July 31st, 2008

_Nobody's Home_ by Thomas Edward Gass

Subtitled: Candid Reflections of a Nursing Home Aide

That title is, I think intentionally, ambiguous in at least three ways. If you want to play it straight, I think the Correct Interpretation would be that Nursing Homes as "Skilled Nursing Facilities" are No One's Home -- and yet they should be. Alternatively, no one is at home in a nursing home. Then of course there's the cognitive decline interpretation, which could be applied, in turn, to the residents, the various castes among the staff, the owners, etc.

I have been really enjoying the New Old Age blog over at NYT, particularly the comments threads. And when I can say with a straight face that I'm enjoying the comments threads at a blog, you know something very special is happening. I figured since any derivative book would be a while coming, I should have a look 'round what already existed that might be worth reading in this area. I picked one each for what was (a history of nursing and home care), what is (this one) and what could be (a pretty idealistic look at stuff like the Eden Alternative, which is mentioned very briefly in the last pages of this volume). The history is a bit of a slog and will take a while. The idealistic entry arrived only just today, so I wound up reading this one first, despite my concerns about how much of a bummer it might prove to be. I'm glad I _did_ read it and, in the event, not a bummer at all.

My good friend A. used to do some nursing home work (as an LPN) and my sister as well (as a CNA and then as an LPN). My friend and my sister were a couple steps up from Gass, who is one of the extremely poorly paid folk that bathe, feed, dress, potty, rotate, etc. the residents. Let's just say, there's a lot of fecal matter in the life of an aide and thus, a lot of shit in this book. Gass cannot be considered a typical aide by any stretch of the imagination. He brings an often Buddhist attitude to the work and writing about it, for example. Unlike most aides, for whom is this is a dead-end, soul-destroying job, he had the education and other resources to work his way up to other positions at the skilled nursing facility he describes. But in this book, he sticks to his yearish as an aide, because he says, it was a lot more interesting.

He anonymizes and combines residents to make for a better narrative. Like most nursing homes, the average age is 80s, with some residents substantially older and a rare few much younger. Visiting family play a peripheral role in the day-to-day stories, but come in for more substantive treatment towards the end. Gass explores the effect of burnout on caregivers (family and paid) and bluntly describes his opinion of the kind of people who do this work. They may be generous, but they are themselves poor and often with poor health habits of their own. The kind of person who takes up this sort of work is someone with such a strong need to take care of others that it might count as a pathology by itself. And the perspective on health vs. illness that that group brings to the home is pretty warped as well.

See, you read about this stuff, it sounds excruciatingly painful and depressing. But it's not. This is one of the best books I've read all year. I know I said that pretty recently about Elizabeth Pisani, but this book is good in a _very_ different way. It's not snarkily funny. It's not about important policy. It is, however, an amazing window in a world that we may well all wind up experiencing unless we die first. And it's a world which is kept very, very far away from (most of) our daily experience.

It's thin. It's good. I assert it is _not_ depressing, altho at times it is wrenchingly sad. It is absolutely worth your time and money. Buy a copy, read it, and press it into the hands of people around you. This is great stuff.

ETA: Also, there are laugh out loud moments, like the bit about the hearing aid discovered in the resident's butt crack.