There is something for everyone in this collection of personal and scholarly reflections about long-term residential care for older people, whether your preference is for poetry, experiences of living or working in, or being someone whose family member has moved to retirement housing, projects carried out with residents, or interpretations of films from gerontological perspectives. According to the editors, this is a collection of essays ‘that challenge stereotypes of institutional care for older adults, that illustrate the changes that have occurred over time, and that illuminate the continuities in the stories we tell about nursing homes’ (pp. 17–18). By enriching the field with these question-provoking reflections, its aim is to alter the prevailing mindset from being one in which such care only becomes relevant when absolutely necessary, to being an attractive option.
It is a subjective collection written by people with experience of living in, working in or visiting care homes. Five poems by Canadian poet Betsy Struthers, whose mother lived in a care home, feature at the beginning and by way of introduction to each of the four distinct parts into which the 16 chapters are organised: Part 1, ‘Personal Perspectives’; Part 2, ‘Working and Playing in the Care Home’; Part 3, ‘Literary and Cultural Perspectives’; and Part 4, ‘Social and Historical Perspectives’. These are preceded by an introduction which sets out the rationale behind the book and outlines each chapter.
Struthers’ poem opening Part 1, on personal perspectives, describes an unpleasant environment and a difficult visit. Aritha van Herk then recounts an outsider's view gained from her regular, long trips to see her mother, who stayed in her own home despite its increasing unsuitability; her mother-in-law, who moved to assisted living when she could no longer manage stairs; and her friend, who moved to a retirement home far away from where he had lived. Monique Lanoix reflects on her experiences of splitting her time between home and the nursing home her husband lived in after an accident left him brain damaged, naming this ‘two-home syndrome’. In the second unhomelike home, she perceives the care provided as impersonal and felt unwelcome because of its institutional physical environment, lack of privacy and rigid scheduling. Amanda Barusch's story of the journey towards residential care as her father's needs increased due to his progressing dementia includes details of daily difficulties, big decisions and her feelings. She shares conversations and email exchanges with her father, step-mother, family and respite provider, and her own journal as well. She also details the intricacies of the US long-term care system, including the practice of being discouraged to visit after a move to allow a new resident to settle. Part 1 concludes with Anne Wyatt-Brown's account of the reasons (from a humanistic gerontological perspective) for her move to and life in a US Continuing Care Retirement Community. She draws attention to how where to live is ‘one of the most difficult choices of later life’ (p. 79) and how different personal observations, broader personal experiences and gerontological knowledge can support decisions.
The lack of personal attachments between residents is the focus of Struthers’ poem that opens Part 2, working and playing in the care home. Laura Dunbar, who trained as a nurse in her thirties, contributes a much-needed worker's perspective. She highlights that high task expectations often meant only fleeting conversations with residents were possible, and that strictly delineated roles sometimes caused tension between different groups of workers. Dunbar spent her breaks perusing residents’ personal display boxes outside their rooms to learn more about them. Doing so, she made mutually satisfying strong connections with some residents and shares anecdotes about some residents. Next, based on his research which involved living in assisted living for two years, visits to dementia villages and a collaborative intergenerational project, Peter Whitehouse advocates for more intergenerational initiatives that would lead to more resilient communities that are better able to tackle the various challenges people face. Theatre is the subject of the next two chapters. Gray and colleagues set out and discuss two scenes from a research-informed play they developed which ‘emphasises the centrality of relationships and humanity when providing care for persons with dementia’ (p. 114). Aynsley Moorehouse's chapter is an adaption of the blog written during a five-month theatre project with a small group of care home residents in one home. Her personal observations and accounts of the participating residents’ reactions offer fascinating insights into how such a project can facilitate the making of relationships within homes.
Literary and cultural perspectives are the focus in Part 3, which is opened by a poem narrating the humiliation felt by the author's confused mother whose first morning encounter with her care worker is less than caring. Amanda Ciafone then analyses The Best Exotic Marigold Hotel which caters for foreigners in their Third Age whose lives become more fulfilling once they have settled in India, their new home. Next, Peter Simonsen draws parallels between the fear resulting from terrorist attacks or violent crime and the fear of developing dementia, using McEwan's novel Saturday, a nursing home-based fiction book. He ends by asserting how rejecting residential care as an option for one's relative undermines women's struggle for independence and how placing one's relative in a home indicates that someone does care for them. Patricia Life then considers what texts are missing from the Canadian literature about nursing homes and identifies groups of people self-excluding from residential care and their reasons for doing so. Commitment to one's partner in the face of dementia and a resulting move to a care home is the topic of Katrin Bendt and Jennifer Hunke's exploration of the film Away from Her and the short story The Bear Came Over the Mountain on which it is based which concludes Part 3.
Struthers’ poem opening the fourth and final part, ‘Social and Historical Perspectives’, conveys the author's distress after visiting her bedridden mother at the end of her life. Chris Gilleard and Paul Higgs consider how nursing homes have unfairly become collective representations of the Fourth Age, a feared stage of ageing involving dependency, incapacity, suffering and voice-lessness, which can be unhelpful as it causes demoralisation, dissatisfaction and depression among care home staff, residents and their relatives. As long as nursing homes are perceived in this way, these negative portrayals of nursing homes will perpetuate. They feel that what is needed are ‘more resources to combat the devaluing nature of the work, the marginalization of the workplace, and the spectacular nature of the care environment, where visitors are encouraged as much as to observe as to share in the quality of care’ (p. 240). Marija Geiger Zeman and colleagues’ next chapter comments on Croatian novelist Zvonko Todorovsi's The Real Captain's Sea, in which a retirement home becomes the opportunity for one of its residents to adopt the identity he had always hankered for, how he benefits from this and the eventual consequences on a newly made friend who discovers the truth. Isabel Atzl and Amamaria Depner's penultimate chapter discusses changes in the layout of and objects in nursing home rooms since the 19th century. James Struther's final chapter, entitled ‘Home, Hotel, Hospital, Hospice’, tracks the conflicting images of long-term residential care in Canada and their development using recurring policy narratives. Concurring with Gilleard and Higgs about nursing homes being equated to the Fourth Age, he cites Johnson, Rolph and Smith's Residential Care Transformed: Revisiting the Last Refuge: ‘what people fear most is not residential care per se but ageing and the challenges of deep old age’ (p. 216).
Although many essays are from a North American perspective, there is acknowledgement that care homes vary across countries and much of what is highlighted in the stories is also relevant elsewhere. Supplementing the stories throughout are interesting and useful footnotes with background or further information to follow up. Of course, its international nature meant some disappointment when finding many references to non-English-language publications, which are challenging to access.
As well as its great readability, Care Home Stories’ key strength is its coverage of a variety of long-term residential settings and experiences. I would recommend it to students, researchers or others wishing to gain personal insights into care home life and the emotions these trigger from different perspectives, including that of people caring from a distance. A recurring theme is the role of contexts and the tensions between these establishments being people's homes, corporate endeavours and working environments. My only criticism is that the final chapter may have been better placed at the start to enable readers to gain an overview of the changing narrative around care homes, setting the scene for the other 15 stories. Based on having read this volume in the Aging Studies series, I would certainly read other volumes.
