Atul Gawande is a surgeon at Brigham and Women's Hospital and a thoughtful and compelling writer. In today's New York Times, he discusses life in nursing homes and the deterioration of spirit that occurs among many residents in this setting. Referring to a person he met, who picked her own high quality nursing home, he says:
The things she misses most, she told me, are her friendships, her privacy, and the purpose in her days. She’s not alone. Surveys of nursing home residents reveal chronic boredom, loneliness, and lack of meaning — results not fundamentally different from prisoners, actually.
Along these lines, a friend's mother left behind a letter with this advice to her family after spending several of her last years in a nursing home (yes, also a high quality one).
Try to find an alternative to nursing homes. People are segregated by age and they have very little in common. I have found them a terrible home. I’ve done the best I could but that’s not good enough.
In the "old days", elderly relatives would have lived with their extended families. That chapter is closed for most people in the US. In lieu of that, Gawande refers to "a small band of renegades" who have created alternatives aimed at replacing institutions for the disabled elderly with genuine homes.
These are houses for no more than 10 residents, equipped with a kitchen and living room at its center, not a nurse’s station, and personal furnishings. The bedrooms are private. Residents help one another with cooking and other work as they are able. Staff members provide not just nursing care but also mentoring for engaging in daily life, even for Alzheimer’s patients. And the homes meet all federal safety guidelines and work within state-reimbursement levels.
They have been a great success [and they are building these in] every state in the country with funds from the Robert Wood Johnson Foundation. Such experiments, however, represent only a tiny fraction of the 18,000 nursing homes nationwide.
I don't pretend to know the solution to this problem, but bravo to Dr. Gawande for bringing the issue to a large audience.