We Need Choices

by, Dr. Bill Thomas

It is a privilege to engage in a debate with a person as thoughtful and accomplished as Australia’s Ray Glickman. He’s a boomer and I agree that he has earned the right to be contrary— and so have I! That said, I will start with a point of agreement. Ray writes…

I hate the nanny-state approach that infantilises older people. I hate the fact that aged care delivery is focused on managing risk rather than enabling people to live the second half of life they want.

This is a pretty good indictment of conventional practice on both sides of the globe. The people who work in this profession are wonderful, the system they work within– is terrible.

Ray goes on to assert…

I suspect we are kidding ourselves if we believe that there shouldn’t be any nursing homes in the future. Do we really think that all older people are going to be in a position to jump into the driver’s seat of the Lamborghini or leap out of an aeroplane in their wheelchairs?

This is an “either or” fallacy doing double duty as a “straw man” argument. Do I think the real choices people face will be between conventional nursing home and skydiving? No I do not.

In fact, I am advocating for a future where older people and their families (including people who are living with chronic health conditions, palliative needs and serious cognitive impairment) have a range of choices available to them. People who have real choices rarely if ever choose to be placed into an institution. Ten years ago, I was fortunate enough to receive backing from the Robert Wood Johnson Foundation and Capital Impact Partners to pioneer a radical alternative to institutional nursing homes — The Green House Project. We built it, we tested it, and we proved elders can receive skilled care in a true home.

A generous reading of the “Baby Boom’s” most important contribution to contemporary society is its enduring endorsement of the power of choice to create a better future. We live in a world that gives us far more choices in every aspect of our lives. We even have far more flavors of ice cream than ever before. The time has come to launch a revolution in aging services that gives elders more choices and caregivers more opportunities.

If I am lucky, I will be invited to attend the closure of the last nursing home in the Australia. The speakers on that day will surely praise the skill and compassion of the people who worked there for so many decades. Then the lights will be switched off and the doors will be locked. Like the poorhouse and workhouse before it, the nursing home’s time will have passed and few will grieve its passing.