Care homes don’t have to be this way

Later life can be as generative as any other period.

I ask you to leap ahead to imagine the care home of your dreams, and you say – what? Are you most interested in the architecture, the grounds, the activities available, the provisions for privacy, the kinds of residents you’d hope to live alongside? In any case, how can you know whether your current perception of where you’d like to end up bears any relationship to what your future self will wish for? It’s a question that probably feels counter-intuitive anyway; few of us dream of living out our final days in a care home.

I’ve been thinking more seriously about care homes because someone I love has dementia. In the UK, nearly half a million people live in care homes. That’s around 2.5 per cent of those aged over 65, rising to 10.8 per cent of those over 85, according to the 2021 Census. Roughly 70 per cent of those in care homes have dementia or severe memory problems. Since the number of people with dementia in this country is predicted to almost double by 2040, care home occupancy is likely to rise too. These are places many of us will one day have to engage with.

I’m starting to recognise the extent to which I use my research to look into the eye of the things I’m most afraid of, or least understand, or both. I wanted to meet someone who had lived experience in a care home, who had gone inside to discover how these institutionalised spaces affect the lives of their inhabitants. So last week I took a train up to Oxford to meet an anthropologist who had, in her mid-twenties, spent a year in a care home for her PhD fieldwork.

Between 2014 and 2016, Carrie Ryan, now an anthropologist lecturing on ageing, play, and creative health at UCL, lived in room 313 of a Continuing Care Retirement Community (a facility that covers the full spectrum of residential care, from independent to assisted to nursing home levels of care) in Los Angeles. It overlooked a tangle of freeways the locals call “malfunction junction” – window-gazing was a common pastime at the Retirement Community, its residents looking out over a city built for fast living from which they were now alienated. Ryan’s board and meals were free in return for her working part time as an activities director. She told me that, more so than any other experience, living in a care home taught her what it meant to be alive, what it meant to live in a body, and what we owe each other.

Soon into Ryan’s stay she felt as if she were living outside of time, severed from the social clock that everyone else her age largely followed. Her days were marked by routine without variation: she was woken each morning by the carer’s knock at her neighbour’s door to deliver their pills; mealtimes ran like clockwork; throughout the days she hosted various events for the residents, facilitating the much-loved Bingo game every Wednesday afternoon; bed at 9pm.

The retirement community soon became deeply invested in Ryan’s future, because she was the one person who would get to leave. They described their own youthful mistakes, in the hope that she would avoid similar ones. “I wish I hadn’t spent my time doing things that took me further from myself,” they’d say, “that brought me so much stress.” It doesn’t matter how illustrious your professional life was: once you enter a care home, everyone is equalised. Ryan’s year there has altered her life trajectory. It taught her to value rest and play, to be sceptical of the rat race that academia can turn into. It led her to her husband, the kind of man, she said, that the old Carrie might never have gone looking for.

And yet, the negatives you might predict when it comes to living in a care home were all present. Residents referred to the site as prison-like. Even though she could technically leave, Ryan too felt institutionalised, constrained by all the rules and policies that governed the community. “You begin to subjugate a lot of your desires and needs,” she said. One resident who loved to lie outside sunbathing and drinking whiskey (he’d hung a “It’s Five O’Clock Somewhere” sign on his door) was often chastised for such behaviour because it wasn’t how the carers deemed those in the community ought to behave. Tragically, Ryan encountered people who returned to the closet on arrival, less out of concern about other residents’ judgement, often because many of the carers were very Catholic. Brandon Clarke, an anthropology master’s student conducting research into queer ageing, told me there are around 50 queer care homes worldwide. And yet, many of his queer interviewees do not want to end up in expressly queer care homes; instead, they fantasise about growing old in places where opportunities for surprise and mess and vibrancy remain.

While these are far from the conditions of a standard care home, in every moment that year, Ryan witnessed how the residents fought to retain a sense of individual identity and resisted being absorbed into a homogeneous idea of “the elderly”. They took risks and sought out joy. “There was so much new life,” Ryan said. “Everywhere you looked, people were exploring new interests and picking up new hobbies. People were developing new selves, new relationships” – residents falling in love and moving into shared accommodation. I had never conceived of ageing this way before: not as an ever-narrowing tunnel but a period of life as potentially generative as any other.

[See also: Labour’s summer of discontent]