The majority of long term care facilities for the elderly have the characteristics of total institutions. Care is based on the medical model which emphazises the physical needs of the residents. Current gerontological research and literature concludes that a biopsychosocial approach offers the highest quality of care to the elderly in institutions. This paper discusses political, economic, institutional and professional barriers to the implementation of the holistic approach to care. It recognizes that accommodation to the constraints identified is required. It then comments on the potential for an active alliance between two important actors in traditional long term care service delivery, the professional social worker and the nurse, to move the institution towards biopsychosocial care.
