Caring for Our Elders with Respect

The state of elder care in this country is reprehensible. Like people with complex medical needs, our elders are locked away in grim institutions, treated like so much luggage to be held until its convenient to pick them up, rather than like the human beings they are. Their families often drift away, leaving them isolated and at the mercy of institution staff. While there are of course exceptions, respectful residential care facilities focused on keeping people healthy and happy, such do not seem to be the norm, and even basic measures of dignity and respect are denied.

There are a number of reasons why it may become impossible to care for a family member at home. It may be due to lack of social supports, the inability to pay for nursing care, concerns about a patient becoming a danger to herself, or other worries. Placement in a residential facility should be accompanied, though, with respect to the individual. There’s no reason, for example, that pets shouldn’t be allowed to accompany their owners (thankfully, some facilities are grudgingly starting to accept this and make arrangements for their residents). Allowing people to be joined by their animals in a new environment isn’t just an act of compassion, but one that can help people settle in, feel more in control of their lives, and even stay healthy — animals provide psychological benefits that can help residents who might otherwise experience distress due to their change of domicile.

Eldercare also requires rethinking what’s most important: Structuring patients’ lives according to ‘reality,’ or offering them respect and dignity as their bodies start to fail them? A really interesting example of how to manage patients with dementia, Alzheimer’s, and other cognitive issues has arisen in Holland, where patients are not so much managed or controlled or isolated but honoured as human beings and provided with social supports. When family members decide that they are no longer able to provide sufficient support, they can take loved ones to Hogeway, an eldercare facility that looks more like a village than an institution.

That’s because it is a village. Dubbed ‘the dementia village’ by callous media, Hogeway offers housing that hearkens back to a variety of generations, features a grocery store, barber’s, and other shops, and allows people to wander the grounds freely, meeting up with each other and interacting with staff members who, rather than looming over residents in clinical garb, appear as part of the community; a groundskeeper, for example, or a shop clerk.

Instead of trying to force patients to understand that their memories and bodies are shifting, that they are living in a state of delusion, the staff simply support residents. It can be traumatic to constantly be told that you’re lying, that family members are dead, that people you think you know are gone. It’s upsetting to be corrected when you accidentally confuse someone with another person, when you’re forced to fumble with change at the market, when everyone around you seems to be involved in a conspiracy to make you feel out of place, yet that’s often how people with dementia are treated in the US, more as objects to be dealt with than human beings.

It turns out that when patients are treated with respect and allowed to live more or less free of interference beyond the care they need to stay healthy, support from staff, and visits from friends and family members, they’re much healthier. Residents at Hogeway are less likely to need psychiatric medications, therapy, and other psychological supports, and they also tend to enjoy a better level of physical health, as well. While they may experience varying degrees of lucidity and familiarity with the world, their caregivers meet them on their own terms, accommodating them rather than trying to force them into a mold they’ll never fit.

For older adults who are facing down the end of their lives, this seems much more compassionate and rooted in a genuine desire to ensure that people receive appropriate treatment. Speaking for myself, I’d rather live in a place like Hogeway than a US institution, personally. In Hogeway, residents are safe as they navigate an environment big enough to make them feel like free and supported members of the world, while still being secure from the dangers of wandering off, via locked gates and controls used by staff members but seamlessly integrated into the landscape so residents don’t feel trapped.

Hogeway encourages patients to feel comfortable, to develop social lives, to interact with staff on a friendly interpersonal basis rather than through the power imbalance of patient/provider. This Dutch model provides a great deal of promise for nations everywhere facing down the issue of how to accommodate aging populations in a way that is respectful and functional. While at-home care is ideal, as it keeps people in their communities, it’s not always the best choice, for a variety of reasons. For families and people forced to make that choice, it should be possible to transition to a facility that treats residents as residents, not patients, that focuses on empowering people rather than taking their choices away, that builds a sense of community rather than medicalising aging.

We all grow old, and we all experience the results of aging. That’s inevitable. What’s not inevitable is how we do so, and the US needs a better approach to eldercare, one that creates environments like this one, where people can maintain their sense of independence and go free as they live out their final years.

Photo: Love Worn, Tim Hamilton, Flickr