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Review

Into the House of Old: A History of Residential Care in British Columbia

By Megan Davies

November 4, 2013

Review By Patricia Vertinsky

Megan Davies’s carefully worked study on residential care for the aged in British Columbia does in deed take us into the “house of old.” And it is a sad journey, made more resonant to many of us through our own experiences of visiting those dear to us who have somehow ended up con signed to live, and often die, in in sti tutional care for the old. A bleak disciplinary Foucauldian perspective seems hard to escape here. The Cana dian old-age home is presented as an instrument of social control, one that manifests both the differential possession of power in the lives of the poor and disadvantaged as well as some of the unique characteristics of the institutional world.

The book covers the years between 1890 and the 1960s and presents the Canadian old-age home as an evolving insti tution, undergoing a fundamental shift from poor law facility to middleclass medical institution. In other words, Davies shows how the cultural legacy of England’s Poor Law was transmitted by immigrants to Canada and reconfigured through generation after generation in various state and institutional policies and practices. Her claim is that the long, dark shadow of the Poor Law had an enormous impact on health and social assistance programs across the sweep of Canada’s geographical and jurisdictional archipelago. She begins with a discussion of the elderly in the community and then examines the evolution of different kinds of old age homes in British Columbia – an evolutionary development that, she points out, was distinctly different from that in other parts of Canada. This is followed by an analysis of the changing ideas and ideals of institutional provision for the aged, taking us inside the world of the institution to get a glimpse of patient life. We are properly reminded that programs emerging from multilevel policy formation around the institutional needs of the elderly are inevitably shaped and reshaped both by those who deliver care and by those who are its recipients.

Finally, Davies considers the place of the old-age home within the emerging welfare state and looks at one in novative program, the Hospital Clearance Program, which unsuccessfully attempted to deinstitutionalize elderly care. In effect, the twentieth-century old-age home is presented as the reconstituted workhouse of a previous era, emerging as an institution run by health and welfare professionals whose middle-class gaze and negative understandings of senescence extended to both clients and the nature of the facility. Professional attitudes, Davies concludes, typically embodied twin prevailing concepts of the elderly – the aged as dysfunctional, and the aged as victim – and while many nurses and social workers were kind to their elderly clients, the darker side of their professional perspective saw the elderly as an unhealthy element in the family, rationalizing their continued institutionalization and the nature of services seen as suitable. Such negative attitudes, she finds, pervade contemporary social work discourse today in its dealings with the needs of the old. Western society is deeply ageist, and the category “old age” is still not applied in any consistent or analytical fashion.

More than simply introducing us to an analysis of the cultural and poli tical place of the old-age home, Davies wants us to meet those who entered there – to have the reader put on the shoes of the elderly, sit in their place, and live alongside them in their home and in the institution. It is here, I think, that she is least effective in achieving her goal. This is because the voices of the elderly, although always there, are perhaps filtered through too many layers of historical writing and are muffled, thus being less evocative than might have been the case with a less cautious and scholarly style. However, through her finely worked history of institutional development, she does begin to pierce the vast silence surrounding the essence of the old-age home both in the past and in the present, and, with her extensive and painstaking research on individuals and institutions, to illuminate the often sorry tale of warehousing the old in Canadian society.

From the outset Davies lays bare her assumption that older people typically prefer to live in the community rather than in institutions, and she considers the factors that make elderly people vul nerable to institutionalization. Her story begins, therefore, with a close-up look at the coping strategies of specific populations of elders in British Columbia who looked institutionalization in the face and did not like what they saw. She shows how the natural resource economy of British Columbia had a particular effect upon the gendered nature of the culture of old age, highlighting the fact that, although we often associate aging with women (due to the fact that they tend to live longer than men), it was single and working men who typically needed assistance in their old age, at least until the 1960s. Single men working in mining, logging, and fishing industries or on road and railway construction were often unmarried and lacked family or community roots. The transient nature of their existence – along with racial and ethnic issues – left them vulnerable to impoverishment and institutionalization in old age. Davies found that older women on their own rarely appear to have been as socially marginal as were their male counterparts. When either group (or married couples, who were more likely to remain independent longer than were single men or women) turned to the state for help, there were a number of options available. And it is to these varied sources of support (again, up to the 1960s) that the rest of the book is dedicated.

Throughout this extremely informative book we are reminded again and again that policies, like institutions, bear the indisputable and indelible imprint of the ideology and time that gave birth to them. Davies’s descriptions of the various facilities that were pro vided over the years of her study are illuminating, especially when she shows us the sparse and dingy interiors, and poor services, of earlier institutions. Nor does she neglect to point out that the changes in later facilities were, more often than not, merely cosmetic. She provides some excellent pictures of the changing shape and st yles of institut ions designed or revamped for old people and, unfortunately, misses a wonderful opportunity to draw upon current discourses in cul tural geography and architecture to show more vividly what the design, construction, and shifting functions and spatial configurations of the various buildings revealed about the values and aspirations of the age. Architects and planners of institutions for old people became, in a sense, partners in a dialogue with the body, and their views on design and society reflected an acute sense of how the aging body should be looked at and what it could and should become through appropriate discipline and care. If anything is described by an architectural plan it is the nature of human relationships, and Into the House of Old tells us a lot about human relationships, professional ageism, the institutional culture of the old, and the continuing low status of the aged on the policy agenda. Above all, through her penetrating study, she reminds us that modern history has not been kind to old people, that institutions do not have hearts, and that residential facilities for the aged continue to harbour the ghost of the poorhouse. Anyone feeling the chill of impending old age can take little comfort in this reminder.