have based my discussion on four major premises that are interwoven throughout the book, each of which is described in the following sections.
Language
The first premise is that language used to name people denotes values. The term “elders” refers to people over the age of 65, although the majority of elders in nursing homes are over the age of 85. I have used this term because it denotes an aura of respect and wisdom. It is the term used by aboriginal people for older adults, who are revered in their communities.
It is imperative that we show respect for elders. Infirmity and frailty are not reasons to treat people any differently from anyone else. Respect can be shown by the way people address each other, by the choices clients are given as well as in the general planning of all activities and the set-up of the environment.
Another term frequently used in the book is “client.” I have used this term instead of “consumer,” “patient,” “resident,” or “individual” because it connotes power. A client has the respect of service providers, and nursing homes provide a service of care as well as housing.
Aging in place
The second premise is that aging in place is a positive concept. When you age in place, you live in the same community (although not necessarily in the same residence) until you die. Most elders prefer to live and die at home, where they are surrounded by familiarity. In fact, 90 percent of today’s elders live independently in their community (i.e., in an apartment, condominium, townhouse, duplex, or free-standing house). They are able to do most things for themselves, although some care is provided by family members or friends (informal help) or paid home care workers (formal help).
Other elders may choose to live in a nursing home or other facility such as Abbeyfield housing or congregate care. If that facility is in a community with which they are familiar, they will also be aging in place.
Definition of health
The third premise is that a broad definition of health is being used. According to the World Health Organization, “health is the extent to which an individual or group is able, on one hand, to realize aspirations and safety needs; and on the other hand, to change or cope with the environment. Health is therefore seen as a resource for everyday living, not the object of living; it is a positive concept emphasizing social and personal resources as well as physical capacity.” In other words, health is influenced by many factors, including where you live, how you eat, how you exercise, and how many friends you have.
Client centeredness
The fourth premise is that any service organization should put the client first. Nursing homes are in the business of providing a caring service. Therefore the client must come first. For example, a nursing home that has set visiting hours is not client centered. Set visiting hours enable staff to do their work unencumbered by visitors. But people living at home don’t generally have visiting hours for guests. A client-centered nursing home would allow clients to receive visitors whenever it suits them.
Chapter 6 discusses the concept of client centeredness in more detail.
Conclusion
Most of the definitions in Making the Right Move are from literature published by British Columbia’s Ministry of Health and Ministry Responsible for Seniors. However, the general concepts of elder health care may be applied wherever you live in North America or around the world.
Throughout the book, I have used personal stories to illustrate how the complicated health care system works. All the stories are true, although the names have been changed for reasons of privacy.
The elders of today are mothers and fathers of the leading-edge baby boomers who are now in their 50s. At each stage of their lives, boomers have changed systems and institutions such as schools and universities. So too will they change the health system and the use of nursing homes. Already health care cuts have resulted in longer line-ups for surgery and limits in home care. This makes it all the more important for you to consider your options so that you can make the right move on terms that suit you.
A Nursing Home Success: Mr. Mckenzie’s Story
Mr. McKenzie lived alone since his wife died. His children lived across the country, and while they phoned occasionally, he had lost interest in their lives and was depressed about his own life. Although Mr. McKenzie had been an active volunteer for the Lions Club, over the years, he had lost interest in anything to do with his community. At 87 years old, he just did not feel well enough, and it was too much effort to go out. He just sat in a chair all day watching tv.
His diabetes was out of control because he wasn’t eating properly, and he had a huge ulcer on his right ankle that refused to heal. Diabetes and lack of circulation were not his only problems. He had congestive heart failure that made him short of breath even when he was moving slowly between his living room and kitchen. Arthritis made his joints hurt all the time, especially his hips and knees.
When Mr. Mckenzie’s daughter came out for a visit one summer, she was shocked to see his horrid condition. She took him to his doctor, who suggested that he should consider moving into a nursing home because he needed care. Although he was not happy at the prospect, his daughter convinced him that it was the best solution.
Having made the decision, Mr. Mckenzie and his daughter talked with a couple of different nursing home operators, before choosing Golden Years Nursing Home as his new home. Although Golden Years was across town from his grandchildren, whom he liked to visit, it was close to downtown, where the action was. The home also had a private room available, which was an essential requirement for Mr. Mckenzie, who could not contemplate having a roommate after living alone all these years.
Now, after only three short months of living at Golden Years, Mr. Mckenzie is a different person. His medical conditions have all improved dramatically. He eats well and now only needs a small pill for his diabetes. His congestive heart failure is under control through medication, and the ulcer on his leg has cleared up with the use of a new medicated dressing. Even his arthritis is not such a problem because he is doing weights three times a week in the gym under the direction of the physiotherapist.
He is also much happier than when he lived on his own. He is well-groomed, with his beard neatly trimmed. His clothes are pressed and clean, and his shoes are shiny. He is an early riser, so he has breakfast from the hot steam table set near the kitchen for all early risers like him. They have a breakfast group of about eight people. The other clients cherish Mr. Mckenzie because he is one of the few men in the home. The women and the staff really like him. He even has a new girlfriend, Pam, who comes to see him daily. He is busy. He loves woodworking in the shop and making toys for his great grandchildren. Pub nights are his favorite night of the week when Pam joins him. Because of her, he even goes to church again, and they meet yet another time in the week on this outing.
The computer club is a boon to his existence. He is now in touch with his kids and plays bridge on the Internet because he is above the level of the players in this home. He gets on a chat-line early in the morning with his daughter who is in a different time zone. Mr. Mckenzie has a new outlook on life. It is fun again. He looks forward to new developments each day. Learning the computer was a long process for him. The activity director at Golden Years spent many hours patiently teaching him, and fortunately, all that time has
