Post-pandemic perspectives in social care. Toward the end of medicine? - Pathos

The new post-pandemic era that, whether we want it or not, is upon us in developed countries will inevitably bring with it a debate about the institutions that care for the elderly, who are, and in particular those among the elderly that are most fragile, the principal target of the virus. In Italy, considering the serious and well known organisational problems that have complicated the first phase of the pandemic, the time seems to have come to interrogate ourselves on what configuration to give to the structures tasked with serving the needs of the elderly population, commonly called RSA (residenze sanitarie assistenziali).

Within the recent discussion, we go from the views of those who reject them entirely, deeming it possible to replace them completely with home-care services,5 to the proposed policies of down-sizing, associated with a greater modularity.6  These stances generally share the same concern, more or less explicit, with “demedicalization”. When talking about the RSAs, we are no doubt dealing with an heterogeneous reality, considering also, among the many elements (such as their juridical status, for example), the fact that these structures have been “draining”, since at least twenty or thirty years,

from other sectors, such as psychiatry,7 intellectual disability8 or again neurological and/or rehabilitative care of chronic/degenerative diseases.9

At any rate, as far as the “structuralist debate about the RSA is concerned, as we could call it, we can observe that in framing the discussion primarily in terms of the containers, we run the risk of feeding the false idea, or at least the ideological presupposition, that constructing good containers represents the solution of the problem, according to the managerial dogma that is today the dominant faith of our time.

Maybe, we should rediscover a logic of subsidiarity, especially since in Italy there is a considerable plurality of actors throughout the social welfare sector, represented above all by private social institutes or foundations, whose very substantial contribution should be further enhanced. At least some of these realities have Medical Directions, and therefore a philosophy of care that for simplicity will be called traditional, which allows to maintain a link with the clinic that otherwise could be easily lost, as the French medical-social context shows. quite clearly.

As has rightly been noted, thanks to advances in medicine, more and more chronic patients are called to accept severe neurological patients with potentially algogenic pathologies, which need to be known and accompanied, starting from different professional skills.11

We ought in summary to safeguard as much as possible the specificity of the care needed by a given person; one should just think of the pioneering philosophy adopted in the Swiss French equivalent of the RSAs, the so-called EMS,13 historically differentiated into geriatric and psychogeriatric, as if recognize the complexities in the management of the mental health of elderly persons, for whom - as it is well known - the algological aspects play a key role.

In other words, we should, preserving as much as possible the clinical (and rehabilitative) dimension, maintain the paradox of an attitude that is meta-institutional, if not exactly anti-institutional, that is an attitude that sees the institution as a means and not a solution in itself, without the fear of words (nursing homes, hospice, old people’s home, chronic care nurses) replacing in time a cosmetic bureaucracy that delineates, or plans, with acronym after acronym a reality, that remains forever virtual.

It is not a question of demedicalizing (whatever we might mean by that term) but of protecting the rights of individuals to medical care. To avoid a dangerous drift into a sort of purely administrative health-care system, strongly biased against physicians (according to the wish expressed by Carlson in his well-know and dystopian text, expressly alluded to in the title of this piece)14 and, precisely for this reason, also antiscientific.