Work in the US around long term and community based residential care provides an interesting model for the English health and social care system to consider. Shreshtha Trivedi reports

Nursing home

Sara McKee says bad residential nursing homes are like a factory, where the schedule is structured around the roster of the staff and not the needs of the residents

According to a King’s Fund report, by 2030 one in five people in England will be at least 65 years old. With changing demographics and a challenging financial climate, it is imperative that the older systems of healthcare and delivery – concentrated around treatment of single diseases – move towards a more holistic model where not only the complex needs but also social issues of our ageing population, such as dependence and isolation, are addressed.

‘The importance of suitable housing in making older people feel secure, happy and independent can’t be overstated’

As HSJ’s Commission on Hospital Care for Frail Older People examines how to better support older people and reduce pressure on our health and care system, one key aspect of that care component is suitable housing. Although hospitals continue to play a vital role in treatment of the frail and elderly, the importance of suitable housing in making older people feel secure, happy and independent can’t be overstated.

It is here that Bill Thomas’s work around long term care and community based residential care in the US can be an interesting model for our health and social care system to consider.

Abolish nursing homes

Dr Thomas, an international expert on older people’s health and geriatric medicine, has been known for taking a strong position in favour of abolishing nursing homes. He is the founder of Eden Alternative and the Green House Project – innovative models of care that are focused on de-institutionalising long term care and focusing on emotional wellbeing of the residents.  

Eden Alternative was started in 1991 and was implemented across the 50 states in the US. It is a programme which converted nursing homes into less institutional care settings by allowing pets, introducing gardens and letting children enter in order to bring in the elements of normal family life. This was followed by the Green House Project where the nursing homes were completely replaced with small, home-like residential settings: the residents had their own private rooms and bathroom but common spaces for an independent, yet united, living atmosphere.

Dr Thomas’s idea was to get rid of “loneliness, helplessness and boredom” of older people who faced isolation and depression in the nursing home setting.  

Widely regarded as a leading authority responsible for bringing a culture change to long term care, he was named as one of the 12 pioneers who are most changing the future of retirement and ageing in the US by the Wall Street Journal in 2008. He has also been responsible for starting “senior wards” in emergency departments in the US, which, according to him, are more efficient and cost effective.

HSJ caught up with Dr Thomas while he was in the UK to meet policymakers and politicians to discuss how the UK can tackle the pressures around care for older people. Dr Thomas is also collaborating with Evermore, a community based environment for older people where the residents live in small households of 10-12 people. It is inspired by the Green House Project and is founded by Sara McKee, former chief executive of Anchor, England’s largest not-for-profit housing association.

‘Most people don’t realise where NHS ends and where social care kicks in’

Ms McKee says Evermore is one of the first household models in the UK where older people are the “not just residents but home owners who take their own decisions and are financially independent”. The first apartments will be built in Cheshire by this summer.

Both Dr Thomas and Ms McKee are of the opinion that despite the differences in the systems some of these innovative models from America that have worked effectively in a public funded environment can be brought here and implemented within the current budgetary framework by helping people stay out of hospitals and starting to talk about integration and sharing the savings.

“Most people don’t realise where NHS ends and where social care kicks in. NHS is free to the point of need whereas social care, where we stand, is means tested,” she adds.

Ms McKee compares residential nursing homes to a factory where the schedule is structured around the roster of the staff and not the needs of the residents who “can’t even decide when to have breakfast, lunch or dinner”.

Ageism barrier

They both, however, feel that the biggest hindrance in providing excellent care to frail and older people is ageism. Dr Thomas has been passionately campaigning against this prejudice and dispelling the negative stereotypes attached with it.

“There is really need to reframe ageing from the concept of decline to concept of growth and development. We create more disability among older people by communicating the idea that when you’re older, you are less worthy, you have less standing in the society; and by further using institutional methods of care, we make them even less capable of taking care of themselves.”

Dr Thomas believes the 21st century will see “emergence of a new, exciting old age” based on the concept of growth and development.

“One of the points I make to people who work in manufacturing, design and healthcare in US is that meeting the design needs of older people is the best way to find a universal design that everyone can use.

“Ageing is going to drive a lot of innovation, which people of younger ages can use too,” he concludes.