Behind closed doors
: The role of the nursing home in the community
The role of the nursing
home in the
care for people with disability is alive and well in Western
A disability service is a service or ogranisation that supports people
with high support needs.
A nursing home is a place where people with high support needs are
The nursing home fulfils an important role in society ,,.
... provides the skills
that are unavailable in the wider community.
... provides a place of security.
... provides for the physical and social needs of it's members.
... provides a knowledge base that is used to provide support.
... supports a service industry designed around the service
(employment, goods and services etc).
... are economical in providing the service
The nursing home also ,,.
... has a set of service
... has formal/informal shared goals,
cultures (institutions) etc.
... is organised within a set of formal/informal
... is funded by private contributions, as well as various government
... is responsible to various government departments in service
... is seperated from the wider community by the various policies and
processes designed to protect the members from the wider community.
There is a great deal of discussion on how people with high support
needs can access and participate in the normal social activities that
others take for granted. The move towards individual
accomodiation for people with high support
needs allows a person to be supported in a setting that designed around
the persons needs, however, the person still needs to be supported
within that setting.
image to view more.
Aged care nursing homes are generally isolated places within the wider
The activities and facilities are generally provided for the residents
of the nursing home. They are designed specifically for the needs of
the residents, rather than open and inclusive places that allow
access for all members of society.
The Institution (and institutionalised care) has been portrayed as a
evil place that has no place in society. Do we really need to pull
down all nursing homes because of a few "bad apples"?
Nursing homes are much better these days
than 50 - 100 years ago. This is mainly due to the advances in medicne
and technology, as well as a shift in the way the care is provided. The
outcomes of the institutional care within the nursing home have become
much better in providing for the needs of its residents. Nursing homes
will always provide a role in society in supporting
disadvantaged people. They provide the social support and community
networks for people that have no other supports. Ultimatly, it is up to
society to determine how this resource is used. Just as
hospitals and schools were historically bad evil institutions, and are
now seen as valued institutions in society, nursing homes also have the
opportunity to become warm community places that provide a valued role
in the wider community.
the person's needs,
the more support the person needs, in fulfilling those needs.
These days we see disability organisations and
service providers providing the same services in smaller facilities
that support 1 to 4 people. These facilities may be grouped together
within a suburb or spread around a city or town. The motivation for
this is to provide a more normal setting that allows for the
emotional/social needs of the person, while still providing for the
person's physical needs. The facility is still a part of the community
of the organisations/service provider who provides the staff,
infrastructure, policies and process, skills and resources, and
institutions that determine service delivery. While the facility may be
located in a suburb and the goal of the srevice provider is to include
the cilents/service users in the normal ativities of the suburb, the
amount of participation (through valued relationships and experiences)
in other communities is dependent on the relationships the person has
within those other communities. If the person has no personal supports,
support needs to come from somewhere else such as a service provider or
organisation that specialises in that support. The reality is that only
a small group has the
opportunity to participate in these activities. Because there is a
large group (and getting larger) that do not have the opportunity to
live in a single residence, or participate in normal community
activities, they spend their whole lives behind closed doors.
the the skills and resources of the community,
and the amount of support that can be provided
care Vrs Institutional care)
We are told by a doctor or public servant that the person can
not look after him/her self and the only place that can provide the
support is a nursing home. The doctor or public servant can only use
this model of care because of a lack of personal skills and resources
as well as a lack of community skills and resources (there is no other
option). We have seen the results where nursing homes have been closed
and the person has lost their own personal support structures as well
as the communities that they were once a part of. Mostly, they get
placed in other services that are less appropriate for their needs.
The amount of support that is provided within the community is directly
related to the skills and resources available within that community.
Social policy and process is as much to blame for this. Communities
have become conditioned (where these activities are nornalised in the
community) to aged care nursing homes
being places of confinement where people that cannot contribute to
society are placed behind closed doors so we can get on with our own
lives. Even within group homes that are supported by an organisation or
provider, the amount of participation (through valued relationships and
experiences) within the wider community is determined by the amount of
skills and resources within the wider community.
talk about breaking down the barriers and opening the doors within
What we need to do is
break down the
barriers and open the doors of the nursing home.
Nursing homes provide a good standard of care these days, They provide
a careing environment for the residents, The activities and facilities
are designed around the needs of the residents. While these strategies
fulfil the needs of the residents, they hardly filfil the needs of the
wider community that the nursing home is a part of.
as current policy is about making society more accessable to people
with high support needs,
we should be making the
more accessable to the wider community.
Barriers to the wider
to the community of the nursing
policy and practice (institutional
Government policy and
prcatice is to
provide the most appropriate setting that provides for the needs of the
residents. Variuos rules and regulations provide the way the service is
delivered within the facility. Issues such as funding, legal issues,
privacy, confidentially, rights and responsibilities, staff issues and
service delivery are all managed within the facility. As a result the
facility is less likely to be a welcoming place to the wider community.
Just as a church or a
designed around the needs of its
members, nursing homes are not places that invite acces to the wider
community. Generally there is some form of "right of entry", "rite of passage"
The institutions of the facility are built around a particular model of
care which is not representative of the institutions within the wider
Just as a church or a
designed to support a small to large number of people, a nursing home
is also designed a particular way that provides for the needs of its
members. Any building that supports a number of members or supports one
or two people still needs the services, skills and resources, policies,
behaviours and expectations of the service provider to provide the care
that is not available within the wider community. While the design of
these facilities have changed over the last 50 years, they still
fulfill the same roles in society. The amount of participation within
any other community a person would like to participate in really
depends on his/her personal resources and relationships within each of
attitudes (them and us), Social
roles, Community roles, Members
Nursing homes are
places that no one really wants to visit. We have a picture of a bunch
of old folks sitting/wandering around or in wheel chairs waiting for
the next excitment of the day ... the next meal. Personal needs have to
wait until a staff member is bothered or has time to attend to the
person. While there may be some sort of sense of social responsibility,
this is probally just a passing thought. We have our one lives to get
on with. A person may think "Ill probally end up in a place like this",
but this is just a passing thought, we have our own life to get on with.
is, that providing
individual accommodation for people with
high support needs is dependent on services being available to support
this group. There are a number of groups (people with disability, poor
and destitute, pensioners, people on welfare, just to name a few)
competing for available land, services, funding and donations and
adequate staff. Are elderly people really better off living in single
or shared accommodation? What happens to the other groups that are also
desperate for accommodation? Do we really care?
Within the human service arena the
nursing home has to compete with other organisations and service
providers for funding, donations, nurses and other staff, equipment and
other resources. The amount of support the nursing home gets is
directly related to it's profile within the human service arena as well
as the wider community. The quality of the service of the nursing home
and it's ability to provide for the needs of it's members is directly
related to the amount of support the nursing home receives within the
human service arena as well as the wider community. The nursing home
has to compete for the physical resources within the
setting of thre facility. Issues such as location, transport, parking,
noise etc all impact on the way the nursing home fulfills it's role in
society. What happens when the needs of the wider community become
greater that the needs of the community of the nursing home? A shopping
Ctr, office tower or football stadium may be more important or valuable
to the wider community than the nursing home (this does happen).
engagement is about developing networks and relationships
within the wider community.
can the community
active in the wider
can the wider
active in the community of the nursing home?
Just as a hotel is a part of the wider community, there is no real
reason that a facility that provides accomodation to the wider
community, and also supports maybe four or five residents that have
high support needs, can not be a part of the wider community by
providing activities and facilities such as shops, hairdressers,
function centre, restaurants etc that are available within the wider
The facility supports a
small to large number of people. The residents are treated with respect
and dignity. The facility provides a secure environment for the
residents. The facility provides the skills and resources in providing
of the residents. The facility is open to the wider community and
various services and activities which support the wider community. In
esence, the facility is a part of the wider community, and in small
communities the facility is the life of the community. The facility is
and welcoming environment where all members of the wider community have
the opportunity to participate in and become involved in the activities
of the facility. Some of the residents of the facility have
high support needs. Their individual needs would be attended to within
the facility, they would have the socialisation and community networks
within the facility, they would be treated with value respect.
Significant others in the persons life would be able to book a room in
the facility and spend some time with the person. Others
the community of the facility would also have the opportunity to become
more familiar with the needs of the residents which helps to break down
the personal and social barriers that there may be. Although there may
be a number of people with different needs being supported within the
facility, the institutions and culture of the facility are designed to
provide positive outcomes for all stakeholders within the community of
the facility and in the wider community that the facility is a part of.
as "nornal" people are able to access a particular service to fulfil a
need, a person with a particular disability would have access to each
service that is most suitable for the person. A person with a
particular need may have access to two or three organisations that
specalise in a particular area. A person (for example) may have an
intellectual disability as well as spina bifida or cerebral palsy, and
needs specalised support for each condition. Having access to each
discipline within the community of the facility allows the person to
participate within that community. Other services such as transport,
recreation, employment, education, spirutial etc would be provided by
each company, service provider or institution that specalises in that
support, and is available to all members of the community of the
The facility may also have a hairdresser, post office, deli, various
restarunts, coffee shops and a function center that provides social
activites for the residents of the facility and the community that the
facility is a part of. Other communities (recreation, edication,
employment etc) that the person is a part of has the support and
resources to support the person within that community. By including the
wider community in the activities of the residents of the facility,
is a greater opportunity for the residents to be included in the normal
activies of others in the wider community through association and
familiarity. Through this process
the acivities of the facility become nornalised (institutionalised)
in the normal activities of the community, where the residents have the
opportunity to become valued as members of their community and other
communities that it is a part of.
The facility provides
community services, and is more
accessable to the wider community.
There are inherent problems in this form of support. There are local
and state government policies and practices to work through, issues of
accountability and funding etc. Communities are not perfect places
either. Politics, different agendas and groups that jostle and compete
for the same resources with each other can disrupt the strongest
community. Communities can be resistant to change, they can also be
dynamic places that can sometimes be a hostile place for someone
without a strong voice. There will be lots of barriers along the way
and will probally not happen in all communities, but, if there is a
genuine desire to include people with high support needs in mormal
community activities, develop community networks, build relationships,
and participate as valued members in their community, solutions can be
found to problems along the way. This will not be an easy journey.
However, it is a start, where future generations grow up in a different
society and have the opportinity to build on the foundations that are
put in place today. Just as you or I have the opportunity to move from
one setting to another according to our particular needs at a
particular time as well as the needs of each community in which we live
work and play, people with high support needs should also have the
opportunity to move from setting to another according to their
particular needs as well as the needs of their community. New
technology or changing personal circumstances means that the person has
the opportunity to find the best setting and support that is
appropriate to the persons needs as well as the community that the
person is a part of.
|I was really interested in your
and wholeheartedly agree with
what you are
saying. My only
reservation is comparing a "nursing home" to a
'hotel' because I
spend my days
reminding residents families that this
hotel! With such
a comparison comes certain expectations which
unrealistic due to
the financial and resource constraints
imposed on aged
organisations. For example, expectations of menu
ratings and extra services for those
paying a large
bond etc. You
will be surprised what some people expect
for their dollar.
I had a vision of
home" having a community centre with a coffee
shop, a GP room,
even a chemist
perhaps. However, now I am getting to
neighbours who are
definitely not community minded, I could see
that this wouldn't
without a fight. The local residents don't
want our cars
coming and going,
they don't want people parking on verges
and killing the
ruining the aesthetics of the street; I
believe they think
we are a
blight in their otherwise prestigious
which is a sad
inditement of our society. One day it will
be them looking
for a nursing
home for their parents or themselves and
perhaps then their
It is also really
hard to get
volunteers too which is another indication
of the lack of
interest. Add to this the expectation that the
responsible for everything once the resident is in the
families rush to relinquish responsibility to
resident out of the
building on an outing or to a medical
of a sudden it
is our job to organise transport,
escorts, buses and
outings. Yet sadly 107 of our 110 residents
all have families
ones that would be more than capable of
taking them out
for a few
hours. We get pestered all the time about when
are we going to
outing for them. The logistics are incredible
yet it would be
far easier for
each family to take out their resident
once per month or
couple of months.
These are just a
few of the
problems we face. Sorry if it sounds like a
gripe but they are
image to view more.
When providing the most
care for people with high support
1) The community is not
person is living, but where the
person participates, shares experiences and has valued relationships
homes for elderly people: questions of quality and policy, Helen C.
Bartlett - 1993, Harwood Academic Publishers
2) People with high support needs (severe disability, aged etc.)
will always need support structures as a part of their lives.
3) The amount of participation in a community (living, education,
employment or recreation) is directly related to the skills and
resources of the person, and, the skills and resources of the
community that the person wishes to participate in.
4) Institutions are going to be around in one form or another
whether we like it or not, It is the way that they are used that is the
5) The institutions of a society towards a particular group
determine the way the group participates in society.
6) The institutions of a particular government department,
profession or service define the way the person is supported within
7) Facilities that support people with high support needs do not
need to be the nursing homes or prisons in the
that they are today, but can become warm inviting community places that
offer a range of services to the community, as well as be a part of the
wider community within that society.
8) People with high support needs are a minority group in our
society, and will have the same problems as other minority groups in
being a part of society.