Less confinement and more community: towards a new model of care for the elderly

Fernando Fantova, researcher and consultant for Social Services, says that the global pandemic "is proving to be a stress test for all the mechanisms and devices of our societies". He also points out, with the foresight to which his followers are accustomed, that this crisis is producing significant "reputational damage" to the residential care system (because of the high number of people who are dying in these facilities). 

Without a doubt, the social consequences of the coronavirus crisis add an emergency bonus to something that was already urgent: the collective approach and confrontation of what has been called the "care crisis" in recent years. This expression refers to the crack generated in the traditional model of care for large sectors of the population (the elderly, the people with disabilities, children, the sick, etc.). 

In our society, care has been considered, for reasons of affection and/or moral obligation, a question of an intrinsically domestic nature, to be resolved by each family (especially women) with its own resources (with the help of the market -whoever possible- or by adding aid from a shrinking public sector -always limited and highly conditioned-). In this pattern, a fissure has opened (a large fault) that obeys force vectors of various types and ranges: The main challenges are: socio-demographic (increased life expectancy and low birth rate, ageing population, changes in household composition), socio-labour (redefinition of roles within families, reduced availability of women to provide care at home), cultural (individualization processes, lack of co-responsibility of many men in care tasks) and, of course, political-economic (expansion of neoliberal policies of social cuts, reduction of resources for public policies on social services).

Esta compleja situación ha llevado a muchas familias a externalizar los cuidados recurriendo, sin saberlo, a servicios incardinados en cadenas mundiales de atención (cuidadoras extranjeras) o en circuitos financieros globales (fondos transnacionales de inversión), dos manifestaciones de “la globalización y la mercantilización de la asistencia”.

This complex situation has led many families to externalise care by unwittingly resorting to services embedded in global care chains (foreign carers) or global financial circuits (transnational investment funds), two manifestations of "the globalisation and commodification of care".

Hopefully, many innovative initiatives have been explored in recent years in the construction of other types of care encouraged by changes in different areas: social (demands for the participation of vulnerable or dependent groups in the generation of social responses to their needs), technological (advances in monitoring health and well-being, in providing telematic services and in enabling safe and comfortable homes), conceptual (demand for a person-centred care model, recognition of the social components of health, revitalization of community links), politics (legal advances and definition of strategies for the promotion of autonomy and capacity), and organizational (demand for an integrated and integral socio-health approach, rooted in the community, to effectively address human fragility).

This is where the imminent and necessary debate on the new model of residential care should be framed. Political, institutional and, hopefully, media reflections on residences should not focus on the ratio of health personnel to people housed. This would imply forgetting the context (the new models of care), distorting the diagnosis (the problem is not logistical but conceptual) and erring in the approach (more institutionalization, more segregation, more "confinement").

El debate debe abordar cómo reorientar la mirada a la vejez lejos de estigmatizaciones y paternalismos; cómo facilitar que las personas puedan diseñar sus proyectos de vida en su hogar, con sus vínculos, con sus redes sociales (y en alojamientos alternativos estimulantes, saludables, abiertos, de convivencia, cuando se requiera); cómo construir alianzas público-privadas ajenas a las lógicas del mercado que han presidido algunas decisiones políticas recientes; cómo articular los sistemas sociales y sanitarios para garantizar la calidad de vida de las personas allí donde quieren vivir (en su hogar); cómo posibilitar que las personas, en palabras de Oliver Sacks (en su libro En movimiento, 2015), “puedan llevar una vida placentera y que tenga sentido, con sistemas de apoyo, participando en la comunidad, sintiendo respeto por sí mismas y sintiendo que los demás les respetan”.

The debate should address how to reorient the focus on old age away from stigmatization and paternalism; how to enable people to design their life projects at home, with their links, with their social networks (and in stimulating, healthy, open, alternative housing, when required); how to build public-private partnerships that are alien to the market logic that has presided over some recent political decisions; how to articulate social and health systems to ensure the quality of life for people where they want to live (in their home); how to enable people, in the words of Oliver Sacks (in his book On the Move, 2015), "to lead a pleasant and meaningful life, with support systems, participating in the community, feeling respect for themselves and feeling that others respect them".

This exercise of reflection and planning must be channelled, in short, around a single question: how to put the person at the centre.

If the debate is not approached in these terms, "to lock up the old", as Mary Beard recently said (El País, 17 May 2020), ageist policies will be encouraged, a necessary reflection on what people can contribute throughout their lives will be stolen, and a criterion that is only important for the socio-economic system that is to be rebuilt will prevail: "pure convinience".

Original source: Cuadernos para la reconstrucción económica y social