Thursday, April 9, 2009

A Revolutionary Idea

...treating older people who need assistance in their daily lives as people, real people, with their own interests and preferences and hopes and concerns.

As a feminist, I spend a lot of time thinking about how people are othered based on their gender, race, physical ability, sexual orientation, conformity to beauty standards, religion, etc. But the othering of elderly people in nursing homes never occurred to me until my grandfather, who had been in relatively good shape, had heart surgery and went into a nursing home for several months for his recovery. There his life was fully institutionalized overnight. He became a "patient" rather than a person. Various care providers came and went throughout the day caring for his physical needs, and his day took on a routine that revolved entirely around these needs. My family watched as he took on a look of complete helplessness and detachment over a period of just a few days. He had gone from being a vibrant man, interested in electrical engineering, weather forecasting, religion, western novels, playing card games, and growing as many flowers as physically possible on the small deck of a condo, to a man who wouldn't even pick up the books and magazines we placed by his bed or dial a number on his cell phone. It seemed to me like the loss of autonomy and the shift to a complete focus on his physical needs had killed his will to live.

According to Dr. William Thomas, this change of personality that comes with institutionalization is fairly typical. After med school, Dr. Thomas went to work in a conventional nursing home for several years, and what he observed there led him to advocate for sweeping changes in the way we provide care for the elderly. These changes have been realized in The GreenHouse Model of care, which sees its clients as "elders" who have multifaceted lives rather than patients whose physical needs are primary. By moving away from the institutional culture and top-down administrative style of nursing homes and focusing on creating an environment that honors the individual autonomy of the elders and gives great flexibility to care providers in working with the elders to create the kind of home they would prefer to live in, Greenhouses have already demonstrated that a much higher and comprehensive quality of care can be provided at a similar cost to conventional care. Greenhouses are developed based on the philosophy of the Eden Alternative, which focuses on "creating a life worth living" for those in their care rather than merely working to keep their bodies alive.

Being reduced to a patient with a constellation of physical needs is othering and dehumanizing. Additionally, it leads to chronic over-medicating and the use of restraints intended to render the patients docile and easily managed rather than focusing on how to help them flourish and maintain as much continuity with their pre-institutionalized lives as possible. It's great to know that somebody is working to revolutionize our treatment of older people to help them retain their dignity and sense of self even as they undergo significant life changes. The Greenhouse model has been referenced as a promising element of health care reform by the Senate Finance Committee. If or when legislation comes through calling for support for this model, I intend to strongly encourage my congressional representatives to support it.


  1. I thought about something similar to this this weekend while I was in Florida with my now 86-year-old grandmother. Every time she wanted to do something, someone would offer to do it for her. Whether it was holding a door open or getting another piece of toast from the buffet, no one wanted to let her do anything for herself - no one believed her to be capable.

    I know that my family is just trying to be supportive and respectful of her as she ages, but I wish that they would remember that she is still her own person, who wants to feel - and be treated - like an individual capable of having her own life.

  2. And I think this pattern of doing everything for them contributes to their helplessness. If everyone around you acts as if you're helpless, then over time, you'll start to perceive yourself as helpless. And the less you do physically, the faster you'll lose the muscle tone, etc. so it's a kind of cycle.