Retirement Homes & Amis' Ending Up

 
Retirement homes don't feature frequently in the news. When they do, it tends to be over an issue of controversy. For example, there is last week's NPR story "Retirement Home Defends Nurse's Refusal To Administer CPR:"

The head of a California retirement home where a nurse last week refused to administer CPR to an elderly woman says his staff followed policy in handling the emergency. In a written statement, Jeffrey Toomer, the executive director of Glenwood Gardens in Bakersfield, Calif., says it is the facility's practice "to immediately call emergency medical personnel for assistance and to wait with the individual needing attention until such personnel arrives. ... That is the protocol we followed." In the audio from the 911 call that was aired by several media outlets Sunday, dispatcher Tracy Halvorson determines that an 87-year-old woman who collapsed in the facility's dining room is not breathing properly. Halvorson pleads with the nurse to begin efforts to resuscitate her. "We need to get CPR started," she says. "Yeah, we can't do CPR at this facility," the nurse responds.

To get the other side of the story, I turn to the article's most popular comment:

As a nurse, I have worked in several facilities where everybody is a DNR (Do Not Resuscitate); so it is routine protocol to not administer CPR for the patients. They have already signed DNRs along with their doctors, and they have met the qualifications for the DNR... CPR has about a 97% chance of NOT working in this population. If someone is dying from a combination of old age and chronic health conditions that have caused the person's health to deteriorate over time, success with CPR is very unlikely.

What a difficult decision for the patient, the family, the retirement home, and the nurse. Can you imagine being in the nurse's position: being required by policy not to resuscitate the patient and having to watch her die?

Anyway, regardless of how grim and controversial the article is, it is a rare instance of retirement homes being featured in the news. Which means it's time to feature a few novels about retirement homes.  I recommend Ending Up by Kingsley Amis:

At Tuppenny-hapenny Cottage in the English countryside, five elderly people live together in rancorous disharmony. Adela Bastable bosses the house, as her brother Bernard passes his days thinking up malicious schemes against the baby-talking Marigold and secret drinker Shorty, while kindly George lies bedridden upstairs. The mismatched quintet keep their spirits alive by bickering and waiting for grandchildren to visit at Christmas. But the festive season does not herald goodwill to all at Tuppenny-hapenny Cottage. Disaster and chaos, it seems, are just around the corner …

Runners-Up

• Probably the most popular recent novel about retirement homes is Deborah Moggach's These Foolish Things, now known as The Best Exotic Marigold Hotel after the film adaptation: When Ravi Kapoor, an over-worked London doctor, is driven beyond endurance by his obnoxious father-in-law, he asks his wife: 'Can't we just send him away somewhere? Somewhere far, far away.' His prayer seems to have been answered when his entrepreneurial cousin, Sonny, sets up a retirement home, recreating a lost corner of England in a converted guesthouse in Bangalore. Travel and set-up are inexpensive, staff willing and plentiful - and the British pensioners can enjoy the hot weather and take mango juice with their gin.  

• The "Not a good match for this article, but sounds hilarious" prize goes to Retirement Homes Are Murder by Mike Befeler: Ornery and robust octogenarian Paul, who suffers from short term memory loss, wakes up in a place he doesn't recognize and struggles to figure out where he is. He learns he's living in a retirement home in Hawaii. Still trying to get oriented, he finds a dining hall where he meets, for what he thinks is the first time, table mates Meyer, a retired judge, and Henry. His frustration builds when he's informed that he ate meals with them the day before. In his growing confusion, he returns to his room, finds a bag of bottles in his kitchenette and decides to discard them in the building's trash chute. When the bag gets stuck, Paul is shocked to discover a body wedged in the trash chute. Things go downhill from there for Paul as he becomes a suspect and then is threatened himself by the murderer.  

• And in the "not my cup of tea, but you might like it" category is Recessional by James A. Michener. I find Michener's writing painfully stilted, but millions of readers can't be wrong, can they? Yes, they can. Anyway, here's the description: As the new, young director of the Palms, Andy Zorn suffers no shortage of loving support and wise advice from his "elders," a group of five passionate, outspoken residents who refuse to accept the passive roles that both society and family have handed them. Yet past scandal has driven Zorn to despondency, until he meets an extraordinary young woman in the rehab wing, who has been forced to rebuild her life in the face of crippling injuries. Now Zorn finds himself falling in love--and with the help and gentle jabs from his more mature friends, he discovers a wonderful new purpose in life....

UPDATE:  a good review of Ending Up is available at the Reading the Bookers blog.

Caregiving Difficulties & Evison's The Revised Fundamentals of Caregiving

 From last month's NYT editorial "The Reluctant Caregiver:"

Now and then, I refer to the people that caregivers tend to as “loved ones.” And whenever I do, a woman in Southern California tells me, I set her teeth on edge. She visits her mother-in-law, runs errands, helps with the paperwork — all tasks she has shouldered with a grim sense of duty. She doesn’t have much affection for this increasingly frail 90something or enjoy her company; her efforts bring no emotional reward... “It’s important to acknowledge that every relationship doesn’t come from ‘The Cosby Show,’” said Barbara Moscowitz when I called to ask her about reluctance. Ms. Moscowitz, a senior geriatric social worker at Massachusetts General Hospital, has heard many such tales from caregivers in her clinical practice and support groups... For a reluctant caregiver, “the satisfaction is, you haven’t turned your back,” Ms. Moscowitz said. “You can take pride in that.”

Okay: interesting moral quandary that I hadn't previously considered. And the debate only gets deeper in the comments section. Here's the most popular comment:

I strongly disagree with Ms. Moskowitz's claim that there's satisfaction in knowing you haven't turned your back, and you can take pride in that. I'm looking back with resentment and regret at the two years I've already spent in the caregiver role, and I can't imagine that I'll look back in 5 or 10 years or whenever it's over and feel anything but greater resentment and greater regret. I'm never getting these years back, after all, and by the time it's over it may be too late even to get a reasonable level of health back. I think it does caregivers a disservice to sugar-coat the reality, and claim that even for the reluctant caregiver, there's a benefit there at that end. I'd much prefer to hear the unvarnished truth - that many of us are simply unfortunate enough to be conscripted into a lengthy period of life-wasting, soul-sucking servitude for which there is no compensation and no benefit. I think if more people started telling the truth about this, it might make a dent in everyone's expectation that adult children (daughters and daughters-in-law, in particular) should and will just suck it up and do it.

Pretty heavy themes.  For a novel about difficult caregiving, try Jonathan Evison's The Revised Fundamentals of Caregiving:

Benjamin Benjamin has lost virtually everything: his wife, his family, his home, his livelihood. With few options, Ben enrolls in a night class called The Fundamentals of Caregiving, where he is instructed in the art of inserting catheters and avoiding liability, about professionalism, and on how to keep physical and emotional distance between client and provider. But when Ben is assigned to tyrannical nineteen-year-old Trevor, who is in the advanced stages of Duchenne muscular dystrophy, he soon discovers that the endless mnemonics and service plan checklists have done little to prepare him for the reality of caring for a fiercely stubborn, sexually frustrated adolescent with an ax to grind with the world at large. Though begun with mutual misgivings, the relationship between Trev and Ben evolves into a close camaraderie, and the traditional boundaries between patient and caregiver begin to blur as they embark on a road trip to visit Trevor's ailing father.

NB:  article focuses on difficult caregiving for parents, while the book focuses on (initially) difficult caregiving for a client who is not a relative.

UPDATE:  some well-written reviews of The Revised Fundamentals of Caregiving are available on The Book Reporter, the Fiction Writers' Review, and the Next Best Book Blog.