What would happen if life within an elderly persons’ home was controlled by its residents? Never! Surely, they’re too old, too frail, too ill. Above all: residents tactlessly labelled “Part III-fit” might be too confused and forgetful to give direction and exercise choice. Better leave things as they are: owners as governors, governors as managers, managers as providers. Top-down, definitely not bottom-up, provision.
Yet ever since retirement homes were first invented, there have been occasional attempts to ask service users or inmates what they’d like: a small portion of beef – or vegetarian lasagne? Tea – or coffee? Jigsaw puzzles – or embroidery? Wakened an hour earlier? Put to bed an hour later? Blackpool for the annual day trip – or Skegness? And residents can always join the Staff/ Relation/Patient Liaison Committee.
The keep fit lady will visit on Tuesday, the hairdresser each Thursday, bingo on a Friday afternoon, with the parson popping in alternate Sundays. The WRVS trolley can be wheeled along every corridor, Monday mornings.
So it was with some scepticism that I visited old people’s homes in Northallerton and Bristol, Nottingham and Chesterfield, where there were conscientious attempts to give both new and longstanding residents a proper voice – real influence – deciding what happens next, next day, next week. But how could this ceding of authority, this award of autonomy, actually work?
Most outsiders see something of what takes place in the nation’s elderly care homes if a friend or relative is admitted to one; or else they despair on hearing media reports of urine-soaked mattresses, showers set at boiling point, irremediable bed sores, angry or sadistic nursing auxiliaries, dehydration, malnutrition.
Worse is a realisation that the Care Quality Commission might only send impressionable, non-inquisitive, non-combative, unqualified inspectors in, by appointment, once every two years – and then only to sit over a cup of tea in the superintendent’s office. No wonder bank nurses sleep at their stations. No wonder one large establishment spends a piffling £13 per week on fresh fruit and vegetables. No wonder most front doors remain bolted, lavatories monitored by camera.
How I remember one summer, an inspired John Humphreys, presenter of Radio 4’s Today programme, recruiting a very intelligent, and articulate, woman to dwell in a big council home for four weeks, under the never-sussed pretext of “urgent family respite”. And once in, this alert 73-year old kept an audio diary as vivid as it was engaging, as wildly revelatory as any producer could hope for. Here, at last, was an authentic, authenticated effort to blow the lid on life “within those walls”: immediate, impartial, insightful... worrying.
Back to the time an establishment might actually award its residents their say. Is there a template?
First you must have a benevolent home run on a not-for-profit basis, or a commercial home whose leaders are totally committed to their guests’ wellbeing. Underline the word “guest” – somebody it is a privilege to serve.
Beginning at the front door, residents could select a panel for the interview and appointment of staff: that selection procedure to include each candidate spending the morning on a Zimmer frame, lunchtime in the refectory, afternoon confined to a wheelchair. And once in post, a nurse, administrator, cook or cleaner would be subject to performance appraisal by that recruitment panel, in tandem with reports back to and from the board or the superintendent.
Additionally, each resident – recent or seasoned, able-bodied or recovering – should order whatever foods they themselves find most delicious or enticing. Not only meals, but also the crockery those meals are served on; not only crockery, but cutlery, serviettes, table-cloths... muzak, also.
Another residents’ panel would be responsible for room allocation, furniture, curtains, carpets, wallpaper, paint. And this group too would be answerable to a plenary weekly meeting where everyone – even those with fewest years’ life expectancy – could vote on education, therapies, treats, outings: the primary responsibility of Residents’ Panel No 3, which might also arrange a bar from 5 till 10 each evening and specially selected films or DVDs, so that random TV shows are not the only daytime “activity”.
But what about disagreements? How can guests hope to cope with the crabbiness, obstinacy, petulance, of ageing? Aren’t most residents too demented to do choice? Won’t there be staff protests, resignations, walkouts, once employees discover they are not in total command of their establishments? And available funds will disappear attempting to meet the limitless demands of individual preference. Such a daring venture, such systemic regime change, will surely be doomed: dismantled, within months of being cranked into motion.
Yet, astonishingly, a democratic establishment with meaningful guest input can meet and match all scenarios, snags, sensibilities, setbacks. Resident panels properly set up can defy their critics.
The best result of devolving day-to-day responsibility for conditions within retirement homes is witnessing residents’ pride: how keen they are to come up with suggestions; how raised their self-confidence and self-esteem. Even 80 and 90 year olds glow when their feelings, emotions, preoccupations, ambitions, are taken seriously.
All we now need is societal, managerial, governmental commitment, and goodwill.
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