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  xi Prologue 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 two-pound box of Maud Mullers, filled with creams, toffees, and caramels, each nestled in a brown fluted-paper cup. My favorite gift is still a box of chocolates. We kids adored Grandma. She seemed to get a kick out of life, accepting the hand that she was dealt. She had lost my grandfather, the love of her life, to lung cancer when he was in his fifties. But I never heard a word of self-pity from her. She had little money, but she knew how to have fun. Weighing in at ninety pounds, she was stylish, wearing sling-back high heels, fashionable dresses, and gold costume jewelry, including a charm bracelet with a silhouette of each grandchild dangling from it. When she told a funny story, her laughter was punctuated with a snort. She grew flourishing roses and collected Hummel figurines. I loved exploring the depths of her basement, which held an amazing octagonal table for playing cards, and the dark corners of her attic. My sister, brother, and I slept up there, in a brass bed on a lumpy mattress. Grandma played endless games of canasta and euchre with us. She let me fix her hair in pin curls and administer facials, slathering her lined skin with concoctions of perfumed creams I mixed from bottles on her dresser. Never mind that she had just come from the beauty parlor—she always indulged us, just as her own parents had done with her, and as my father continued with us. When Grandma was ninety-two, she decided she was too frail to live on her own. She had already given up the house on Kipling Drive and moved to an apartment. But when that became too much for her, she entered a nursing home. Once Grandma crossed the threshold, she seemed to fade away and xii Old Age in a New Age be replaced by a generic old person. I knew she was happy to see us, but the spark was gone. I wondered if the staff even knew that she had worked in chocolate and could play countless varieties of poker. The last time I saw her was shortly before she died in 1982. I was then thirty and indulging my own Sarah. My husband, Ross, and I took our twoyear -old to see her namesake in the nursing home. It was like most such institutions back then—and now, in far too many cases. To enter, we passed through a glass door and were met with the malodor of medicine, Mr. Clean, and urine. A long hall of linoleum led to the hospital-like rooms where residents lived. Our daughter was knee-high, with wispy blond hair and sturdy legs. In a photo taken that day, she wears a dark blue jumper with embroidered flowers . A serious child, she was not the kind to make a ruckus. She held my hand as we made our way through the lobby. To do so, we passed a phalanx of very old women wearing faded housedresses or hospital gowns, sitting in wheelchairs. In my mind’s eye, they moved as one long pale organism, leaning out of their chairs, quavering arms outstretched, painful yearning on their faces, to touch our daughter. I could feel their hunger for life, as represented by a small child. If she was frightened by this display, Sarah did not show it. She solemnly submitted to the touch of these strangers as if she knew she was giving them a gift. The haunting vision of elderly women grasping at life beyond their reach was frozen in my mind for the next twenty years. I never considered there could be an alternative for those who live in a nursing home. But wiser people, with far more imagination, are challenging the way we’ve done things. They are creating homes where people with physical or mental frailties live not as wards, patients, or inmates, but as contributing, creative human beings. These visionary leaders demonstrate that radically changing the culture of nursing homes transforms the lives of both elders and caregivers. “The people in long-term care are the elders of our people,” said Barry Barkan, a California leader in this emerging movement for...

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