The easiest rule to break in long-term care?

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Tim Mullaney
Tim Mullaney

If you work in long-term care today, you might feel like you're drowning in an alphabet soup of possible deficiency ratings. So forgive me, but let's imagine there's yet one more possible citation to watch out for: the GR.

That's GR as in “Golden Rule.” Yes, that one: Treat others the way you would want to be treated. How many GR citations would surveyors give out for caregivers breaking the Golden Rule? More than you might expect, according to an article in the April 2013 print issue of The Gerontologist.

Not all caregivers break the Golden Rule out of malice or negligence, according to Hakan Jonson, Ph.D., of Sweden's Lund University. Rather, some nursing home workers think elderly people under their care have different expectations, even different needs, than the workers themselves have or will have in the future.

Jonson describes a situation in a Japanese nursing home as an example. The home's manager actually told Jonson in all seriousness that, because of the era in which they were raised, residents at the home like sharing rooms with up to five other peopled. However, the manager's colleague claimed the manager was actually breaking the Golden Rule, saying, “That man would certainly not like to share a room with others if he had to stay in a nursing home."

The manager was convinced that, due to a generational divide, he could and even should treat his residents differently than he would want to be treated. Other Japanese nursing home managers have presented similar misaligned arguments for putting many people in a room, according to Jonson. They say people born before World War II are products of a different time and so have different expectations about communal living. "I don't think that our residents have a sensitive feeling for combining people as compared to our generation,” one manager told Jonson.

This mindset, that old people of the coming generation will be very different than old people of the present and past, is not limited to Japan. Consider the beginning of a New York Times article from last Friday:

Most of us are aware that there are two types of old these days. There is baby-boomer old, an audacious, aspirational sort of old. Common depictions include couples sky-diving for their 40th anniversaries … and the woman of a certain age on a seashore holding a fluttering piece of voile toward the winds of freedom. Then there is old old, a realm often belonging to the parents of the baby boomers. This is nursing-home old. This is prunes-for-breakfast old.

Here's what care workers should know, according to Jonson: People have been thinking and saying similar things about aging for decades. In the 1950s and '60s, scholars such as Ethel Sabin Smith said the next generation of old people would live longer, feel younger and reshape approaches to elder care. Advertisers ran with this idea in the '60s and '70s, creating the concepts of the “golden years” and “gray power.”

“A cohort of ‘new old' has repeatedly been described as active and self-conscious, in comparison to the passive, frail and grateful older people of the past,” Jonson writes.

Each generation does have its own characteristics, medical and technological advancements do reshape senior care, and Jonson acknowledges the Baby Boomers probably will have unique needs and expectations as they age. As the Times pointed out, we may be at something of a watershed moment, with young people as well as the “new old” changing perceptions of aging — see Betty White, “Advanced Style” and advertising trends.

But, needless to say, the great gray revolution that has been predicted to redefine long-term care since at least the 1940s has never materialized. It's folly for caregivers to think they'll be much different than current nursing home residents, and this folly can have serious implications. The overcrowding of Japanese facilities is one example of how quality of care deteriorates when administrators accept the myth that their residents are accustomed to, accept and even desire tough conditions. But not all consequences are so dramatic. Providing baths too infrequently or just not treating requests seriously and respectfully can also result from this myth that current residents have lower or different expectations than their caregivers, Jonson says.

The Golden Rule may be a simple enough concept for young children to understand, but as Jonson's work shows, it's not always as straightforward as it sounds and can be very difficult to put in practice. It's something we'll probably all still be working at even when we're older and wiser — and not all that different from the seniors of today.


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Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.