Abolish not demolish institutional care

People are being incarcerated across the country just for growing older but ageing is a normal part of life. Join our call to abolish institutional care.

There are around 487,800 places in care homes in the UK and a study by the Institute of Ageing and Health predicts this number needs to increase by 82% by 2030 to ‘cope’ with our ageing population. Yet instead of building more care homes to accommodate our elders, should we try a more radical approach and abolish them instead?

In the US we are seeing the end of the nursing home. This has been spearheaded by Dr Bill Thomas who has been prescribing ‘bulldozer therapy’ since 2003, with the intention of taking America from 16,000 nursing homes to zero.

Like Bill, I’d like to take a bulldozer to the nation’s care homes and it’s not because I have anything against the building themselves.

Some of them are beautifully designed and appointed, in fact many appear and function like quasi-hotels. They boast luxurious settings with accommodation for 100 or more residents, meals are served in restaurant-style dining rooms, and there are facilities like libraries and swimming pools to enjoy.

These care homes are lovely to look at but they are set-up to suit management and, if you dig deeper, the signs of institutionalisation become clear. There are hospital-style beds in rooms situated off endless corridors, fully equipped kitchens where food is prepared en-masse and brought down to a restaurant in lifts, and industrial size laundries churning through clothes with name tags.

Residents pay a lot of money to stay in these homes – around £1200 to £1500 a week – so they are served and waited on but there is little encouragement to carry on doing things for themselves. Meals are only available at certain times due to staffing levels, and activities are designed to keep residents occupied rather than giving them purpose.

Yet prior to entering a care home these people were booking holidays, doing the weekly grocery shopping, looking after their family members and basically making decisions every day about their life. Why is their right to choice, thought and desire suddenly negated because they might need help walking or have a chronic health issue?

It’s not the fault of staff that this choice has been taken away from residents. Staff try to do their best but they are handcuffed to transactional activities, dictated by management. It’s really tough to be a good carer or to show initiative if you have to complete a check-list in an allotted time.

What we need is fewer rules so staff have more freedom to create the environment and experience that meets the needs of their customer. It’s simple really. Give staff space to do their job, provide the training and support to help them master their role, and empower them to make the decisions on the day. This means flattening the hierarchy and not having to ask 72 people for permission!

We have to move from patriarchal way of supporting older people to one where it’s more of a joint enterprise, so we work together to optimise their health and wellbeing. In this instance, the building may still be large but the approach to engagement between staff and customer is done on a small scale. That way you can build the long-term meaningful relationships that enhance the environment for both the member of staff and the individuals they’re supporting.

As you can see, it’s not the building that creates the problem so any attempt to create a new vision for care homes is completely misguided. It’s what’s happens inside the building that needs to be addressed and the underlying attitudes that guide residential care – that ageing is an illness, older people are vulnerable and incapable, and they need to be fixed.

People are being incarcerated across the country just for growing older but ageing is a normal part of life. We don’t need institutions to care for our older relatives or friends. What we need is a place that enables them to continue living the life they want, with help when they need it.

So rather than building more shiny new care homes, let’s abolish them altogether. Who’s in?

Sara McKee, Evermore Founder and Director of Market Innovation
Follow Sara on Twitter @SaraMcKeeFRSA

This blog originally appeared on the Huffington Post.