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Nobody's Home: Candid Reflections of a Nursing Home Aide (Culture and Politics of Health Care Work), by Thomas Edward Gass, Bruce C. Vlade
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"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.
- Sales Rank: #871699 in Books
- Brand: Brand: ILR Press
- Published on: 2004-03-01
- Original language: English
- Number of items: 1
- Dimensions: .84" h x 5.84" w x 8.70" l, .95 pounds
- Binding: Hardcover
- 216 pages
- Used Book in Good Condition
From Publishers Weekly
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. Perhaps Gass's most important observation is how uncomfortable everyone is around the home's residents—the staff, the relatives and the visitors. To combat that, he tries to do something to engage them: "Face to face, up close and personal, I learn to focus my full attention in flashes. One moment at a time, out comes my inner child. When I happen to touch residents softly or treat them affectionately, something may melt within and they become temporarily free of these depressing walls...." In the epilogue, Gass offers specific suggestions to reform nursing homes. He proposes having pets for the patients and letting children interact with older people more regularly. While this volume's depressing subject may be off-putting to some people, the book should be required reading for health care professionals and others in the medical field.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
Review
"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 Inside Flap
"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
Most helpful customer reviews
0 of 0 people found the following review helpful.
From a nursing aide perspective
By patricia_grace
From an actual nursing aide! The author has now moved on, but he writes about his experience working as a nursing assistant (sometimes called CNAs - certified nursing assistants), in an elder care nursing home. CNA's are the backbone of a nursing home. All the unpleasant work that docs don't do, and now that nurses (RNs, LPNs) don't do are passed on to the CNA. Feeding, showering, toileting, dressing, and basically dealing with all manner of bodily fluids from adults who are no longer able to live on their own.
This book is a real look at the hard facts of both living and working in a nursing home.
Although he was very clear about the hard work and unpleasantness of the job, the book still managed to have a good amount of humor and touching moments. Found myself smiling several times.
After reading, you should have more compassion for both workers and residents of nursing facilities. I could see this book being required reading in some college classes.
2 of 2 people found the following review helpful.
It helped me learn to take care of a loved one at home
By Amazon Customer
I read this book at the point where we moved my mother-in-law from assisted living and into our home under hospice care. I then became her full time at-home CNA.
I always appreciated the CNA's who are the first line care givers. I appreciated them even more after reading Nobody's Home, and especially when I had to perform their role at home. I shared the book with several aides who also seemed to enjoy it and confirmed that it captured and represented aspects of their work and experiences.
Most importantly, this book gave me the knowledge and courage to perform the mundane caring and hygiene tasks that my mother-in-law required. Gass's accounts of his own experiences helped me get passed these issues, and provide the care my mother-in-law needed and deserved. In effect, Nobody's Home served as an operating manual for me as I learned how to be an aide. It helped me get through an extra-ordinarily difficult time.
If you have a loved one in assisted living, a nursing home, in home care, or on hospice, consider reading this book.
13 of 13 people found the following review helpful.
A candid and compassionate story
By M. Flesner
At 189 pages, the book does a wonderful job of telling the story of a CNA who goes to work in a nursing home in the Midwest after the death of his mohter. He wants to do meaningful work that would gain depth to his character. He is not the typical aide, having spent years working and learning in a variety of areas. His past experiences and education allow him to write about the job, the nursing home, his colleagues and the residents with beautiful insight and compassion. These words in his Epilogue have stuck with me. "Few of us are prepared for what happens. First we grow up and get stronger by the day. Then one day the process reverses. At first we deny and resist, but evenutally we all surrender."
Gass has some wonderful insights for people working in the LTC industry and for those of us who will one day be admitted.
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