Care Homes in a Turbulent Era: Do They Have a Future? is part of the In a Turbulent Era series investigating best practices, research and new ways of operating in the post-pandemic era. Edited by Canadian professors Pat Armstrong and Susan Braedley, the book analyses the multifaceted care home challenges and offers alternative approaches focussing on four main themes: approaches to care, financing and ownership, work organisation, and accountability structures. Drawing on more than 15 years of traditional and site-switching ethnographic research in Canada, Germany, Norway, Sweden, the United Kingdom and the United States, each chapter concludes with concrete insights or recommendations to improve care home operations and confront the underlying structural challenges in a post-pandemic world. ‘The research indicates that we need nursing homes now and in the future and … that there is no single best way to construct and organize care homes’ (p. 14).
The opening chapter, ‘Care homes in crisis: Promising ways forward’, sets forth general assumptions by recognising: (1) the complexity of care home communities, which involves all who live and work in, visit and manage care homes; (2) the care relationship, which may involve inequalities of power, gender and race; and (3) the challenges of for-profit models, as a solution to which it advocates for public ownership and transparency, supported by a feminist political economy framework. Armstrong and Braedley address the immediate challenges faced by care homes during Covid-19, calling for a fundamental shift in how care homes are structured and managed. The editors illustrate eight lessons learnt, including government leadership, (non-)profit care, working conditions, community building in and outside the nursing home, physical environments and diversity, among others.
In Chapter 2, ‘Piercing the corporate veil: Nursing home ownership in turbulent times’, Hugh Armstrong acknowledges the growing number of for-profit nursing homes and highlights the ethical and practical issues of profit-driven care, advocating for public or municipal ownership to ensure transparency and accountability.
By questioning ‘What’s critical to care?’, Chapter 3 calls for a holistic approach to care, referring to care as a relationship. Armstrong et al. concentrate on balancing ingredients and tensions when promoting care relationships in nursing homes, aiming to support not only mere survival but the thriving of residents and staff. Based on the principle that ‘conditions of work are conditions of care’ (p. 42), the authors emphasise the need for sufficient staffing, proper training and supportive working conditions. This theme is intensified in Chapter 4, ‘The crisis in the nursing home labour force: Where is the political will?’, where Armstrong et al. underline that staff also need support and security, for example in relation to permanent employment and training, as well as physical environments that support teamwork and health.
Chapter 5, ‘Negotiating internal and external boundaries of nursing homes during Covid-19: A case study from Norway’, seeks to understand the general function, relevance and significance of nursing homes. Ågotnes and Jacobsen expose the boundaries between isolation and connectedness in Norwegian nursing homes during Covid-19, through the eyes of residents, relatives and staff.
Specific themes are refined in the final chapters. In Chapter 6, ‘Are safer, welcoming care homes possible? Considering physical environments’, Braedley and Armstrong elaborate on six principles to consider the impact of physical environments: (1) the different perspectives involved; (2) location, space and size; (3) relationships, connection and privacy; (4) frailty, disability and dying; (5) dining, meaningful activity and sensory pleasure; and (6) food preparation, cleaning and laundry. In Chapter 7, ‘Family members and nursing home care: Lessons from Ontario and Sweden during Covid-19’, Lowndes et al. focus on the role of relatives in communication and advocacy by reinforcing the importance of family support, as opposed to compensation for staffing shortages. In Chapter 8, ‘Equity and diversity in nursing home care: Lessons from Canada and Sweden’, Owusu et al. underscore the necessity for culturally specific care and safe, inclusive and supportive environments for staff and residents, and propose approaches to and future visions of equitable and diverse nursing homes.
In Chapter 9, Banerjee et al. reflect on the lessons learnt through the process of their research, specifically the need for accountable regulation, that is, measuring quality of care not by the premise ‘what counts is what can be counted’ (p. 138) but by ‘the recognition that care is provided through relationships, that care focusses on residents, that residents and families should be empowered’ (p. 139). They also note that good staff and conditions of work are essential to good care.
The final chapter, ‘Making joy possible in care home policies and practices’, reviews types of care home quality improvement initiative and their challenges in improving quality of care, including conditions of joy. In this chapter, Braedley et al. discuss the structural elements that foster joy by referring to four kinds of basic human experience as conditions of joy: a sense of belonging, purpose or meaning, sharing with others, and pleasure.
The book is particularly strong in its comparative approach, drawing on diverse international experiences of all types of people who live in, work in, visit and manage nursing homes, to accentuate both common challenges and unique solutions. The book stresses that there are no universal best solutions, only promising practices at multiple levels and in multiple contexts. Bringing together empirical studies, with overall themes and above mentioned dilemmas is of international and cross-jurisdictional relevance (e.g. finding ways to continue pressing for elimination of for-profit firms and setting principles for creating welcoming and safe care home physical environments). Despite its focus on Western contexts and research, this book is an essential resource for researchers, practitioners and policy makers involved in the nursing home sector. By advocating for systemic changes, inclusive practices and supportive environments, Care Homes in a Turbulent Era: Do They Have a Future? offers a valuable vision for the future of care homes.
