A Revolution in Care Requires a Revolution in Thinking

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It would appear that a revolution is required in our thinking of older people as a ‘demographic time bomb’,
‘burden’, ‘bed blockers’ and an economic liability all of which engender ageist attitudes. We’ need to recognise
the contribution of older people in the workplace, supporting families, friends, neighbours and society. We also
need to radically rethink how different services and sectors collaborate to identify innovative solutions.

Shirley AyresThe Long-Term Care Revolution , A Provocation Paper

Many of you will know of the famous experiment by Ellen Ranger and Judith Rodin in which a number of older people in a care home were split into two groups.

The first group were given a speech by staff which emphasised that residents should have more responsibility for their lives. To demonstrate this new choice a film night would be held twice each week, and it was up to residents to decide which night they wanted to attend. Each resident was given a gift of a small plant. It was strongly emphasised that it was up to the residents to take care of it.

The second group had exactly the same speech. Except all references of taking responsibility and making decisions were omitted. They were told which movie night to go to and that a member of staff would look after the plant.

After 18 months 15% of the first group had died compared to 30% in the second.

This small exercise in recognising the importance of individual decision making and giving people a little more control over their lives had a dramatic effect. As well as living longer , the residents in the first group became happier and more fulfilled.

One of my earliest experiences of working in housing was being asked to manage a brand new older persons scheme. They were purpose built bungalows for people who had reached the ripe old age of 55+.

“You’ve got it really easy now” a colleague told me. “You move them in , get their rent or housing benefit sorted – and you’ll never hear from them again. It’s much better than housing young people.”

They were right.  The only contact I had was because of an occasional death and the subsequent reletting of a property.  Demand wasn’t an issue as there was an endless conveyor belt of people eager to get a bungalow. As a model of business efficiency it would have made Amazon proud.

We never asked those people what their skills were. What they dreamed of. Where they were going. They were people society deemed to have served their purpose. They could now be placed in the quiet and polite customer demographic –  living out their days in peace and rarely complaining about anything.

In 2014 Morrissey , Kevin Spacey and Simon Cowell could all qualify for older persons housing and services.  Next year they’ll be joined by Nigella Lawson, Daryl Hannah and Tilda Swinton. I don’t know any of them personally but I imagine they have aspirations beyond the occasional game of bingo.

As Shirley Ayres pointed out at the launch of her paper (which I urge you to read) the default position is to view older people as an economic drain on society rather than a source of skills and potential.

Two weeks ago as part of the work of Bromford Lab we began to revisit our Older Persons offer. The first thing colleagues decided to do was to stop calling it an older persons offer. It’s ageless.

Older people do not exist as one homogenous group. They have the same skills , aspirations and dreams as the rest of us and the current lowest common denominator service provision is unfit for this generation.

At Bromford we are putting a lot of focus on how we unlock the skills and potential of all ages. There is a unique opportunity to unleash the experience and wisdom of older people across communities at time when they are needed more than ever.

This will take radical new thinking. It will involve reimagining the housing , health and care sectors that have a long history of doing things to and for people rather than promoting autonomy , connectivity and self determination.

Old age is a social construct. It essentially means a person older than yourself. Nobody stops dreaming when they hit 65, 75, 85 or 95.

Nobody dreams of ending up in a care home. And nobody dreams of being warehoused in a community where the knowledge they have built up is left to slowly dissipate.

The long term revolution we need calls for a radically different view of age and skills.

  1. Yes, they do not deserve to be put i an attic. One, their wisdom is of great value to the younger ones. Two, the values they can pass on to the coming generations is virtual bounty. Many of our society’s current problems emanate from an absence of the latter.

    Reply

    1. Thanks Ashok for the comment. I agree completely.

      Reply

  2. very good article thank you. Part of the problem is how ‘ageist and superior’ some young people have become and I never thought I would experience this! I’m currently in Tunisia and respect for their elders and affection for the elderly is still very apparent.

    Reply

    1. Thanks. Although this is changing Eastern cultures do place significant value on family and older people where the values of the West tend to focus more around youth and individualism. Perhaps we have a lot to learn from each other?

      Reply

  3. I love that you talk about the self determination. When did it become the norm that ageing meant being infantilised, with limited choices and a tendency to be ignored? Got to be a better way and this relies on health, housing and care getting their acts together and working together to enable people to realise their dreams whether that be bingo, baileys or basketball

    Reply

    1. Thanks Siobhan. Wondering why health , housing and care can’t get act together? Lot of people have blamed cuts but surely that’s a reason to hasten collaboration rather than delay it…

      Reply

  4. The concept of active ageing has existed for some time in more enlightened organisations. The starting point should be to listen to the needs of the individual. Some want to be actively involved and contribute others do not. We should also be wary of the myth that some communities respect their elders more. This is breaking down in some 2nd and 3rd generation Asian communities for example. I developed one of the first schemes for Asian elders in the 1980s. It was very popular then and is still popular now, if a bit dated in its provision. Many of the extra care schemes we developed in the 1990s and 2000s were designed to maintain independence and encourage involvement. Independent research has shown that this improved well being and life expectancy. As for the future we should ask ourselves what sort of provision we would want and how should it be provided. As you point out I already qualify for “elderly accommodation” but I hope to avoid it for as long as possible. My younger brother who is disabled and has mental health issues was extremely glad to move into a “sheltered scheme” when he turned 55.

    Reply

    1. Thanks Tom for your ever thoughtful comments. You are right – there’s some great practice out there and we need much more of it.

      As Shirley Ayres pointed out in her presentation – the baby boomer generation has grown up in the age of the consumer and that means the offerings that are out there may often be unfit for purpose. And we must remember the people who are saying that are often doctors, patients and relatives!

      The work of care , housing and health must become much more intertwined and co-ordinated.

      Reply

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