I recently sat through an internet video promoting a new assisted living residence in the Midwest. In this video, the developer boasted of having individually created the household model of elder care. This is not the first such statement I have heard, nor from the first individual to have made that claim. Such self-promotion is fundamentally provided by the claimants in order to sell something: care services, design services or consulting services, by touting themselves as being the most knowledgeable or most experienced within this area of elder care.
But if so many diverse individuals stake a claim on creation of this model of care, who can really be correct? Probably the nearest statement to being accurate is that they all are, at least to one degree or another. As with any knowledge-changing idea, there is a construction of knowledge base, trial and error, experience and history, which ultimately leads to the successful introduction, development and implementation of that idea. Then, over time, that idea continues to evolve into differing iterations, both good and bad. Whatever one may think of Christopher Columbus, he didn’t create the idea of a round world, but simply collected information and knowledge previously generated, passionately embraced it and then positively acted on it. Then additional explorers added to this body of obtained knowledge.
Much the same can be said for the small house or household model of elder care, whether nursing or assisted living. In the United States, prior to the prevalence of organized or licensed long-term care, individuals were provided the long-term care and living services they required within the confines of a home, one that was generally of a close family relative. As families became more geographically diverse with multi-income households, this evolved into privately owned residential care models which, for the most part, were housed in a large home in the community converted into a congregate aged care setting. The number of residents was restricted to the size and number of original bedrooms in the converted structure.
An Assembly Line Approach
In the middle of the twentieth century, highly organized and institutional elderly health care came into being through a number of government financial initiatives that favored staff efficiency and a sort of “assembly line” approach to long-term resident care. Double-loaded corridors, shared-occupancy rooms, central bathing and centralized dining and social spaces, all of which were based on the prevalent acute care model, ruled for some forty years, and, in some places, is clamoring to remain in place even today.
Evolution of the Household Approach
In the late twentieth century, assisted living began making its presence known in the United States. Highly influenced by the collaboration of care and built environment from Scandinavia, this model provided a more residential, non-institutional and home-like environment coupled with a much less overt staffing presence for those individuals whose health did not require the full rigors of nursing care. Residents and their families quickly discovered this more resident-oriented model and flocked to it, often migrating out of institutional nursing environments.
Evolution of the Care Model
In order to maintain some semblance of financial stability, nursing homes began to see the need to reinvent themselves into that resident-oriented, home-like model of care in conjunction with the built environment and staffing model. So, all of this history, combined with a number of forward thinkers and passionate professionals’ input, led to the household model of elder care. It was not a single individual awaking in the middle of the night having had an epiphany, but a number and variety of folks who were truly concerned about the quality of care for the elders and brave enough to push for change. This group of forward thinkers includes that developer whose internet video I watched. The real point is this: we should spend less time claiming bragging rights and more time working hard to provide the most compassionate care and most comfortable environment for our elderly population.
Jeff Anderzhon, FAIA