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Happily Ever Older: Revolutionary Approaches to Long-Term Care: Moira Welsh

After reading Leisureville, I stumbled across Moira Welsh’s non-fiction book Happily Ever Older: Revolutionary Approaches to Long-Term Care. Since I was on a roll when it came to reading about aging, I decided to take a chance and see what I could learn. As it turned out, I learned a lot. Canadian author Moira Welsh is an investigative reporter, with a career focus on the elderly. The book was written during the COVID pandemic, and considering how hard nursing homes have been hit, the book’s publication is timely. Covid was fueled by “the system that controls seniors homes. For decades, long-term care has operated on a tight budget, draining the life pleasure of the people who reside within while devaluing the work of staff forcing many to work in two or three locations just to make a living wage. This is how the virus spreads from one home to the next.” Someone I know runs a care home and, under Covid, he says “it’s like being in a war zone.”

After a long career in journalism Moira Welsh acknowledges that her stories “always exposed the negative, neglect, abuse and isolation with the goal of improving the system.” This book takes a look at the established system of care for the elderly and then examines some of the revolutionary alternatives. As a result, writing the book, visiting the various homes, was, the author explains “like opening a door to another world.”

At one point, an Emotion-Based care “observational audit” is conducted in a highly rated care home by David Sheard, Founder of Dementia Care Matters. There are some descriptions of typical ‘interactions’ between residents and staff–for example– staff checked icons on computer screens such as “food eaten” “bodily functions” etc. There’s one mention of residents parked “like cars in a parking lot.” Residents are ignored, meals served with staff “whisking away plates on schedule.” Yes it’s all very efficient but rather ignores the whole premise that we are dealing with people here. For this reader, it sounds like the staff are monitoring lab rats. The author states that “neutral care is a form of abuse,” and I agree. One image that sticks in my mind is that of a nurse entering a room every once in a while and tossing a ball at the residents who are parked in a circle.

The author describes various new approaches to Elder Care: The Butterfly Model and its emotion-based care (uniforms banned, hallways painted bright colours, removing central dining rooms), The Eden Alternative, The Golden Girls Network, The Pioneer Network, Toronto HomeShare Programme, The Green House Project, and an incredibly interesting visit to a nursing home in the Netherlands. Another approach, outside of any sort of institutional, is the growth of acceptance of “Tiny Houses.” The book is packed with various stories of improvement in residents when Emotion-Based Care became the underlying philosophy of the various care homes. It may be difficult to formulate studies that scientifically measure specific improvements in residents, but things under consideration are a decrease in medication, less aggression, putting on weight, increased interactions. Other results are anecdotal and not so easy to measure– improvements in resident social behaviours, for example. Of course none of this comes cheap. Canada predicts that the cost of long-term care will increase from 22 billion in 2019 to 71 billion in 2050.

This is a very upbeat look at a depressing subject. The author argues that a shift in social attitudes is underfoot and must continue. There were a few too many sentimental anecdotes for my taste, but at the same time, it’s probably hard to avoid given the topic. I would have like more $$ numbers because that’s how my brain works. I would have liked more on the kids that stuff their parents in homes while looting the estate. I would also have liked more on the ethics of homes providing services to residents (there’s one near me that provides cleaners). I know it’s based on the hotel type of model, but I keep thinking about Better Call Saul. But all these things belong in another book. Or two.

Anyway…. I learned a lot that I had no idea about, and the book gave me food for thought. I decided to chop down some of the ornamental trees in my back garden as the annual trimming (on ladder) is something I can do without going forward. There are a few times in the book when numbers are bandied about. One home costs over 6K a month. Another 9-10K. I know someone who pays 8K a month. Good care doesn’t come cheap; I get it, but ye gods who can afford this??? In America the average social security check is around $1500 a month (numbers vary). Social security estimates that 50% of married couples and 70% of singles receive 50% or more of their income from Social Security. It’s debatable just how many Americans rely of social security alone. There’s a range of numbers on the internet–anywhere from 12% -40%.

During the creation of this book, the author had to confront her aging parents’ health issues which necessitated a move from their home, and her very personal experience is both candid and tender.

Review copy

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