Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare

For anyone who works in the field of geriatrics, or has friends, relatives who are advanced in the aging process, this is a "must read". You may not always agree, or may wince on occasion, but this author relays his story from both a professional and personal perspective of aging in nursing homes. Well worth the read and actually somewhat uplifting.

How old are you? Do you ever think about what life will be like if you reach seventy, eighty, or ninety? In "Nasty, Brutish, and Long," psychologist Ira Rosofsky offers his personal and professional perspective about "old age and the world of eldercare." Rosofsky is an outside contractor who is paid to treat clients in assisted living facilities and nursing homes. For confidentiality reasons, the men and women he describes are not actual patients. However, it is a fair assumption that the doctor bases his characters on people he has met during his long experience in the trenches. Rosofsky introduces us to Sam Rosen, who is one hundred and two. Sam's wife, who died at one hundred and one, "was buried in the cemetery" last year, while Sam is now "buried in the nursing home." Sam cannot believe that his seventy-seven year old marriage is over, his house has been sold, and his kids never visit. His universe has become a constricted space with a few possessions he can call his own. Although the residents of eldercare facilities vary widely in age and in their ability to function mentally and physically, many of them deteriorate rapidly as a result of a lack of stimulation and "benign" neglect on the part of relatives and staff. Nursing homes are a $115 billion a year business. This exorbitant amount of money pays for a highly regimented bureaucracy in which "all the routines are scrupulously documented" and "every procedure is by the book." The goal is "to keep a body alive to pass on to the next shift...." The government pays for a huge number of pills dispensed and a wide array of therapies, but many patients have little face time with concerned caregivers. When Dr. Rosofsky speaks to his clients, he makes eye contact and listens to their heartrending and repetitious stories about their memories, relationships, dreams, and nightmares. They are often delusional or in denial about their circumstances. Although some of them insist that they would never kill themselves, they admit that they wouldn't mind "waking up dead." Rosofsky makes his book even more poignant when he muses about his own fear of aging. He recounts the death of his father, who suffered from dementia before passing away in a hospice just shy of his ninetieth birthday. The author has seen the system from both sides of the fence and for the most part, he is not thrilled with what he sees. If the baby boomers are lucky enough to stick around for another two or three decades, their chances of seeing the inside of a nursing home or assisted living facility greatly increase. They will need to spend down their money (unless they have long-term care insurance), resign themselves to an almost total lack of privacy ("living in a nursing home is life interrupted"), and be willing to accept the fact that unless their children are attentive and live close by, they won't receive many visitors. If they are fortunate, they won't suffer from cancer, diabetes, Parkinson's, Alz

Since finishing this book I find myself recommending it over and over to people with aging parents. If you are middle aged, you are like to be one of these - or know many of these - so I recommend it to you as well. The book provides invaluable insight into the (nasty and brutish) process and system of aging that few of us are likely to escape (if we are lucky). Dr Rosofsky addresses this irony in a thought provoking and humorous way -by openly sharing his own professional and personal experiences. Also, as a teacher who is always preaching about good writing, I give Dr. Rosofky high marks. His writing is clear, descriptive, fast moving and accessible. You will enjoy reading this book - inspite of the subject matter.

This is a well-written, informative and humorous portrayal of every aspect of nursing homes in the U.S. today. It's also grim, depressing, morbid and horrific - but that's because nursing homes are like that. I'm considering the necessity of my 92-year-old mother going to a nursing home, and I'm glad I read this because now I'll do everything I can to keep her out of there. Read this if you want the real story and not the sugar-glazed version.

I had enjoyed excerpts from this book on the author's website, but what really works when reading the entire thing is the flow from chapter to chapter. I really like how he integrates his professional and personal experience, and unlike a reporter who's simply done a lot of research, this guy draws upon a wealth of experience. His knowledge of nursing home practices combined with his own thoughts about his oncoming old age and mortality really make this book come alive. I had orginally thought this would be a dry examination of the state of nursing homes. But it's really a fun book to read, if you can laugh at what might be in store for you. And reading about his own parents made me feel as if I knew them. This is a good one.