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Old Age in a New Age

The Promise of Transformative Nursing Homes

Beth Baker

Publication Year: 2007

On investigative visits to nursing homes across the nation, Beth Baker has witnessed profound changes. Culture change leaders are tearing up everything -- the floor plans, the flow charts, the schedules, the lousy menus, the attitudes, the rules -- and starting from scratch. They are creating extraordinary places where people live in dignity and greet the day with contentment, assisted by employees who feel valued and appreciated. Perhaps most surprising, these homes prove that a high quality of life does not have to cost more. Some of the best homes in the nation serve primarily low-income people who are on Medicaid. In this new book, Baker tell the story of a better way to live in old age. Although each home is different, they share common values: respecting individual choices; empowering staff; fostering a strong community of elders, staff, family members, and volunteers; redesigning buildings from a hospital model to a home (where pets and children are part of everyday life); and honoring people when they die. Her visits to more than two dozen facilities include those associatd with the Eden Alternative, Green House, Kendal, and the Pioneer Network. Whether these transformational homes become the norm or the domain of a lucky few is the question that faces the next generation of elders, the baby boomers.

Published by: Vanderbilt University Press

Title Page

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pp. iii

Table of Contents

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pp. vii-viii

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pp. ix-x

First, I wish to thank the elders, their families, staff, and administrators of nursing homes who welcomed me and shared their stories. Their kindness, honesty, and good humor inspired this book. Charlene Boyd, Heidi Gil, Steve Shields, and Bill Thomas...

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pp. xi-xii

My grandma Sara always worked “in chocolate,” as she put it, either making chocolates for Maud Muller Candies or selling chocolates at Rikes Department Store in Dayton, Ohio. She worked until she was in her eighties. Every birthday, I got my own...

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pp. 1-4

I came to this story in a roundabout way, while writing a piece for the Washington Post on an unusual line of medical research. Scientists were quantifying what many people feel instinctively—that there are health benefits to being around nature. As part of my...

I. The Last Resort

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1. "Promise You'll Never Put Me in a Nursing Home": Why We're in Denial

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pp. 7-24

For decades, aging parents have begged their children, “Promise you’ll never put me in a nursing home.” Older people declare they will never move to one—as if by stating it emphatically enough, they can protect themselves from this terrible fate. Indeed, many seriously...

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2. "I Almost Cried": The Universal Longing for Home

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pp. 25-38

In the spring of 1999, Steve Shields, administrator of a well-regarded nursing home in Manhattan, Kansas, was in the midst of an upheaval of his own making. Convinced that the organization he led was stagnating, he had embarked on an ambitious campaign to...

II. Stories from the Front Lines of Change

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3. "We'll Fly to Paris": Honoring Individual Choice

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pp. 41-60

I began my visit to Manhattan, Kansas, at one of those popular chain restaurants that serve artery-clogging breakfasts and endless cups of weak coffee. Steve Shields sat across from me in the booth. He ordered an enormous platter consisting of a three-egg...

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4. "We Are Nothing": Empowering Staff

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pp. 61-84

In the conference room at Crestview Nursing Home in Bethany, Missouri, a dozen or so staff members were given time out of their workday to talk with me about their jobs. Crestview had a far different feel from Meadowlark Hills. Originally the poor farm, Crestview remained...

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5. "This Is My Home": Tearing Up the Blueprints

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pp. 85-108

Before architect David Dillard began redesigning the Village’s nursing home, the staff gave him an assignment. He was to spend twenty-four hours as a typical resident there. To fully appreciate what people endure, he was to pretend he had had a stroke, with his right side paralyzed. It was a challenge for the tall, fit Dillard to keep...

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6. "You Can Dance Alone or We'll Dance with You": Creating Community

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pp. 109-122

When I first entered Providence Mount Saint Vincent in Seattle, Mardi Gras was in full swing. A Dixieland band was swaying in the lobby, and plenty of folks, young and old, were gathered around, some in wheelchairs, all tapping to the beat...

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7. From the Top of the Ferris Wheel: Breaking Barriers

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pp. 123-135

My friend Lynne’s aunt had lived in a nursing home for only a few months. But her world had rapidly shrunk. The cloistered institution had already clouded her memory of the wide Kansas sky she had known all her life. On her first outing, she looked around in amazement. Lynne cried when she told me this...

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8. Beyond Bingo: Finding Meaning in Late Life

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pp. 136-151

I met Jean at the end of my visit to Pleasant View in Concord, New Hampshire. She was in bed, resting before dinner. She said she would ask me to sit down, but—she waved her hand at the tiny half-room, where there was no space for a chair. Jean moved to the nursing...

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9. Family-Friendly Homes: Welcoming Relatives to the Team

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pp. 152-160

Ellen Proxmire, whose husband, the late senator William Proxmire, had Alzheimer’s disease, described how it felt to be thrust into the role of caregiver. “The hardest thing is you can’t believe this is happening,” she said. “It affects your friendships. People...

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10. The Zen of Memory Loss: Living in the Moment

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pp. 161-173

My visit to Arbor Place in Rockville, Maryland, was a revelation. As I entered, I heard Latin jazz throbbing. Before me, in the living room, the household was in full swing. A gentleman in a plaid shirt dipped into a romantic embrace with a regal...

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11. "My Bags Are Packed": Dying in the Nursing Home

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pp. 174-182

Perhaps no other aspect of life so starkly contrasts the old way and the new in nursing homes than dying. Unlike any other place where people live, death is an expected outcome of the nursing home experience. It may take several years for death to come, but people...

III. Making the Case for Change

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12. Too Good to Be True?: Overcoming Obstacles

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pp. 185-199

Bill Thomas is fond of saying that transforming nursing homes is akin to coaxing the draft horses on his farm to work in tandem. He told me this as I was bouncing along on a wooden wagon seat behind two 1800- pound horses, Ned and Dan, plodding...

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13. Baby Boomers' Legacy?: Building a Movement

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pp. 200-208

Cultural transformation is an idea whose time has come. What began as a dream of a handful of radical reformers is rapidly gaining acceptance as the way life should be for people in nursing homes. This is especially remarkable given how truly radical that vision is. In his best-selling...

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pp. 209-210

I sit in the living room of a Green House in Tupelo and absorb life here. If going to a nursing home meant this, would people live in fear and dread? I would not. People were sick and had trouble moving, and some were more than a century old. Many were clearly living in a different sort of reality. But the house was full of life, of warmth,...


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pp. 211-218


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pp. 219-228


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pp. 229-236

E-ISBN-13: 9780826592286
Print-ISBN-13: 9780826515629
Print-ISBN-10: 0826515622

Page Count: 248
Publication Year: 2007

Research Areas


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Subject Headings

  • Older people -- Nursing home care -- United States.
  • Older people -- United States -- Social conditions -- 21st century.
  • Nursing homes -- United States.
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