Friday, October 07, 2011

Ageing in place smoke and mirrors and self-deceit

Anybody who reads my blog will know I am a great fan of Laurie Orlov. Not only does she know a lot about the subject of Ageing in Place but she expresses herself brilliantly and gets to the messy core of issues.

I guess the fact that I agree with a lot that she writes also accounts for being a fan.

Long ago in the UK we had "care in the community" this was a fancy name for shutting down expensive intuitions for people with mental health problems. There were lots and lots of good arguments, honestly expressed, about it being much better for people to be 'intergrated' in 'the community'.

OK, there was the point that this saved a hell of a lot of money and the reality was far away from the nice theories. We just shunted people from mental health institutions to the street or into hospitals / prisons.

Nobody can disagree with the theory of "ageing in place" but my fear (certainty) is that it will be used as a way of saving money. We can add some tinsel of technology to show how we connect to older people but for many (not all) the outcome is going to be horrible. Of this I am certain.

Apologise to Laurie but I am going to give a verbatim quote from her blog. She expresses a similar sentiment much better than I ever could.

Okay, okay, we get it – everyone wants to age at home. How do we know? AARP say so. 

Forget that AARP’s survey sample might be skewed towards the younger end of fifty- and sixty-somethings, not 80-90 year olds. Forget that life expectancy is lengthening -- the good life or the not-so-good – apparently indistinguishable among the life expectancy extender-types, aka the healthcare system. 

Forget that this is a gloomy and isolating picture for those with limited transportation in their 80’s and 90’s, those living alone with mild to moderate dementia, and those for whom it is a great chore just to get up and about.

 Tech and service vendors (want you to) believe home can trump assisted living. So if one more vendor tells me that the monthly cost of their (monitoring, sensor, chronic disease checker, whatchamacallit) subscription service is one-tenth (one-fifth, half, or whatever) the cost of a month in assisted living, I may just lose it. 

Does their product/service offer up group activities? Trips to the park? Shared dining experiences? Redirection and therapy programs for the mildly disabled or those with dementia? Is there a dietician on staff? How about an activities director? Need I go on? 

This sales pitch is designed to make adult children and the vendor feel self-righteous, but all that their products do (hopefully) is in the specs – sense this and track that, and hopefully forward the info to someone who can react. Someone who can react is certainly an improvement over no reaction, but on the continuum of oversight, it skews to the left.

Is there a place for using tech to assist older people live longer in place - sure. But it is not the only answer and we mustn't use it as a distraction from providing decent face-to-face care. Dick Stroud

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