Historically, most humans in the world used to pass their evenings together around a fire. While this is still the case in many places, for many cultures the fire has been replaced by the television set. Prior to the Industrial Revolution, Western societies were generally structured such that the young and the elderly, the sick and the healthy, all lived together, taking care of one another. But as societies became increasingly stratified, these connections dwindled. The extended family home gave way to the home of the nuclear family. How have these changes affected the quality of health care?
Today, in Western industrial societies, most young children pass their time in childcare outside the home. Many people living with chronic illnesses or cognitive disabilities pass their days far away from their loved ones and family members. Likewise, the vast majority of seniors reside in an institutionalized assisted living situation rather than with their extended family. In Central Europe, one in every two people ends their life outside the home. These trends are perplexing, considering that in-home care is more cost effective than institutionalized care and science tells us that those who receive care in their homes are more likely to have better health care outcomes.
Anthropologists who specialize in the study of aging adults, for example, tell us that seniors who remain in their own homes with the assistance of in-home health care have the best of both worlds. Their research shows that people who remain in their own homes during their elder years are happier, healthier and more active than their counterparts who enter assisted care facilities or nursing homes, while at the same time enjoying the benefits of in-home help with tasks that have become difficult, such as housecleaning, meal preparation, transportation and keeping track of medications.
On average, their cognitive abilities also remain intact longer, as they go about their usual daily activities and make decisions about what they will do each day, from what they eat to what they wear. Elders who remain in their own homes with the assistance of in-home health caregivers stay more engaged with their families and with their long-time friends and neighbors, which stimulates the parts of the brain involved with memory, communication and a sense of identity. Depression is far less likely among this group.
Moving to an assisted living facility or nursing home is a traumatic event for most elders, who must part with many of their cherished possessions and become oriented to a whole new way of life in a new place. The unfamiliar setting and the challenges of adapting to scheduled meals and activities can overwhelm seniors, who often react by slipping into a passive state of depression and dependency.
An older person or couple who can stay in their own home, with the assistance of an in-home caregiver, continue to feel independent and in control of their lives, which boosts their self-esteem. Studies show that a sense of control of one's life is an important factor in preventing depression. Elders in their own homes are more likely to keep up with world events through newspapers and television, use the telephone to stay in contact with friends and family, enjoy their long-time hobbies and even take up new activities.
So why is care so often taken outside the home? The way industrial societies are structured plays a huge part. As German sociologist Reimer Gronemeyer explains: "Those societies that see themselves as productive societies tend to 'marginalize,' or even to suppress...elderly citizens and their interests because their needs could be perceived as an unacceptable pressure on the budget." While medical developments have dramatically increased the life expectancy in industrialized societies, with people over 65 constituting the fasted growing segment of the U.S. population, these societies have not yet adapted to embrace family models that account for this increase.
The problem may lie in how these societies conceive of personhood. This question is one of the most telling tools by which anthropologists can make cross-cultural comparisons. Is the value of a human life based on how much a person produces or on how that person treats others? Likewise, for Gronemeyer, the manner in which a society "responds to the weak, needy and fragile members within its own structures measure[s] the sense of humanity of any society."
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Finding a caring, professional in home caregiver or health professional can be a challenging task. You want to be sure that that the person you are bringing into assist with everyday needs will provide quality care. Quality doesn't mean just showing up, it means being there emotionally to help keep spirits high and improve quality of life.
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