Tag Archives: dementia

Happily Ever Older: Revolutionary Approaches to Long-Term Care: Moira Welsh

After reading Leisureville, I stumbled across Moira Welsh’s non-fiction book Happily Ever Older: Revolutionary Approaches to Long-Term Care. Since I was on a roll when it came to reading about aging, I decided to take a chance and see what I could learn. As it turned out, I learned a lot. Canadian author Moira Welsh is an investigative reporter, with a career focus on the elderly. The book was written during the COVID pandemic, and considering how hard nursing homes have been hit, the book’s publication is timely. Covid was fueled by “the system that controls seniors homes. For decades, long-term care has operated on a tight budget, draining the life pleasure of the people who reside within while devaluing the work of staff forcing many to work in two or three locations just to make a living wage. This is how the virus spreads from one home to the next.” Someone I know runs a care home and, under Covid, he says “it’s like being in a war zone.”

After a long career in journalism Moira Welsh acknowledges that her stories “always exposed the negative, neglect, abuse and isolation with the goal of improving the system.” This book takes a look at the established system of care for the elderly and then examines some of the revolutionary alternatives. As a result, writing the book, visiting the various homes, was, the author explains “like opening a door to another world.”

At one point, an Emotion-Based care “observational audit” is conducted in a highly rated care home by David Sheard, Founder of Dementia Care Matters. There are some descriptions of typical ‘interactions’ between residents and staff–for example– staff checked icons on computer screens such as “food eaten” “bodily functions” etc. There’s one mention of residents parked “like cars in a parking lot.” Residents are ignored, meals served with staff “whisking away plates on schedule.” Yes it’s all very efficient but rather ignores the whole premise that we are dealing with people here. For this reader, it sounds like the staff are monitoring lab rats. The author states that “neutral care is a form of abuse,” and I agree. One image that sticks in my mind is that of a nurse entering a room every once in a while and tossing a ball at the residents who are parked in a circle.

The author describes various new approaches to Elder Care: The Butterfly Model and its emotion-based care (uniforms banned, hallways painted bright colours, removing central dining rooms), The Eden Alternative, The Golden Girls Network, The Pioneer Network, Toronto HomeShare Programme, The Green House Project, and an incredibly interesting visit to a nursing home in the Netherlands. Another approach, outside of any sort of institutional, is the growth of acceptance of “Tiny Houses.” The book is packed with various stories of improvement in residents when Emotion-Based Care became the underlying philosophy of the various care homes. It may be difficult to formulate studies that scientifically measure specific improvements in residents, but things under consideration are a decrease in medication, less aggression, putting on weight, increased interactions. Other results are anecdotal and not so easy to measure– improvements in resident social behaviours, for example. Of course none of this comes cheap. Canada predicts that the cost of long-term care will increase from 22 billion in 2019 to 71 billion in 2050.

This is a very upbeat look at a depressing subject. The author argues that a shift in social attitudes is underfoot and must continue. There were a few too many sentimental anecdotes for my taste, but at the same time, it’s probably hard to avoid given the topic. I would have like more $$ numbers because that’s how my brain works. I would have liked more on the kids that stuff their parents in homes while looting the estate. I would also have liked more on the ethics of homes providing services to residents (there’s one near me that provides cleaners). I know it’s based on the hotel type of model, but I keep thinking about Better Call Saul. But all these things belong in another book. Or two.

Anyway…. I learned a lot that I had no idea about, and the book gave me food for thought. I decided to chop down some of the ornamental trees in my back garden as the annual trimming (on ladder) is something I can do without going forward. There are a few times in the book when numbers are bandied about. One home costs over 6K a month. Another 9-10K. I know someone who pays 8K a month. Good care doesn’t come cheap; I get it, but ye gods who can afford this??? In America the average social security check is around $1500 a month (numbers vary). Social security estimates that 50% of married couples and 70% of singles receive 50% or more of their income from Social Security. It’s debatable just how many Americans rely of social security alone. There’s a range of numbers on the internet–anywhere from 12% -40%.

During the creation of this book, the author had to confront her aging parents’ health issues which necessitated a move from their home, and her very personal experience is both candid and tender.

Review copy

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Appointment with Yesterday: Celia Fremlin (1972)

“What happened to Milly was what happens to most people when they are confronted by mistakes or disasters too big to be borne; they let in the reality of it inch by inch, as it were, a little bit at a time, avoiding at all costs the full, total shock of it.”

Celia Fremlin’s suspense novel Appointment with Yesterday is packed with the author’s signature theme: the suffocation and claustrophobia of domestic life. The Hours Before Dawn is the story of a young mother who feels inadequate (nosy neighbours, nasty critical husband) but her biggest threat is the woman who rents a room in her home. Uncle Paul is the story of very different sisters who go on holiday together but find that the past catches up to their present. Listening in the Dusk is the story of a woman who takes a room in a third rate boarding house after being kicked to the curb by her husband. So that brings me to Appointment with Yesterday, my favourite of the lot so far. Yes, it’s definitely Celia Fremlin–here she’s in top form and … there’s humour.

The novel opens with a middle-aged woman who is on the run. Just what she is running from .. what and who … becomes apparent over the course of the book as hints slide into memories and flashbacks. At first the woman who, like a hunted animal, is so terrified she’s not rational, spends a day riding the Tube. She’s certain the police will be looking for her, so she fabricates a name, Milly Barnes. She has no possessions, no luggage, just a coat, and a handbag containing a little over 2 pounds. Eventually she calms down enough to make a decision of sorts; she takes the first bus that comes her way and ends up in the small coastal town of Seacliffe.

Milly’s survival instants kick in. Soon she’s rented a room in a drab boarding house and she starts cleaning houses–at least she can eat and pay the rent. Gradually over time, we learn Milly’s story. She was, at one point Candida Harris, a plump, plain little nurse who caught the eye of a “promising young house-surgeon,” good-looking egotistical Julian Waggett. Many nurses tried to get his attention, “wear[ing] their sober uniform[s] as if it were part of a striptease.” But Julian shocks the entire hospital community when he marries dumpy little Candida (aka Milly).

Milly, of course, knew why. She had known all along, but had no intention of allowing the knowledge to mar her joy and excitement over her extraordinary good fortune. She had known right from the start that what Julian wanted–nay, needed–was a wife who would serve as a foil for his own brilliance. A woman so retiring, so inconspicuous, that in contrast to her dullness his own wit, his own charm, would shine out with redoubled radiance. A woman who never, ever, in any circumstance, would draw attention away from him and on to herself.

Well it worked for a while, but as Julian goes up in the world, the poor dowdy little Mrs. can’t keep up with his glittering peacock image. Milly “had seen it coming.” It happened a lot “in their sort of circle.

The brilliant, ambitious husband rocketing his way to the top and discarding his dowdy, middle-aged wife en route, like a snake shedding its outworn skin in springtime. She’s met the wives, too, after the amputation was over: drab, dejected creatures moaning on and on about the meagerness of the alimony, and about ‘his’ ingratitude after all they had done and all they had sacrificed for him during the early years of struggle.

Milly is humiliated, of course, when she’s dumped for a young movie star, but not ready to be defeated, she marries again. The scenes of Milly’s new life in Seacliffe are splintered with memories of the tortured path that led to her panicked, desperate escape. Two young men who also live in the boarding house adopt Milly and their haphazard chaotic lives spill over into Milly’s terror-ridden loneliness. In Seacliffe, her first cleaning job is for a ridiculous, desperate, harried, upper middle class woman. The job is supposed to be cleaning, but the woman suddenly produces a baby, and dumps the neglected child into Milly’s care. Like Drums Along the Mohawk, word of Milly, a domestic savior, echoes around Seacliffe, and with dizzying speed, other women flock to poach Milly’s services. These harried wives frantically juggle the demands of their cluttered lives with appeasement of sulky, peevish spouses and each household has its own miserable pathology and chaos. It’s through these jobs, each which presents a window into a variety of unpleasant, tortured marriages, that Milly begins to put her own life, her own marriages, with the constant conditioning of appeasement, into perspective. Victimhood may be instant, but all too often it’s a slow process–confidence and courage slowly chipped away for weeks… years…. It’s through Milly’s views of various versions of dreadful home life that the humour appears:

Already she had sized up Mrs. Lane (or Phyllis, as she must remember to call her) as one of those employers who have at the back of their minds an imaginary dream-home: one which has no relation to the one they are actually living in, but which they believe –and continue to believe–will one day suddenly materialize if they only go on faithfully paying someone forty pence an hour, like sacrificing enough sheep at the temple of Athene. With an employer of this type, a Daily Help’s first task is to get as clear a picture of this imaginary dream-home as she possibly can, so that she can then make all her efforts tend in this direction, or at least appear to do so.

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