As I travel and speak, I often find myself challenging a notion that seems deeply rooted in long-term care–an idea that, in its essence, is a barrier to deep culture change. That notion is that people move to nursing homes because of complex medical or nursing care needs.
My contention is that for nearly every person who lives in your nursing home, I can find an identical person still living at home. The reason people move to nursing homes is primarily socioeconomic, not medical. If you have the resources–family or financial–to receive care in your home or in more independent housing, you will virtually always choose that option and stay where you are.
So here’s the rub with culture change: We often cite the complexity of people’s care needs as an excuse to medicalize their lives in nursing homes. This bleeds over into taking over day-to-day decisions for the elders because of their “needs”. But the fact that many other elders with similar needs who receive home care can remain in charge of their lives puts the lie to this idea.
It stands to reason that if people with complex care needs who have financial and/or family resources can live a balanced life in their homes, then nursing homes (who satisfy the shortfall in financial and family support) should be entirely able to provide the same kind of life for their elders.
The only real difference is that the nursing home is a congregate setting for many people’s care. But that is not an excuse to medicalize life for our elders. If anything, the pooling of clinical resources in one place (as opposed to traveling home health workers) should make it easier to provide treatment that does not interfere with life. It is only our chosen system for providing that treatment that turns things upside down.
This is not about diminishing the role of doctors and nurses; it’s about having the doctors and nurses do what they are trained to do, and elevating the role of the elders to drive the rest of their lives, restoring the balance that has been lost.