Radical Change Needed for an Activist Generation… and for Future Generations

The 1960s generation was defined by its commitment to social change, civil rights, and persistent questioning of authority. As this generation transitions into elderhood, the antiquated “care system” must radically transform.

Historically, the shift from nuclear family support to institutional care was accelerated by the industrial revolution and the subsequent creation of Medicare and Medicaid in the mid-1960s. While these programs provided essential funding, they also cemented an "ageist bias" viewing aging primarily as a series of medical problems to be “managed” rather than a life stage for continued growth.

This bias was further reflected in the architecture of “care” facilities, the regulatory structure, the institutional construct of medically modeled “care”, institutionalized staff regiments, scheduling and job descriptions.

The Limitations of the Medical Model

This "medical model" of care resulted in a "declinist view" of aging.  Medically frail residents are often placed in sterile, overcrowded environments characterized by semi-private rooms and shared bathrooms. These settings often lead to boredom, loneliness, depression, over-medication, and an overall failure to provide an environmental milieu necessary for elders to continue to fulfill their potential despite physical limitations.

In 1987, a significant push for system reform culminated in the Nursing Home Reform Act (OBRA '87), which aimed to elevate resident rights and prioritize "physical and mental psychosocial well-being". This legislation led to the development of resident-focused organizations like the Eden Alternative, the Green House Initiative and the Pioneer Network, which sought to move away from the institutionalized model of “care”. However, the reform was only a partial success as the reimbursement and regulatory system did not adequately support these models.

The Pandemic; "The Perfect Storm"

The systemic failures of the existing model reached a tragic climax during the pandemic (2020–2024), which acted as the "perfect storm" for the elder care system. Approximately 150,000 nursing home residents perished as the novel virus exploited long-standing vulnerabilities. 

This catastrophe was fueled by:

• Outdated Architecture: Shared rooms and bathrooms—relics of the 1965 declinist view—facilitated the rapid spread of the virus.

• Lack of emergency preparedness: Lack of personal protection equipment (PPE) for staff and insufficient infection control.

• Systemic Neglect: A combination of ageism, intransigent lobbying for the status quo, and a splintered reform movement left the system unprepared.

• Labor Vulnerabilities: Low wages forced CNAs to work multiple jobs, inadvertently carrying the virus between facilities.

The Death of the Institutional Approach

The devastation of the early 2020s should be viewed as a collective systemic failure that never fully remedied the flaws introduced at the inception of modern nursing homes. This "low point" marks a necessary turning point: the death of the institutional approach to “care”.

For the 1960s generation and for future generations, the path forward must involve developing social models of care which prioritizes quality of life, autonomy, emotional wellbeing, and engagement with community in addition to meeting the medical needs of residents. 

More to come in the next post to provide vision for care and support for the activist generation which in turn will benefit future generations.

WE HAVE A DREAM!