Big Is Not Always Better, Especially In A “Covid-19 Crisis”
Ernest F. Schumacher wrote Small is Beautiful: Economics as if People Mattered. He wrote this over forty years ago, but if you did not know it, you might think the book was published last year.
Schumacher begins with one of his biggest concerns, as it relates to the abuse and degradation of humanity and the environment in the name of “giantism,” a combination of the notions that “growth is good” and “bigger is better.”
If we have learnt anything about Covid-19, it is that this virus is thriving in large environments that promote “economies of scale.”
For the last few years Memory Lane Home Living has been promoting small community homes to care for our dementia population. We have used a model out of Germany called Freunde Alter Menschen translated as Friends of the Elderly. This German, not-for-profit organization opened their first home in 1995 (25 years ago) because they realized that Long-Term Care (LTC) was not a viable solution for this vulnerable sector of the population. I think facilities which promote “economies of scale,” facilities that “warehouse” seniors, do not best serve people living with dementia.
Friends of the Elderly create small homes or apartments allowing 6-8 seniors with memory loss to carry on everyday activities in a supportive setting. The small size of the house is critical. Friends of the Elderly believe that any number greater than 8 individuals living together in a house causes it to lose its quaintness and opportunity to promote relationships.
Co-housing is the legal structure of the houses which allows families, with their loved ones, an equal voice in making decisions relating to the trained care service, and how the house is run. This housing model also encourages family participation, volunteerism, and care service that provide direction and guidance to their loved ones living with dementia. This form of community prevents isolation for families and their people living with dementia (PLWD) while promoting safety and good economic sense.
When we first brought this idea to Canada, some found it confusing. “Who would monitor such a house?” we were asked. The same people who are speaking up and monitoring long-term care and retirement homes today: THE FAMILIES.
Believe it or not, families know their loved ones best. They are the advocates who challenge faulty systems. They may be more effective in challenging and protecting their loved ones in this Covid-19 crisis than all the guidelines and regulations set out in the Long-Term Care Homes Act, 2007 and the Retirement Home Act, 2010.
The families’ greatest challenge right now in this Covid-19 Crisis pertains to “economies of scales” that the government has been promoting since the first long-term care home opened in Canada in 1965.
Many years ago, the original purpose of the these LTC homes was to provide necessary medical care and daily meals for the elderly and disabled. Today, we know that not all individuals with dementia symptoms need medical care. In the last ten years, we have seen that there are many social models of care that help PLWD thrive.
The European success story clearly shows that small home environments work best for the dementia community. Even The Hogeweyk, a dementia village located in the Netherlands, acknowledges that part of their success is PLWD living together in small apartments in community. The Hogeweyk have 152 residents on average in 23 apartment units. This means that on average 6-7 people live together in each apartment. They prepare their food, eat, and sleep and socialize together.
Ernest F. Schumacher, an Oxford educated economist, was ahead of his time. It was as if he could see into the future. I leave you with one of his famous quotes:
“Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius — and a lot of courage — to move in the opposite direction.”
Do we have the courage to imagine a better, more humane and thriving lifestyle — Memory Lane Home Living’s “Living Well with Dementia” approach — for our senior dementia population? Are we willing to risk trying something new that has already been successful in Europe for over a quarter century?