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Rethinking Long-Term Care: Changing Mindsets, Valuing Older Adults


As the ravages of COVID-19 press on and the dire shortcomings and tragic consequences of life – and death – in long-term care homes are laid bare, what is also apparent, if we are willing to look it in the eye, is the importance of giving more time and consideration to the voices of the very residents of these homes. The opinions and needs of older, often frail residents, and those of their institutional and family caregivers, are too seldom sought or taken into regard when it comes to designing services and resources to support them.

It is as if the changes that come with old age, including the physical and cognitive challenges that develop for some, render the opinions of these seniors less relevant, and unimportant. Many of us do not give much thought to what residents of long-term care have to say about their lives, needs and goals. As a society, we have too frequently shelved and silenced frail older people.

But to silence, disregard and exclude these older adults – and any group in society – is wholly wrong.

This is ageism: “a belief system…that attributes specific qualities and abilities to persons on the basis of their age…[and] may manifest with respect to older adults in attitudes that see them as less worthy of respect and consideration, less able to contribute and participate in society, and of less inherent value than others.” (Law Commission of Ontario, A Framework for the Law as it Affects Older Adults)

As a society, and within the systems that serve older persons, prejudicial attitudes prevail. We continue to stereotype and discriminate against those who are older, particularly as they become frail or develop complex needs.  While old age brings changes, some of them challenging, negative attitudes about age have troubling impacts. None of us are immune to ageism and it is not cost-free: older adults with negative attitudes about aging live, on average, 7.5 years less than those who have more positive attitudes, the World Health Organization notes.

Further, ageism shapes how we see the big picture, and how we plan. The WHO 2020 report, Aging: Ageism states, “Ageism limits the questions that are asked and the way that problems are conceptualized, and is hence a major barrier to developing good policies.”

Over the past ten months, a group of like-hearted professionals at Barnes Management Group (BMG) has turned its attention to ways in which to reimagine long-term care systems and supports. In a forthcoming report that examines 25 years of efforts towards meaningful reform of Ontario’s long-term care system, BMG notes that governments and policy makers have indeed reconsidered approaches to aging and older adults. While the rights of older persons are confirmed in the Ontario Long-Term Care Homes Act of 2007, the National Framework on Aging, 1998 and in international plans and policies, the reality of the value placed on the lives of older adults, and the conditions under which many of them live their final years, is saddening.

If long-term care is to change and improve – and we would all readily admit that it must – then we must start by acknowledging and finding ways to gather, listen to and magnify the voices and needs of senior residents of long-term care and their caregivers. We must tackle ageism head on, developing a new understanding of ageing, moving away from seeing older persons as a burden and asking how society could do better for our seniors.

And from here, we must create and demand new approaches and a new system of supports for older persons who are frail or disabled, based on what they themselves and their caregivers express that they need and desire. Older adults, like all of us, have goals and wishes to live with meaning and purpose. A better system of long-term care will allow older people to live out their lives in accordance with their values and goals.

Bringing together those who want to see a different future for seniors, we can move beyond what is wrong with the long-term care system, and start imagining what would be right, with the voices and opinions of the residents of long-term care, their families and front-line workers driving these thoughts and plans. They know: they are living the experience, and surely are our best guides.

Written by: Jill Palmer, BMG Associate

Image Copyright: Fernando Saldanha

March 01, 2021

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