Nobody's Home: Candid Reflections of a Nursing Home Aide / Edition 1

by Thomas Edward Gass, Bruce C. Vladeck

Overview

"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 oldest citizens.

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 home.

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.

Product Details

ISBN-13:	9780801442438
Publisher:	Cornell University Press
Publication date:	02/13/2004
Series:	The Culture and Politics of Health Care Work
Edition description:	1ST
Pages:	224
Product dimensions:	6.00(w) x 9.00(h) x 0.88(d)
Age Range:	18 Years

About the Author

Thomas Edward Gass has divided his life between working in the trades and using his psychology degree in a variety of social work settings. At the age of thirteen he entered a Catholic seminary, which included a year of silence. In 1970 he learned meditation, which he still practices daily. He has lived and traveled through most of Asia enhancing his interest in eastern thought. He worked in a nursing home in the Midwest for three and a half years, first as a nursing aide and then as a director of social services. Bruce C. Vladeck is Professor of Health Policy and Geriatrics at Mount Sinai School of Medicine and the author of Unloving Care: The Nursing Home Tragedy. From 1993 through September 1997, he directed the Medicare and Medicaid programs as Administrator of the Health Care Financing Administration of the U.S. Department of Health and Human Services.

Table of Contents

	Foreword	ix
	Editor's Note	xv
	Preface	xxi
	Acknowledgments	xxiii
	The Setting	1
	Initiation	7
	The Cast	13
	Regs	57
	Back on the Hall	63
	Nurses and Aides	73
	Lot's Wife	79
	Feeding	83
	Back to Reality	91
	After Breakfast	111
	Aching Hearts	115
	Baths	125
	Life Goes On	131
	Interactions	137
	Late Shift	145
	Back on Days	157
	Epilogue	177

What People are Saying About This

Andrew L. Stern

Thomas Edward Gass presents without embellishment a portrait of what life is like inside a modern nursing home. Nobody's Home lets the readers see the cruel tricks aging can play on residents, the frustrations of declining health, and the indignities of not being heard. This book shows us the physically tough and emotionally sapping work that aides have to do every day in a health care system and society where their work is not assigned the monetary or cultural value that it deserves. Gass shows what happens when there are simply not enough caregivers to provide that care the way we would want. This book gives us portraits of real people—residents and workers—who deserve better care and a better health care system. Members of Congress who do not have better nurse staffing at the top of their legislative agenda should read this book!

Choice 42:2

Those planning careers in nursing and allied health will find Gass's book a must-read. Readers will learn many lessons from the perspective of one of the most important caregivers in American nursing homesThe nursing home aide.... Gass gives the reader an honest picture of himself and what he gains from his experiences. Many important analogies and conclusions about health care and the quality of life may be drawn from this book. Anyone interested in a depiction of the universality of aging won't be disappointed. Recommended. General readers, undergraduates, faculty/researchers, and professionals/practitioners.

Susan Eaton

"Nobody's Home is a brilliant ethnography, compelling and achingly vibrant and realistic. Thomas Edward Gass defines in human terms what it is like to be a frontline caregiver in a for-profit nursing facility, and he gives us an incredible sense of what it might be like to be a patient there. This book will surely be a tremendous resource for policymakers and for students of social work, aging, sociology, work organization, disability, and public policy."

Chuck Grassley

I recommend this insightful and well-written book to all those who may want to know, or need to know, more about daily life in a nursing home from the perspective of the residents and the nurses' aides who provide their basic care. Although Thomas Edward Gass details the realities of toileting, feeding, and bathing often disoriented residents, he also discovers their more fundamental need for meaningful human connection and shows that this need is most often met, if it is met, by overworked and exhausted nurses' aides like himself.

Choice 42:2

"Those planning careers in nursing and allied health will find Gass's book a must-read. Readers will learn many lessons from the perspective of one of the most important caregivers in American nursing homesThe nursing home aide.... Gass gives the reader an honest picture of himself and what he gains from his experiences. Many important analogies and conclusions about health care and the quality of life may be drawn from this book. Anyone interested in a depiction of the universality of aging won't be disappointed. Recommended. General readers, undergraduates, faculty/researchers, and professionals/practitioners."

Jill Quadagno

"In this profoundly moving book, Thomas Edward Gass describes his experiences as a nursing home aide. He documents the daily struggles of nursing home residents to preserve their dignity in an often uncaring institutional environment but also shows great empathy for the poorly paid aides who provide that care. I intend to assign this book in all my classes on aging."

Alice H. Hedt

"Thomas Edward Gass simply refuses to avert his gaze from frail elderly and disabled residents' humanity, and so we witness the daily indignities of institutionalized care. The nursing home residents whom Gass must hurriedly turn and spoon feed and toilet have complex lives and rich histories, and throughout this heartrending account Gass reminds us regularly that, if we live long enough, we too will likely be reduced to medical charts listing our disabilities. Gass's recounting of small gestures of tenderness and moments of compassion provide us with glimpses of what it might mean to really care for the elderly—and how our current long-term care system fails miserably at that elemental task."

Charlene Harrington

"Thomas Edward Gass describes beautifully the highs and lows of caring for people with dementia. He manages to see both the humanity and the humor in everyday experiences of nursing home residents and those who care for them. His philosophy, a unique combination of realism and universalism, has much to offer all of us as we try to make sense of our lives."

Editorial Reviews

For those of us who care about direct-care workers and the conditions of their work in long-term care, Nobody's Home: Candid Reflections of a Nursing Home Aide is a thrilling read.... Quietly eloquent and unfailingly honest, Gass shares his experiences and the thoughts they spurred in him, capturing the complexity of life and frontline work in what sounds like a fairly typical nursing home.

Quality Jobs/Quality Care Newsletter

"Nobody's Home, a disarming memoir of meditations and straightforward observations by former nursing home aide Thomas Edward Gass, is a stark yet illustrative look into an industry based on money and death but oiled by compassion and sacrifice.... Gass dives in and brings to the surface immensely rich stories out of an environment full of pain and decrepitude, whether it is an intimate conversation or an accident in the bathroom. He describes his residents in an intuitive yet brutally honest manner so that the reader can truly witness the realities of aging.... By the end of the book, you feel compelled to meet the author or, at least, want the kind of person putting the Depends on your own aging parents to be as caring and perceptive as he."

The San Francisco Chronicle

"Nobody's Home is a humorously written, easy airplane read, more useful than other Chicken-Soup inspirational texts in that it reflects insights from an author who has directed social service programs, has a degree in psychology, and helped his mother through the process of dying.... This book is written for anyone who has a friend or relative in a nursing home or who will grow old and frail and require nursing home care. In sum, it is written for everyone, and from that perspective. The reader comes to understand and perhaps the fear the limitations and dependencies that sometimes accompany aging. The reader also comes to understand what it means to be a resident in a nursing home and, perhaps, to hope that all nursing home aides are as sensitive as Gass is to the fact that life is happening behind these walls.... The main issue, however is that the reader comes away wondering, as does the author, what elder care would look like if it were not about controlling costs but, rather, fulfilling basic needs to be meaningful and connected until the time of death."

Journal of the American Medical Association - Sheryl Zimmerman

"In an interview, Gass elaborates. 'It was just natural for me to come in close, because there is such loneliness.'... Nor did he fall for the idea that his charges were inert, their minds blank and their spirits benumbed. 'It may seem on the outside that they're not doing anything, or that nothing is happening,' said Gass, a social worker who rose to become director of social services at the Midwest nursing home where he worked. 'But people have had a whole lifetime to build up their character, and they don't lose that, necessarily. And so there just a whole lot of texture and depth in how they interact and how they interpret what's going on.'."

Older Americans Report 28:17

"This honest and heartfelt book is a firsthand account of the reality of life in a nursing home. Gass, who spent five years in a Catholic seminary, ran a halfway house and was a teacher, returned to the U.S. after many years in Asia to care for his dying mother. That experience led him to work as a poorly paid aide in a long-term care facility in the Midwest. In a calm, intelligent and matter-of-fact style, Gass describes his often unpleasant daily routines. He cleans, feeds and dresses the patients; tries to converse with them, although they are often senile; and mostly, attempts to preserve their dignity. The book should be required reading for health care professionals and others in the medical field."—Publishers Weekly, February 23, 2004

"Nobody's Home, a disarming memoir of meditations and straightforward observations by former nursing home aide Thomas Edward Gass, is a stark yet illustrative look into an industry based on money and death but oiled by compassion and sacrifice. . . . Gass dives in and brings to the surface immensely rich stories out of an environment full of pain and decrepitude, whether it is an intimate conversation or an accident in the bathroom. He describes his residents in an intuitive yet brutally honest manner so that the reader can truly witness the realities of aging. . . . By the end of the book, you feel compelled to meet the author or, at least, want the kind of person putting the Depends on your own aging parents to be as caring and perceptive as he."—The San Francisco Chronicle, April 11, 2004

"Nobody's Home is a humorously written, easy airplane read, more useful than other Chicken-Soup inspirational texts in that it reflects insights from an author who has directed social service programs, has a degree in psychology, and helped his mother through the process of dying. . . . This book is written for anyone who has a friend or relative in a nursing home or who will grow old and frail and require nursing home care. In sum, it is written for everyone, and from that perspective. The reader comes to understand and perhaps the fear the limitations and dependencies that sometimes accompany aging. The reader also comes to understand what it means to be a resident in a nursing home and, perhaps, to hope that all nursing home aides are as sensitive as Gass is to the fact that life is happening behind these walls. . . . The main issue, however is that the reader comes away wondering, as does the author, what elder care would look like if it were not about controlling costs but, rather, fulfilling basic needs to be meaningful and connected until the time of death."—Sheryl Zimmerman, Journal of the American Medical Association, May 10, 2006

"In an interview, Gass elaborates. 'It was just natural for me to come in close, because there is such loneliness.' . . . Nor did he fall for the idea that his charges were inert, their minds blank and their spirits benumbed. 'It may seem on the outside that they're not doing anything, or that nothing is happening,' said Gass, a social worker who rose to become director of social services at the Midwest nursing home where he worked. 'But people have had a whole lifetime to build up their character, and they don't lose that, necessarily. And so there just a whole lot of texture and depth in how they interact and how they interpret what's going on.'"—Older Americans Report 28:17, May 7, 2004

"For those of us who care about direct-care workers and the conditions of their work in long-term care, Nobody's Home: Candid Reflections of a Nursing Home Aide is a thrilling read. . . . Quietly eloquent and unfailingly honest, Gass shares his experiences and the thoughts they spurred in him, capturing the complexity of life and frontline work in what sounds like a fairly typical nursing home."—Quality Jobs/Quality Care Newsletter, April 2, 2004

"Those planning careers in nursing and allied health will find Gass's book a must-read. Readers will learn many lessons from the perspective of one of the most important caregivers in American nursing homes"The nursing home aide. . . . Gass gives the reader an honest picture of himself and what he gains from his experiences. Many important analogies and conclusions about health care and the quality of life may be drawn from this book. Anyone interested in a depiction of the universality of aging won't be disappointed. Recommended. General readers, undergraduates, faculty/researchers, and professionals/practitioners."—Choice 42:2, October 2004

"Nobody's Home is a brilliant ethnography, compelling and achingly vibrant and realistic. Thomas Edward Gass defines in human terms what it is like to be a frontline caregiver in a for-profit nursing facility, and he gives us an incredible sense of what it might be like to be a patient there. This book will surely be a tremendous resource for policymakers and for students of social work, aging, sociology, work organization, disability, and public policy."—Susan Eaton, Kennedy School of Government, Harvard University

"Thomas Edward Gass simply refuses to avert his gaze from frail elderly and disabled residents' humanity, and so we witness the daily indignities of institutionalized care. The nursing home residents whom Gass must hurriedly turn and spoon feed and toilet have complex lives and rich histories, and throughout this heartrending account Gass reminds us regularly that, if we live long enough, we too will likely be reduced to medical charts listing our disabilities. Gass's recounting of small gestures of tenderness and moments of compassion provide us with glimpses of what it might mean to really care for the elderly—and how our current long-term care system fails miserably at that elemental task."—Alice H. Hedt, Acting Executive Director, National Citizens' Coalition for Nursing Home Reform (NCCNHR)

"Thomas Edward Gass presents without embellishment a portrait of what life is like inside a modern nursing home. Nobody's Home lets the readers see the cruel tricks aging can play on residents, the frustrations of declining health, and the indignities of not being heard. This book shows us the physically tough and emotionally sapping work that aides have to do every day in a health care system and society where their work is not assigned the monetary or cultural value that it deserves. Gass shows what happens when there are simply not enough caregivers to provide that care the way we would want. This book gives us portraits of real people—residents and workers—who deserve better care and a better health care system. Members of Congress who do not have better nurse staffing at the top of their legislative agenda should read this book!"—Andrew L. Stern, International President, Service Employees International Union

"Thomas Edward Gass describes beautifully the highs and lows of caring for people with dementia. He manages to see both the humanity and the humor in everyday experiences of nursing home residents and those who care for them. His philosophy, a unique combination of realism and universalism, has much to offer all of us as we try to make sense of our lives."—Charlene Harrington, Professor of Sociology and Nursing, University of California, San Francisco

"In this profoundly moving book, Thomas Edward Gass describes his experiences as a nursing home aide. He documents the daily struggles of nursing home residents to preserve their dignity in an often uncaring institutional environment but also shows great empathy for the poorly paid aides who provide that care. I intend to assign this book in all my classes on aging."—Jill Quadagno, author of One Nation, Uninsured

"I recommend this insightful and well-written book to all those who may want to know, or need to know, more about daily life in a nursing home from the perspective of the residents and the nurses' aides who provide their basic care. Although Thomas Edward Gass details the realities of toileting, feeding, and bathing often disoriented residents, he also discovers their more fundamental need for meaningful human connection and shows that this need is most often met, if it is met, by overworked and exhausted nurses' aides like himself."—Chuck Grassley, U.S. Senator, Chairman of the Committee on Finance and former Chairman of the Senate Special Committee on Aging

From the Publisher

In an interview, Gass elaborates. 'It was just natural for me to come in close, because there is such loneliness.'... Nor did he fall for the idea that his charges were inert, their minds blank and their spirits benumbed. 'It may seem on the outside that they're not doing anything, or that nothing is happening,' said Gass, a social worker who rose to become director of social services at the Midwest nursing home where he worked. 'But people have had a whole lifetime to build up their character, and they don't lose that, necessarily. And so there just a whole lot of texture and depth in how they interact and how they interpret what's going on.'.

Older Americans Report 28:17