HARVEST MOON Portrait of a Nursing Home By Sallie Tisdale Holt. 204 pp. $17.95
Several months ago it was my sad but inescapable duty to deliver my father to a nursing home; he was no longer able to care for himself and none of his four children was in a position to take responsibility for him, so a nursing home was the only realistic alternative. But the step was taken with regret and apprehension; not merely had my father for years expressed the fear that he might one day be relegated to "the old folks' home," but none of us knew much about life in a nursing home and all of us feared we might be consigning a parent to a living death.
As it happens that turned out not to be the case at all; so far as his children can determine, our father is receiving good care in a reasonably congenial environment. But it would have been a great help to us, and countless others like us, had we been able to read "Harvest Moon" before taking this momentous step. This vivid account of life in a nursing home, written by a woman who has worked as a registered nurse in such establishments, is anything but the horror story one might expect to emerge from a place that cares for the dying and the decrepit; to the contrary, it is a description of how professionalism and human decency combine to make the nursing home a livable world of its own.
To be sure, the nursing home to which Sallie Tisdale gives the fictitious name of Harvest Moon is not precisely typical. It is "a nursing home for one hundred people, located in a residential neighborhood in a medium-sized West Coast city," which is not unusual, but it is also "owned by a large fraternal organization with a long-standing interest in caring for the elderly" and it "remains decidedly non-profit," which is. But Tisdale is convinced, and persuasively so, that life at Harvest Moon is characteristic of life in most responsibly operated nursing homes.
It can only be hoped that she is right, since for more and more American families, the nursing home is now a fact of daily life. As Tisdale writes:
"There are almost 24,000 nursing homes in the United States. More than 19,000 of these are run for profit, by corporations, tax syndicates and individuals. Nursing homes house 1.5 million people at a cost of over $30 billion annually -- about eight per cent of all the dollars spent nationally on health care. The population of the United States is growing steadily older, and among people over 65, the 'very elderly' group over 85 is growing significantly faster than any other."
As Tisdale depicts it, life in one of these establishments is peculiar, even bizarre, by the standards of the "normal" world, yet it has its own logic and dignity. Tisdale sees the nursing home as "a kind of tribal village, a place of misfits," and adds: "It has a language of its own, customs of its own. It is slightly out of place, not quite polite, designed for people who have no other place to go, no other place to be, and who don't mingle with the rest of us. Nursing homes are communities of people incapable of claiming more than they receive, utterly at the mercy of our good will."
What will strike many readers as remarkable is that so much good will is given. Tisdale describes the relationship between those who care and those who are cared for as "something made of equal parts love and disinterest." The description is apt, for it recognizes both the human connections made by these people and the need of nurses and other staff members to remain slightly distant and unattached; without this dispassion, no one who deals daily with disease and death can hope to remain sane.
The tasks these various people perform are all discussed by Tisdale, from administrators faced with pressing budgetary questions to nursing aides who routinely give patients the most intimate attention to housekeepers and janitors who almost invisibly keep the enterprise operating. Much of what they do is repetitious and mundane, and much else would seem degrading to persons unaccustomed to nursing-home life, but with few exceptions they do it in good cheer and with an awareness that they are performing valuable service -- an awareness that seems undiminished by the inability of many of their patients to thank them.
"I like nursing homes," Tisdale most disarmingly announces at the outset. She may not succeed quite so far as to make others like them as she does, but she certainly helps us understand that they are places where patients' dignity is not denied but affirmed. Since for so many Americans nursing homes are now the last stop on the line, this is good news.