When a care home takes its residents seriously

In Swiss elder care, democracy is usually treated as a decorative concept: pleasant to mention, less pleasant to practise. Yet the Alterszentrum Wengistein in Solothurn has spent nearly three decades doing something rather unfashionable. It lets residents and relatives have a formal say in how the place is run, and it appears to have survived this radical experiment in participation.

Hansruedi Moor, who runs the centre, introduced a residents’ council almost 30 years ago because the institution is, as he sees it, the residents’ home. They should be able to raise criticism, suggestions and wishes. The point, he argues, is quality of life, not paternalistic management dressed up as care. Esther Ludwig later joined the leadership, and together they developed the framework that is now being used as a model for others.

The system is deliberately plain. Around ten residents sit on the council, meeting six times a year. They act as intermediaries, collecting concerns and bringing them to the centre’s leadership. The range is broad, from complaints about night-time noise to more fundamental questions such as staffing levels, provided the issue is not purely individual. A residents’ council is not a complaint box with better branding; it is meant to filter, discuss and negotiate.

Because not every resident can represent themselves, Wengistein also created a family council a few years later. Again, about ten relatives are involved. They can speak for residents who are too frail or too affected by dementia to take part directly. They can also be asked for their view on a topic or a purchase. Meetings are formalised, with a chair, agenda and minutes. The centre’s management takes part, because democracy without the people in charge in the room would be little more than therapeutic theatre.

The arrangement has produced tangible results. On the recommendation of the residents’ council, for example, a garden was created for people in the nursing and dementia units. That may sound modest, but in long-term care even small changes can decide whether a place feels like a home or a holding pattern.

The federal government now recommends such councils after the review of the pandemic showed how badly older people in institutions could suffer from protective measures such as visitor bans or restricted movement. The dilemma was obvious: protect vulnerable residents from infection, and risk isolating them socially. Switzerland’s National Research Programme Covid-19 in Society, run by the Swiss National Science Foundation, is examining those consequences through 25 projects started in 2021. Another project, led by the University of Basel and the University of Applied Sciences and Arts Northwestern Switzerland, is studying participation in long-term care until the end of 2027.

Curaviva says participation is becoming more important and expects more homes to adopt resident and family councils. Guidelines already exist for those interested. Wengistein’s experience suggests that the basic ingredients are not especially mysterious: trust, routine and a willingness to listen before a crisis arrives. Moor puts it more bluntly. During the contact bans, the councils could not meet, but the dialogue and trust had already been built. In other words, participation cannot be switched on like emergency lighting. If institutions want a voice system that works under pressure, they had better install it before the fire alarm goes off.

Written by Christiane Hofreiter christiane.hofreiter@alpineweekly.com