medicine, assistive devices, robotics, transport (e.g. self-driving cars), communications, are enabling all to expand their life choices. Psychotropic meds de-institutionalized/freed many ill persons from a restricted life. Now, though masked by the swell of the baby boom generation, these same forces free growing numbers of older persons from a restricted or institutional life.
Not addressed for older folk are financial/emotional/social needs without family support. Expanding social programs like social security/medicare in our competitive society may help. “Senior” communities with access to resources relevant to the continuum of care and support needed by older adults might include peer-operated clubs based on interests, security, nursing, entertainment, appropriate transport/communication supports.
This movement has merit it has been part of my radar for eight years falling on deaf ears, but suggestions should also allow implementation thoughts as we are fighting an entire nursing home for profit industry.
Like so many of the above, I too get it —- but what are you proposing instead????
Yes, Dina what is/are the alternatives?
First looking at the healthcare situation as it is today. Medicare in the infinite wisdom of ?? does little to care for well=being – no coverage for prevention of deterioration in sight, hearing, dental care. No focus on quality of life.
Second, as is being shared here, creating a mutually supportive community so people can stay in the community they are aging in makes so much sense – economically as well as for quality of life. That is the way of societies until more recently. Programs like “Villages” and those communities that tap into the resources that old people have and can offer(I have been motivated to use that term instead of elders, seniors, gezzers).
Third – now is the time to stop objectifying old people and understand that they are the greatest untapped resource that exists.
Fourth – it is time to make this issue, concern, and search for better ways rise to the top, to become an important part of the conversation in the political world, in looking at the economic concerns, in restructuring neighborhoods, in creating communities that can demonstrate the solutions.
Fifth – so where do those who want to be part of this movement, this contribution to themselves and others, so where do we sign up and who do we look to?
Bill Thomas – what do you and those with whom you have been discussing and dealing with, what do you recommend? I think it is time to form a Council of Elders in this country with branches everywhere to look to for advice and support. Come on Bill – you know how to help make this happen.
Arthur Rashap
I’m with you Arthur, but I want to see some of these things in my life time so I believe in starting small with some things we can actually accomplish. Living arrangements for example is more doable than changing our nutty healthcare system. And things like “villages” and cohousing are a great start. Been studying these alternatives and thinking of ways to modify and extend them. Tearing down what is already there is lots easier but less useful than rethinking the alternatives that might be constructed.
“Tearing down what is already there is lots easier but less useful than rethinking the alternatives that might be constructed.”
Really nice point, Dina
I’m new to this site but not new to caregiving (for my mother and now for my husband). I have a “suggestion” re Abolishing the Old Age Asylum – and that is to put cameras (with recording and sound) in place. Cameras are everywhere and yet not in the facilities where we leave our most loved ones. This will afford accountability/transparency for the people who are caring for the residents. If there is an “invasion of privacy” issue, this is something that can be worked out. I presently have caregivers in my home. I’ve told them about the cameras and they see them. Responsible caregivers will tell you that they are happy that there are the camera because it’s for everyones’ safety.
https://changingaging.org/blog/abolishing-the-old-age-asylum-part-3-no-compromise/
Sadly this post does not deliver on the promise of the title as it does not offer any indication of what might come next….???
OK, I watched all three video clips, and I get it. You don’t think nursing homes are a good idea, akin to institutionalizing and on a parallel with slavery. I’m sure many 50-somethings have already come to that conclusion. I know I have, on behalf of my parents, who are in their 80s and dealing with dementia. Are you proposing any concrete alternatives or solutions? North American culture needs to change, but how? We need to provide people with clear directives, and start demanding better in-home services, and/or products that help seniors remain in their homes, and/or incentives and behavioural change that encourage families to re-integrate aging parents for the remainder of their lives. Ideally, we should be grateful for the opportunity to nurse our aging parents, not cringing from the thought of it. Also, there’s a strong sense by a lot of women that this is going to land squarely on their shoulders, as it always has. Can you talk about gender equality in this battle as well? These would be points worth discussing, beyond the hype. And thank you for being a champion of “changing aging.” I look forward to following your journey.
Well, Bill, good to hear you are now “out” promulgating what you and I agreed was the mission a decade ago. If you would like to re-engage, I am there and can fill you in on doings and ideas.
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Great!