Other than criminals, the elderly are the only people who are routinely kept in residential custody in the post-industrial world. The massive, brick edifices of the nineteenth century that housed the parentless, the impoverished, the mentally ill, and the disabled closed their doors permanently in the twentieth century. Residential schools for Indigenous children in North America, Australia, and New Zealand were finally shuttered, once and for all, a couple of decades ago and good riddance to those awful places.

Nursing homes have bucked the trend. 

     A twenty-first century Naturalistic Pagan might well ask, “Why?” 

     The easy answer, because nursing homes provide shelter and care for frail, old people, is only a partial answer. The full answer is more interesting.

     Modern long-term care facilities are direct descendants of Victorian poor houses. The municipally owned nursing home where I work sits on the site of the former county house of refuge. Our ancestors viewed institutionalization as an efficient, compassionate solution to the human suffering and need wrought by industrialization, urbanization, and mass migration. They built asylums for lunatics and the feeble-minded, orphanages for incorrigible urchins, vocational shelters for friendless and fallen women, and houses of refuge for deserving paupers. 

     Decades passed. Society evolved.  After a century and a half, give or take a few years, those massive institutions had served their purpose.

     By the mid-twentieth century, most parents lived long enough to raise their children to adulthood and foster care replaced orphanages. Mentally ill people had access to effective medications and out-patient psychiatry, and stable patients were discharged from mental hospitals. Disabled adults were re-housed in their communities and disabled children remained with their families. Women with unconventional lifestyles joined regular society. After the Second World War, rates of unemployment plummeted, and social assistance supported people who couldn’t work. 

     The only people left in institutions were the very old. They’re still there. Except now the building is called “River Styx Manor” or “Pearly Gate Terrace” instead of the “House of Industry”. Essentially, empty institutions were a solution looking for a problem, policy makers decided the problem was old people, and the Victorian institution morphed into a human-eating zombie that forgot to die. Problems such as violence, boredom, and neglect inherent in earlier forms of institutionalization persist in its current, twenty-first century format, the long-term care facility.

     Upon entering institutionalized care, human beings become widgets. Whether in privatized or socialized systems, each nursing home resident is quantified for funding purposes, placed on a care plan and schedule that dictates how his or her days will unfold, and monitored using documentation tools for quality control purposes. Health care experts spout jargon such as “resident-centred care” but many facilities are understaffed and overburdened with bureaucratic record-keeping, protocol, and routine, ironically at the behest of those same experts, making resident-centred care an unattainable ideal. My experience as a frontline RN is common. I lead a team of kind, dedicated care workers and we struggle to keep our residents clean, fed, safe, and comfortable. On every shift we fall short though we’re compliant with ministry regulations and our “quality indicators” are acceptable. The nursing home is doing fine. The frontline staff and residents? Not so much.

     Rant over. I’ll take a question. “If the institutional lifestyle sucks, why does it persist?” 

     I’m glad you asked. Factors that perpetuate the institutionalization of old people include:

• Money. Plenty of people do well by nursing homes. My critical gaze rests on administrators, CEOs, government policy makers and inspectors, health care gurus, and all the services that keep the proverbial lights on. Furthermore, placing old people in care frees their family members to participate in the labour market and take holidays.  
• Epidemiology. People in post-industrial societies usually live long lives but they tend to be sick and infirm in their final years rather than dropping dead suddenly after brief, acute illness as they did in the olden days… say till the 1970s. On average, elderly Canadians suffer through eight years of chronic illness. They are a steady source of raw material… umm… I mean “residents” for the “institutional industrial complex.” 
• Demography. Post-millennial families tend to be small and they are often geographically dispersed. Some elders are like very old orphans without sons or daughters, nieces or nephews to look after them. Nursing homes serve as latter-day orphanages.
• Culture. Western society is remarkably squeamishness about old age and death. It suits us to sweep the portents of our own mortality into the tidy bins of long-term care. Many of us are like the legendary Prince Siddhartha in his palace, happily ignorant about the realities of getting very old. Nursing homes shield us from the facts.

     Hark! I hear a voice saying, “Wait just a minute! I’m not naïve. You just haven’t met my Aunt Ethel. She lives in a nursing home, thank Zeus, because she’s a handful. She wanders about, ransacking closets and throwing books into the aquarium. She’s so messy she has to wear a bib at mealtime. And don’t get me started on the diapers. Surely we need facilities for people like Aunt Ethel?”

     Well, no, we don’t. Consider what happens when two hundred Aunt Ethels live under the same roof with roughly one care worker per fifteen Aunt Ethels. Some frustration? Perhaps a squabble over the ketchup bottle? Yup. Here’s a Not Fun Fact: the homicide rate among people in long-term care in Ontario is roughly quadruple that of Canada’s largest city, Toronto. This is resident-on-resident violence. Aunt Ethel and her gang of ruffians deserve better. 

     We can tap into the ideas of Naturalistic Paganism to address the problem of institutionalized elder care because, at base, the problem is moral and spiritual. Naturalistic Pagans do not seek to sanitize senescence and death. On the contrary, we acknowledge these processes as normal and natural in the cycle of life. In addition, many of us are used to challenging orthodoxy and dogma, and we’ve abandoned highly structured, oppressive religions to devise systems of belief and spiritual practices that make sense to us. We can apply this experience to the deinstitutionalization and reconstruction of elder care. Finally, many of us view community engagement as a practical expression of spirituality. In particular, when we oppose injustice and relieve suffering, we uphold the ideals of Humanism, a pillar of Naturalistic Paganism.

     I call on my community to act for better elder care. The following is a game plan, in accord with Naturalistic Pagan principles, that could revolutionize how we care for old people:

• Radically de-bureaucratize and de-professionalize nursing homes to transformed them from healthcare facilities into homes, with quality rather than quantity of life as the goal of care. In practical terms, this means staff in street clothes, pets welcome, tearing up care plans, loosening routines, and guiding Aunt Ethel into the kitchen to stir the pancake batter.
• Break up large facilities into apartment-sized units, and open communal recreational amenities such as pools and libraries to the wider community. My Unitarian congregation holds Sunday services in the nursing home auditorium where I work. It’s a start…
• Encourage young people to live with old people. Offer young adults cheap rent in exchange for leading the intergenerational glee club in Sinatra-Drake mashups or helping Aunt Ethel fold her laundry. Such co-housing models already exist in the Netherlands.
• Allow family members to stay over night when they come from out of town to visit. Better yet, recruit them as caregivers to the extent they are willing and able.
• Support families caring for old people in multi-generational homes by offering reliable, caregiver respite such as adult daycare and home care, and financial relief for expenses on items such as incontinence products and equipment.
• Advocate for the provision of medical assistance in dying for cognitively intact elders who request it and the use of advance care directives for people with dementia. When old people say they want to die or they wish to refuse lifesaving medical care, we should uphold their right to self-determination. And if Aunt Ethel wants to eat ice cream six times a day, we should give her a carton of Chunky Monkey and a spoon and stop checking her blood sugar. 

     Until we close the last long-term care home, and no one must ever live in an institution again, nursing home residents like Aunt Ethel need us. The final line of the Naturalistic Creed, published on this website, expresses a core tenet of Naturalistic Paganism. Namely- “A life of compassion and service is our offering.” Let’s work together in the spiritual tasks of opening our social circles to include old people as full members and ending the Age of the Institution.

About the Author: Renee Lehnen

Renee Lehnen is a registered nurse and nature lover. She has a bachelor’s degree in environmental studies and a master’s degree in social history. She lives and works in Stratford, Ontario, Canada.

Editors note:  There is another good article on this over at Atheopaganism.