Older People in Long-Term Care Institutions: A Case of Multidimensional Social Exclusion

Abstract

Living in a long-term care (LTC) institution provides older people experiencing health and social problems with a comprehensive range of support services that address their quality of life. Despite access to such services, challenges arise in relation to their participation in key activities both within and outside the institution. This chapter examines such challenges, reviewing and describing ways to prevent exclusion along various domains, specifically social relationships, civic participation and socio-cultural life. Firstly, we discuss ways in which bio-medical models of care and the quality control systems, which are dominant in LTC services, standardise care, tending to put decisions exclusively in hands of staff, taking away residents’ autonomy, and ultimately curtailing rights and citizenship status. Secondly, we examine how LTC services might prevent such exclusion and promote older people’s participation in at least four respects: (1) prompting and supporting residents’ ability to take decisions on their own care, (2) favouring the maintenance and creation of social relationships, (3) enabling residents’ participation in the activities and management of the institution, and (4) guaranteeing residents’ rights and full access to citizenship. We discuss the impact and limitations of recent initiatives put into practice in these areas of practice.

What’s Keeping Residents “Out of the Mainstream”: Challenges to Participation in the News Media for Older People Living in Residential Care

“…The potential for civic and news media exclusion should be acknowledged as policies in residential care are reshaped following the COVID-19 pandemic. Community integration of residential care homes should also be a focus of communities and care home operators ( Villar et al, 2021 ), and policy should ensure that urban planning and architecture are purposely designed so that older residents can access their neighborhood and be included ( Andersen et al, 2021 ). Strategies to include residents in the news media can both increase their civic engagement and create more accurate portrayals of their experiences, which could improve policymaking surrounding residential care.…”

“…Older adults living in residential care have historically been positioned on the fringes of their communities ( Villar et al, 2021 ). The news media is one domain where older resident representation and involvement is largely missing.…”

“…In a study on the civic engagement of nursing home residents ( n = 139), less than half (46.8%) reported voting in a recent election ( Leedahl et al, 2017 ). Research on civic engagement of older people living in residential care is limited, and residents have inadequate participation opportunities because of organizational and contextual barriers ( Villar et al, 2021 ). Rowles et al (1996) suggest that a care home’s integration into its community depends on its permeability, which is “the exchange of people and communication between a nursing home and its community context” ( Rowles et al, 1996, p. 195 ); permeability goes both ways: from the outside-in and from the inside-out.…”

Cuidados a la vejez en la pandemia. Una doble devaluación

“…Y, en tercer lugar, discursos públicos sobre la vejez que ofrecen miradas paternalistas y medidas proteccionistas que homogeneizan la vejez y consideran a las personas mayores como sujetos vulnerables y pasivos, lo que ha ocultado la diversidad de situaciones y necesidades y también las iniciativas de las personas mayores que surgían durante la pandemia (Walsh et al 2021: 13-14). La percepción de las personas mayores como meras receptoras de cuidados genera prácticas edadistas que, entre otras cosas, presuponen dependencia, falta de competencia y estigmatizan, lo cual contribuye a su exclusión social (Mesnier 2020;Previtali, Allen y Varlamova 2020;Villar et al 2021). Así se ha mostrado durante el confinamiento, con respuestas políticas que afectaron específicamente a las personas mayores y que, aunque se erigieron en proteccionistas, actuaron en la práctica como mecanismos de exclusión y de marginalización, lo que se acentuó en quienes viven en residencias.…”

How Do the Support Networks of Older People Influence Their Experiences of Social Isolation in Care Homes?

“…Despite being surrounded by people every day, 22-42% of older people in care homes (CH) feel severely lonely, which is at least double the rate of their community-dwelling counterparts (Victor, 2012). Moving into a CH can lead to older people becoming isolated from the wider community, as well as having a more regulated social life through professional monitoring (Villar et al, 2021). Further, older people living in CHs have high levels of physical and cognitive impairment (Age UK, 2019), which can result in reduced social interaction, fewer meaningful relationships, and diminished wellbeing (Grenade & Boldy, 2008).…”