We’re days away from entering what the World
Health Organization proclaimed to
be “the Decade of Healthy Ageing.” Health systems around the world, however,
are woefully underequipped to provide the care that healthy aging requires.
From 2020 to 2030, the pressure will be on for
national governments, policymakers, and healthcare providers to redress the
scarcity of resources available to the elderly and the people who care for
them. High on any country’s list of priorities should
be the research, development, and funding of robust long term care systems.
Within thirty years, the number of older adults in need of long term care is
expected to reach 277 million globally. Of these, millions—27 million, to be exact—will be living in the United
States.
To build long term care systems with the sole
purpose of purveying end of life supports and services is not enough—not
nearly. For these systems to be accessible, affordable, and equitable to all,
they must discard a notion of health overdetermined by illness and treatment in
favor of one befitting the full complexity of the person.
Why Traditional Long Term Care No Longer Works
So institutionalized is the traditional model
of long term care that its nursing homes, assisted living facilities, and other
constitutive settings operate at a certain remove from the actual lived
experiences of older adults. The estrangement manifests geographically, in the
time and distance that separates older adults from health service hubs, and
interpersonally, in the lack of intimacy inherent in interactions with
providers who authorize care regimens from the top down.
Of every three seniors who pass away, at least one is
living with dementia or Alzheimer’s disease. Compounded with the acute social,
mental, and emotional needs that typically emerge later in life, these health
challenges demand attention at multiple points, and from multiple people, along
an individual care journey. In practice, long term caregiving is far more
distributed—not to mention more reliant on the unpaid labor of informal
caregivers like friends and family—than traditional models would have providers
believe.
Person centered models of long term care, on
the other hand, are designed to provide meaningful support at every step of the
way. Rather than dispensing generic instructions on when to sleep, shower, and
eat, caregivers honor the individual rhythms and preferences of the older
adults in their charge. They function as a dedicated team in which loved ones
take part, and to the best of their ability they meet patients where they’re
at—in their homes and communities.
Creating Pathways To Person Centered Long Term
Care
Alternatives to institutional care exist for
the elderly among us who can no longer live at home. In the United States, a
small home movement led by The Green House Project strives to “create homes for
elders that demonstrate more powerful, meaningful, and satisfying lives, work,
and relationships.” Crafted with sensitivity and care, small home settings
might include private bedrooms, gentle lighting, spacious communal spaces, and
plants and animals. Green House providers have furthermore reported better
financial outcomes than what they witnessed at the traditional senior living
facilities they left behind.
As might be expected, the barriers to building
person centered long term care systems are numerous. Identifying these barriers
at the regional level and preparing guidelines for global action is the focus
of one of the World Health Organization Healthy Ageing initiatives,
which seek to “prevent, slow or reverse declines in capacity” that keep aging
societies from caring for their elders. Responding to their urgent call for
more dialogue and education around person centered long term care is one way to
begin shifting the tide in its favor, though transformative change will most
certainly require supportive financing, public health policies, and
organizational buy in from healthcare providers.
Will we see the emergence of person centered
long term care systems by 2030? The reality, it goes without saying, is that
our vision must extend far beyond the next ten years. Over the course of the
last decade, the notion of healthy aging—of not just living longer, but truly
aging well—fully entered the realm of possibility. To make it a reality is the
challenge of not just the decade to come, but all to follow.
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