REVIEWED BY SR. M. PETER LILLIAN DI MARIA, O. CARM, L.N.H.A.
Vanderbilt University Press, Nashville, Tenn., 2007, 284 pp., $24.95 (paperback)
www.vanderbiltuniversitypress.com
The elders of our society facing a decision to leave home should experience a seamless transformation into a continuum care facility. Beth Baker's new book, Old Age in a New Age: The Promise of Transformative Nursing Homes, provides a clear picture of how such a conversion should look.
It is a challenge to change the medical model of nursing homes into a social model that is full of choices, independence, and, most importantly, one that nurtures interpersonal relationships. Yet, this book shows this change can occur. Through many success stories, Baker provides a framework from where to begin. Plus, it presents a detailed history of how nursing homes evolved and a strong argument as to why they must continue to evolve into homes that respect each individual as a unique human being.
The three-part book opens with "The Last Resort," helping readers understand how each decade in the United States provided its own set of services and prejudices toward those who were in need of care, especially the poor elderly. "Decades of disordered actions by state and federal legislators, entrepreneurs, nonprofit agencies and, eventually, large corporations produced nursing homes" (p. 10). Baker explains the thinking and history of each decade, which outlines the necessity of culture change in all providers.
The second part of the book, "Stories from the Front Lines of Change," takes the reader along many paths highlighting the importance of honoring individual choices that help residents find meaning in life, create sustainable relationships with family and community members, and understand the importance of living in the present. This section reminds the reader how important it is to educate all caregivers on appropriate end-of-life care.
"Making the Case for Change" is the final part. It prepares the reader to overcome resistance to culture change by examining the various reasons often cited for maintaining the status quo. Baker dismantles the many obstacles raised by opponents of culture change by debunking the myths associated with comments such as: "We can't afford it," "The regulators won't let us," "We'll get sued," "It can't last" and "But will it work?"
This book is a must-read for all those moving toward culture change as well as those who have yet to be convinced that culture change is the future of continuum care communities. Baker challenges readers to empathize with elders by realizing that, "Elders' needs are our own: to live in dignity, in an environment of home, in a community of nurture and love, leading a life that has meaning" (p. 207).
The author shares many heartwarming stories that challenge the thinking that nursing homes can only be dreaded places where people come to stop living and disconnect from society. Some examples of success stories are:
- At Providence Mount Saint Vincent in Seattle, a jazz band performs on Friday nights in the summer that brings people from the neighborhood.
- Lenawee Medical Care in Adrian, Mich., had the first licensed Head Start center inside its nursing home.
- Teresian House in Albany, N.Y., has an on-site day care center for children of staff, as does Fairport Baptist Home in Rochester, N.Y.
- At Crestview Nursing Home in Bethany, Mo., a staffer named Charlie took residents to the Harrison County Fair. Baker relates the following tale about Elsie and Charlie. "One evening, when they got to the rides, some wanted to go on the merry-go-round. One little lady, I got her on the Ferris wheel, and they stopped us up on top," Charlie recalled. I said, 'Elsie, I was doing pretty good until they did this. She said, 'Yeah.' I said, 'Elsie, how long's it been since you been on a Ferris wheel?' She said, 'Charlie, I ain't never been on a Ferris wheel.' She was 100 years old." Baker says it all, "Elsie challenges every notion we have about who lives in nursing homes" (p.124).
Baker provides a well-researched resource with an informative bibliography and appendix, which allows the reader to have the most current information to design a blueprint that leads to change. Baker's on-site visits to more than two dozen facilities and interviews with leaders who have embraced culture change confirm the fact that culture change is attainable in all types of continuum care environments. Health care providers will find this book a well-organized reference for making a case for culture change. I recommend it to all health care providers who continue to seek best practices in improving the quality of life of those we serve.
Sr. M. Peter Lillian Di Maria, O.Carm
Director, Avila Institute of Gerontology, Inc.
Germantown, N.Y.