Dr. Sholom Glouberman is the philosopher-in-residence at the Baycrest Centre for Geriatric Care in North York, Ont.
This unique position is often viewed with considerable skepticism.
Why does a hospital need a philosopher? Should other hospitals or long-term care facilities have a similar position? But most importantly, what does Dr. Glouberman actually do?
I recently paid a visit to Dr. Glouberman to find answers to these questions. I was also curious to learn if his answers would cast any light on the challenges faced by family caregivers of people who suffer from dementia.
The Baycrest Centre is composed of a series of modest buildings located on an otherwise quiet block in midtown Toronto. Founded in 1918 as the Toronto Jewish Old Folks Home, it has evolved into an innovative leader in aging and brain health. Baycrest prides itself on combining comprehensive systems of long-term care with cutting edge research in cognitive neuroscience.
Filled but far from crowded with a small community of pleasant elderly patients and support staff, the hushed interior of the Baycrest Brain Health Centre feels less like a hospital than a quiet university campus.
Leading scientists who were once dedicated to finding a cure for Alzheimer’s are now dedicated to learning about how to live with Alzheimer’s.
I find Dr. Glouberman’s office, brimming with bookshelves, tucked quietly on the seventh floor. Sporting a maroon shirt and a matching tie in the colorful semi-formal fashion typical of the academic, the heavily bearded and ambiguously aged philosopher exudes immediate warmth and kindness. His speech is deliberate and unhurried, his manners appropriately contemplative.
As I enter, he is playing solitaire, apparently unperturbed by my sudden presence. Perhaps, so I wonder, he is musing on the great thinkers, from Maimonides to Virchow, whose ideas he explores on his blog, Health and Everything.
But beyond these mild and befitting eccentricities, I quickly discover a man with an unwavering dedication to an imperative and controversial undertaking. For over 20 years, Dr. Glouberman has used his distinctive position as philosopher-in-residence to change the nature of long-term geriatric health care within Canada and beyond. “My job,” Dr. Glouberman suggests, “is to bring the hard truths to the people in power.”
The contemporary healthcare system, he explains, is struggling to shed the remnants of an outdated perspective on health adopted from the early modern period of scientific rationalism.
“Descartes thought that the body was simply a machine. Keep it running smoothly, and you have health. What is recognized now is that health includes community, family, and relationships. We now look at the body in the context of society.”
But a significant rise in the prevalence of chronic and degenerative diseases such as dementia has run parallel to this change, and to rapid advancement in medicine and healthcare. Indeed, according to a recent study by the Alzheimer Society of Canada, the number of Canadians living with cognitive impairment, including dementia, now stands at a staggering 747,000 – a number expected to double within the next two decades. These changes, of course, have led to a new understanding of health and of care.
“The idea of a magic bullet that will cure you is no longer relevant,” Dr. Glouberman explains. “Leading scientists who were once dedicated to finding a cure for Alzheimer’s are now dedicated to learning about how to live with Alzheimer’s. We need to age better – not avoid aging.”
The doctor has knowledge the patient doesn’t have, but the patient and their caregivers also have knowledge the doctor doesn’t. Only together can they figure out the care needed to cope with specific conditions.
Today, it is understood that the key to better aging is patient-centered care based on collaborative relationships between the patient and their providers. For patients with Alzheimer’s or dementia, caregivers also play an essential role in collaborative and relational care. Not only do they voice the needs of those who are no longer able to speak for themselves, they also take on the responsibility of ensuring that the patient’s capabilities are properly recognized and activated.
Yet modern healthcare, Dr. Glouberman contends, remains instrumental and institutional, rather than relational and patient-centered. Moreover, the hospital has become increasingly specialized in its services, each of which is guided by distinct and sometimes contradictory central values. For a patient with unique chronic conditions or multiple degenerative diseases, balancing simultaneous demands from different specialists can be overwhelming. The patient’s voice is often lost in the fray.
In his capacity as a philosopher, Dr. Glouberman works to dissect the modern hospital in all its swirling complexity. He attempts to clarify the competing philosophical bases of the various services a hospital traditionally provides. His job, as he sees it, is to remove the superfluous obstacles that exclude the patients’ and caregivers’ perspectives.
In 2011, Dr. Glouberman founded Patients Canada – a patient-led, patient-governed organization that aims to empower the voices of patients and caregivers, and develop patient-provider partnerships at every level of care. Supporting patient and caregiver engagement through a number of dynamic initiatives, including Open Meetings and large conferences, Patients Canada has also developed a number of practical measures, including the Key Performance Targests, to identify which organizations are meeting the standards of patient-centered care.
As the current president of Patients Canada and as an insider at one of Canada’s most progressive geriatric hospitals, Dr. Glouberman is confident that our healthcare system is headed in the right direction. Yet the road ahead remains a difficult one.
In an ideal world there would be no institutional beds and no nursing homes.
“We have very little support for old people living at home. There are not enough occupational therapists or physical therapists, and not enough day-care facilities for people with Alzheimer’s or support for their caregivers. Our system is still structured to go the institutional route.”
Institutional long-term care is also far costlier than the day-to-day support required by those with chronic conditions living at home. This fact, along with Canada’s aging population, is the likely impetus behind Ontario’s new Aging at Home Strategy, which notes the “critical importance, both for its potential to improve the lives of Ontario seniors and to ensure the sustainability of the overall health system.” Yet the transition continues to move at what Dr. Glouberman considers “a snail’s pace”.
“In an ideal world,” Dr. Glouberman suggests, “there would be no institutional beds and no nursing homes. People with Alzheimer’s would not be cared for on a scheduled basis. What we would have would be a series of houses, not institutions, in which people could live at a much more human scale. Unfortunately, we are having a lot trouble making the transition.”
But if he seems pessimistic, he is only doing his job. Like the subversive Socrates of the ancient agora, Dr. Glouberman’s ideas aim to both enlighten and provoke. “I play at the edge,” he says. “Always.” For Dr. Glouberman, innovation in aging, at Baycrest and beyond, requires imagination, a boldly critical eye, and a willingness to change. In other words, it requires philosophy.
To find out more about Baycrest Centre for Geriatric Care, click here
Richie Assaly is a Toronto-based writer.