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oon after startingmy first prac-
tice as a country doctor north
of Peterborough, Ontario, I
was asked if I would accept the
position of house physician for the 20
elderly residents of the county’s “Home
for the Aged.” Its former name had
been the county “House of Refuge” – a
name presumably chosen to indicate
that it was the place to which county
residents could be taken when there
was nowhere else to go, they were
destitute and no family member was
available to look after them. I accepted
the position and can remember the
routine drive up the long lane to the
large, century-old farmhouse which
had been converted many years earlier
into a “nursing home.” A close doctor-
patient relationship developed with
those elderly residents over the several
years during which I held that respon-
sibility and, to most, I was the only
person to visit them on a regular basis.
As my practice grew, it became neces-
sary for me to visit some of my patients
in other area nursing homes (as they
were all called) and it was sad to real-
ize that the majority of residents were
quite unhappy about being there.
There were always two or more per-
sons to a room, the facilities were al-
ways large, old, converted homes and
the odour was universally unpleasant.
Although well cared for under the
circumstances, there were very few
supplementary services or programs
and I always dreaded the idea that
someday, I might have to suffer the
same fate.
Over the years, the transition to more
appropriate housing and care in
Canadahasbeenremarkable. Although
there are still “nursing homes,” a much
greater range of choices is available
for most Canadians when, because of
age and/or health, they can no longer
live independently. Furthermore, the
nursing homes that are still needed
are often modern, appropriately de-
signed dedicated buildings staffed by
Future Care
Better Choices
by Robert MacMillan MD