The end of nursing homes and what will replace them

Where do you want to live as you grow older? We bet it’s not in a nursing home. The era of institutionalised care is over as people demand better choices and more options. Options that let them remain in their community, living their way and to their timetable instead of hidden away in grey ghettos.

In this video, Evermore founder Sara McKee and global chair Dr Bill Thomas discuss ‘what’s next after nursing homes?’, exploring why older people want the same as everybody else (gasp!) and the role planners and developers have in giving people more choice as they age.

You can watch the video here or read the transcript below.

Live Happy!

Sign-up to receive Evermore insights into how we can inject humanity back into health and social care, so older people can live a life in full colour.   

Video transcript

Dr Bill Thomas, Global Chair of Evermore

When you talk to older people about how they want to live, it turns out they want to live like everybody else. They want to live in a place and in a manner of their own choosing. That’s what everybody wants. One of the reasons nursing homes have failed is because almost nobody would choose to live in an institution – it’s not the place they would choose to live.  That’s why, over the years, I’ve become a nursing home abolitionist.

You know there was a time when people thought that poor houses and sanatoriums were absolutely essential and could never be replaced. Those people were wrong. We’ve found new ways of addressing social issues without institutionalising people. We’re living in a similar moment now.

Millions of people believe nursing homes are inevitable. Nothing can replace them. It’s wrong. We’re actually in the middle of exciting time where technology, culture, and architecture are coming together to create solutions and new options that don’t require them to leave home and their family and their community to move into an institution. As a geriatrician, it’s the most exciting time to be part of this journey. Here in the UK, Evermore is leading the charge. Evermore is dedicated to putting together new combinations of technology, building structures, culture changes and habits so people can live where they want to and how they want to.

It’s to understand that we all have care needs whether we’re young, middle age or old…its universal of human experience. What’s specific to old age, is the nature of the needs change. It’s really important to develop the way to meet those needs without sacrificing the independence, dignity and autonomy of older people. That is really the central challenge of our time.

Sara McKee, Evermore Founder

Nowadays care and nursing homes are end of life, so people put off going in there until they’re really dependent, really frail and have no other options. It’s just grim and shouldn’t be allowed. Nursing homes have gone from intimate places to up to 150 beds and they are industries, resembling not much difference to a workhouse. It’s not where I want to end up or my parents…for us, the concept is dead. What we’ve not done is create other opportunities for people to live well either in their existing homes or new homes but that’s the mission we’re on.

I fundamentally believe that care homes, like any other institution we’ve abolished, will go. What will replace them is lots and lots of variety of places where you can live together – cohousing, extra care, communal living, student living. Spaces where you can dip in and out of those relationships. Have your own space.

The big thing is that older people want to stay in their own homes. This is only because the alternatives are so grim. If we create aspirational places to live, like the rest of us, they will choose those lovely places. That’s where developers need to get their heads together. It’s a massive market. Massive opportunity because older people have all the housing wealth currently. If we can get developers behind that notion so they build brilliant urban and suburban developments for older people that are not ghettos then we would have a really vibrant urban culture in some of the market towns now failing.

One of the things I’ve always felt, if you live with other people or in a community there is a lot of contribution that is given freely. You tend to look out for each other. You tend to check if there is milk in the fridge of your neighbour if they are less mobile because it’s neighbourly. The concept of how does care work in the community is different. It’s not about having rigid structures, it’s really flexible so there will be professionals in the mix but a lot is about sharing tasks, working together, contributing to the same community, participating in things and doing things together in a way that promotes health and wellbeing for the individual because they feel like they belong to something.

Yes, people will always have care and support needs at some point but that can happen at any age. We don’t say to small children that we’re not going to look after you because they’ll be a burden, like we do with older people. If you’re part of a community, you have a seat at the table like everything else. You have a right to be there and we should be designing things that fit my lifestyle, to my timetable, in my way.

One of the really interesting things policy makers could get involved with is less about new build development and more about looking at the buildings we already have. We’re never going to build enough retirement housing stock if you look at the stats. It’s just not going to happen. Look at all the redundant buildings above shops in high streets, look at all the empty office buildings.

Some bright spark has worked out you can convert office building into micro apartments for young professionals.  Why are we just doing it for young professionals?

I don’t want to have loads of stuff in my 80s and I don’t want to clean a big flat. Having a space in the heart of the community, we should be reusing all the housing stock available, filling in all the brown field sites, creating different communities and different housing options as well as building some new. If you can imagine the cost of redeveloping an existing building rather than starting new and eating into green belt, it’s got to be attractive to policy makers and developers.

What policy makers have to do is make the planning process really simple, really easy and accessible for people to get on with it. We also need to make sure these places are really affordable and attractive. So we don’t want to say only people over 60 or 70 can live here. It’s an apartment building. You can all live here, whoever gets here first can live here. Fostering intergenerational community is going to be really powerful. What works for young people getting into first rental or mortgaged property, will work for older people who no longer need to rattle around in a big house.

ENDS

If you like what we say, share the conversation online.