A Conversation about Ageism: Time to Deinstitutionalize Long-Term Care?

Abstract

Ageism is arguably one of the least challenged forms of discrimination globally and manifests in many obvious and subtle ways. Situating our conversation within the context of COVID-19, we discuss peculiar and unchallenged forms of ageism in current times as well as the intersections with other forms of discrimination such as ableism, racism, sexism, and heterosexism. We highlight the limits of current understandings of ageism, specifically those that seek to identify positive aspects of ageism without appreciating how these forms of ageism reinforce inequalities among older adults. With regards to spatial manifestations of ageism, we explore the failure of critiques of institutionalization to include older people. Only in the context of “mass death” during COVID-19 has the public eye turned toward the problems of long-term residential care facilities as spaces of care, yet disabled, mad, and D/deaf people and allies have challenged the mass institutionalization of disabled people for decades, highlighting how physical and social segregation constitutes an obvious form of ableism. Institutions are notorious for their physical, spiritual, and emotional harms, but when it comes to residential long-term care for older people, especially older people living with dementia, responses to segregation and isolation have generally been ambivalent. Even aging studies scholars call for “transformation” but do not call for the elimination of large-scale institutions (e.g., Theurer et al.). We discuss this softer critique from aging studies, raising questions about whether institutionalized and segregated congregate living for older people is inherently discriminatory, and we consider the implications for families, health care administrators, researchers, and scholars working in the field of long-term residential care.