"At present nursing homes are designed . . . like outmoded zoos.
Residents are kept in small rooms, emotionally isolated.
Occasionally they are visited by family members who reach through
the bars and offer them treats. Aides keep their bodies clean and
presentable. . . . America invests huge amounts of money to
maintain the body while leaving the person to languish, cut off
from all they love." From Nobody's Home
After caring for his mother at the end of her life, Thomas
Edward Gass felt drawn to serve the elderly. He took a job as a
nursing home aide but was not prepared for the reality that he
found at his new place of employment, a for-profit long-term-care
facility. In a book that is by turns chilling and graphic, poignant
and funny, Gass describes America s system of warehousing its
Gass brings the reader into the sterile home with its flat metal
roof and concrete block walls. Like an industrial park complex, it
is clean, efficient, and functional. He is blunt about the
institution s goal: keep those faint hearts pumping and the life
savings and Medicaid dollars rolling in. With 130 beds in the
facility, the owner grosses about three million dollars annually.
As a relatively well-paid aide, Gass made $6.90 an hour.
Seventeen of the twenty-six residents on Gass s hall were
incontinent, and much of his initiation to the work was learning to
care for them in the most intimate ways. One of the many challenges
was the limited time that he had available for each of his charges
17.3 minutes per day by his calculation. Even as he learned to
ignore all but the most pressing demands of the residents, he
discovered the remarkable lengths to which aides and their patients
will go to relieve the constant ache of loneliness at the nursing
With Americans living longer than ever before, elder care is
among the fastest growing occupations. This book makes clear that
there is a systemic conflict between profit and extent of care.
Instead of controlling costs and maximizing profits, what if
long-term care focused on our basic need to lead meaningful and
connected lives until our deaths? What if staff members dropped the
feigned hope of forestalling the inevitable and concentrated on
making their charges comfortable and respected? These and other
questions raised by this powerful book will cause Americans to
rethink how nursing homes are run, staffed, and financed as well as
the circumstances under which we hope to meet our end."
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