Navigating the world of long-term care can be an overwhelming experience for family members. Peter Silin draws on his extensive experience as a social worker in long-term care and as a geriatric care manager to provide family members with valuable and practical information and advice.
This book is written for family members who are in the process of placing a relative in long-term care or who have a relative already in long-term care. Silin explains that this book is also written for those contemplating a move to long-term care themselves, although the book is unlikely to attract these readers, given the book’s title and primary audience. It would be useful, nonetheless, to people working or planning to work in long-term care as they could gain additional insight into the needs and concerns of family members and help improve the quality of life of people residing in long-term care.
Throughout the book, Silin has chosen to use a randomized selection of family members when citing examples (for instance, referring to “your mother” in one instance, and “your husband” in another), which is unfortunate. Although intentionally used, this device distracts the reader. The choice of a more generic noun, such as your “relative” or “family member,” would likely be less discordant.
Silin targets a wide range of family members in this book and integrates, with some success, both Canadian and U.S. content. While much of the book refers to family members irrespective of the country in which they reside, Silin recognizes that important differences exist between the two countries on such issues as accessing long-term care and subsidization policies. However, since long-term care is provincially administered in Canada, and therefore varies greatly from province to province, it is difficult to capture succinctly inter-provincial variation. For example, Appendix 1, which includes specific information on accessing care in Canada, could include more-specific information on accessing care in each of the provinces. It would perhaps be more beneficial to the reader if both a Canadian and a U.S. version of the book were available.
Another way in which Silin appeals to a broad audience of family members is his inclusion, in this second edition, of assisted-living facilities in addition to nursing homes. While many issues are shared by family members who are placing relatives in both forms of long-term care, great differences exist, such as in the extent of care and support needed. For example, information concerning family members with advanced forms of dementia would more likely be of interest to those placing relatives in nursing homes. Again, two versions of this book, one addressing assisted living and one nursing homes, might well be valuable, especially if the former focused more extensively on helping older persons make their own decisions about moving.
Although this book is written for a lay audience, Silin does incorporate some concepts that are intriguing to an academic or professional audience. For example, in Chapter 5, Silin makes the distinction between good care and good caring. “Good care means up-to-date and competent professional practice from all the staff members in a home. It can come only from people who have training and knowledge in the field of geriatrics” (p. 96). In contrast, “Good caring means that the staff understands and responds to the emotional needs of the residents and behaves in a manner that meets those needs. It comes from people who are warm and loving” (p. 97). Thus, Silin argues that while good care and good caring are both ideal, they do not always occur simultaneously in long-term care, an important point that everyone involved in long-term care should understand. Silin also raises the following question: “Can a nursing home or assisted living facility provide meaning and purpose?” (p. 100). This query is integral to the very nature of long-term care facilities and how they function.
Silin clearly understands the experiences of family caregivers both before and after a relative is placed in a nursing home or assisted-living facility. He thus provides the reader with information on some anticipated, and worthwhile, topics, such as how to continue the very important family-caregiving role after a relative is placed in long-term care. The content in Chapter 4 that focuses on dealing with guilt, loss, and grief is exceptionally insightful with respect to long-term care placement. Silin provides family members the much-needed reassurance that, in some instances, using nursing home and assisted-living services is the right decision for the older person and his or her family members.
In Chapter 9, Silin offers extensive information on preparing for the move, focusing on how to prevent problems, how to anticipate what should and can be done ahead of time, and how to reduce stress on moving day. His specific advice for those caring for relatives with dementia is also particularly useful. Each chapter ends with a story by a family member that memorably reflects and illustrates the content of each chapter.
Silin effectively includes some content that might not be expected by family members reading this book. His treatment of abuse goes far beyond identifying its existence in long-term care. He tries to help family members identify when and why abuse occurs and also explores the family’s role in preventing it. Making effective complaints, a very pragmatic issue, is addressed from a problem-solving perspective, while offering compliments is referred to as “throwing bouquets” (p. 261). Although Silin recognizes that complaints are often warranted, he purports that they occur at a ratio of 20 complaints to 1 compliment. Since employees find it difficult to work under these conditions, he recommends that family members try to throw more bouquets. Finally, although it is not financially feasible for many families, Silin suggests that family members, especially if they are unable to be physically present in the long-term care facility, hire a companion to provide additional physical and emotional support.
This is a valuable book that can help family members immensely both before and after placing a relative in long-term care. Silin’s writing style is readily accessible by a broad audience, and his humour is likely to be appreciated by family members experiencing what is often a highly charged and emotional situation.
