We are a lodge, not an institution.

Step-down facilities are supposed to be institutions, but we are not ready to be one

The first thing you have to do when opening a sub-acute facility is to change your property zoning to be institutional. By definition the word “zoning” conjures images of forms, money rapidly exiting your account and government red tape which immediately scares the living daylights out of any entrepreneur.

In the past there were two step-down facilities in our area that looked similar to ours. They had gardens, privacy and pools. Within a few years though, both had changed their buildings to mimic hospitals. They became much more clinical, with long corridors, shared rooms, shared bathrooms, no gardens, small windows, visiting hours and strict policies and procedures.

I fully understand why they did this. It simply makes it easier to control routines, staff schedules and meal planning, to name just a few complex issues, but in those institutional structures there is a consistent dynamic tension between individual autonomy and procedures, which are usually change-resistant and definitely geared to costs and efficiencies.

Where does the human need then fit into this?

I read about Audrey King’s experiences while she recovered from Polio in a rehabilitation hospital in the 50’s. The scars left on her psyche had a worse effect than the destruction caused by the virus. She says that this is what troubles her: “The realisation that humans have power over other humans, putting them away and controlling their basic human needs and freedoms”.

Hospitals are essential parts of our society and they certainly have an irreplaceable role to play. I have the utmost respect for the work they do and the brave souls that staff them, but once a patient is out of immediate life-threating danger from a medical perspective, they have many needs that hospitals and other clinical settings simply cannot meet, attend to, or even consider. Hospitals may be places of healing, but as anyone who has tried to get a good night’s sleep in a hospital will tell you, they are certainly not places of rest or wellness. In the extremely difficult circumstances surrounding Covid, the human-element in clinical settings is even harder to navigate. Many of my post-Covid guests arrive with us traumatised after being isolated and alone in hospital. The amazing doctors and nurses saved their lives and did their absolute best for them, but they leave the hospital feeling frail and fragile, stripped of dignity and psychologically traumatised.

More than ever the psychological impact of the work health-care workers does has been on all our minds, but I’ve really been wondering how doctors, nurses and other medical professionals manage in the rigours and pressure of clinical settings that often don’t allow them the freedom to hold a dying patient’s hand, or allow a child to see a mother, or to chat to a lonely patient a little longer or give in to the humanity and compassion they feel.

I know that our lodge will run better if we wake our guests at a certain time. It would make much more logistical sense to have a set time for serving food and to prepare it in bulk. We’d make more money if people shared rooms and bathrooms. We could make things easier by employing our own therapists, instead of allowing our guests to choose their own and then co-ordinating these schedules. We would run to open gates much less often if visitors were only allowed at certain times and we would save a fortune if we did not spoil our guests’ visitors with cake and cappuccinos on the house.

But then of course, we wouldn’t be us anymore.

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