I am taking a step away from the topic of death and dying as I finish gathering my thoughts. It is proving to be a larger task. So, on to a different topic for this week – Silos!
Did your eyes roll when you read that word, Silos? Did you think about clicking off this page and moving on to something else? I know I probably would. It is not a new topic of conversation in this world or our field of aging and dementia, YET, we still bring it up. I first heard the term when I was in high school, and 15-20 years later, it continues to be a point of conversation.
The term “silos” is frequently used to describe the barriers and invisible, well silos, that the various disciplines within our medical and aging community live in. But it goes beyond that. It is something deeper that we refuse to (or maybe have never thought of) acknowledging. The silos in our medical and aging community start with the very people we seek to serve. We silo people based on dementia or no dementia, the bingo players and the trivia players, the people who come out for events, and the people who don’t. We silo people based on care needs, the people who are in this level of care, and the people who are at a different level. I understand the mindset behind why this happens, but that doesn’t make it the best way to live. We are accidentally (maybe) isolating and de-humanizing care. We prevent the natural community we say we strive for from actually coming together because we don’t foster connections between people, but connections between care needs. Our residents and clients are placed in silos.
The next layer up is the staff within our care communities. The sales and marketing team, the clinical team, the CNA and nursing staff, the life enrichment team, and HR. We don’t come together as one team with the same mission to care for those in our community but separate teams, and harbor animosity, resentment, distrust, and competition between the various levels of care. We label people as skilled care or unskilled care. Medical care or social care, and social care is often said with that nose in the air sort of tone, you know the one that makes anyone who is not an RN somehow lesser of a human being. Our residents and family see this, and no wonder they too come to distrust care communities.
We silo families when giving the diagnosis of dementia. It becomes the silo of “person living with dementia” and the silo of “care partner or family for a person living with dementia.” We talk to the “able-bodied, sound mind” family member or care partner, while the person with dementia becomes the invisible warm body in the room. We provide support groups for the care partner but not the person with the diagnosis. We question why someone with dementia is attending an event for care partners or why a care partner is attending an event geared towards someone living with dementia.
How can we expect to break down the silos within the medical and aging community if we still insist on creating them for those who trust us to care for and guide them on this journey? This picture is much larger than the one I just presented, and in some cases, incredibly damaging. Let your thoughts wander on the topic, and I dare you to come back to me and tell me these additional silos are a good idea.
Let’s leave the silos on the farm.