Old and Sick in America: The Journey through the Health Care System

By Muriel R. Gillick | Go to book overview

CHAPTER NINE
Going to Rehab

When I was growing up, I had minimal exposure to older people. I never knew my grandparents: they were all dead, either directly or indirectly at the hands of the Nazis. What few older people I knew lived in their own homes, not in a nursing home. The little I did know about nursing homes was what I learned from two books that were published in the 1970s, Robert Butler’s seminal work, Why Survive? Being Old in America,1 and Mary Adelaide Mendelson’s consummate exposé, Tender Loving Greed.2 People like me who read these two acerbic critiques of nursing homes decided then and there that we would never, ever live in such a place.

We also thought we would remain healthy and vigorous until, at some very remote date, surely after our 85th birthdays, we would die in our sleep. But, just in case we needed help getting by, we wanted to be sure there would be somewhere to move to other than a nursing home. Assisted living was designed to be that alternative. It offered the privacy that nursing homes lacked and provided the requisite support, or so we believed, without the loss of dignity and independence characteristic of nursing homes. And so, based on the deep-seated conviction that assisted living is the answer to the aging conundrum, it became one of the leading growth industries of the 1990s.3 We baby boomers breathed a collective sigh of relief: we were safe, we would have plenty of possibilities other than nursing homes waiting for us if the time came. Never did we imagine that we actually would go to nursing homes, and in droves, to nursing homes that had been retooled as short-term, post-acute “skilled nursing facilities.” Today, 1.7 million older people each year spend time in such a skilled nursing facility, not for the long haul, but short term, for rehabilitation after a hospital stay.4

A brief stay in a nursing home is, of course, different from a far longer stay: a month might be tolerable even if a year would not be. But, to a large extent, these are the same facilities, the same institutions, that provide shortterm and long-term care. Older people are once again relying on nursing homes for care at a very significant time in their lives, and the people who make use of SNFs tend to be the frailest, oldest, and sickest of the elderly population. Their experience matters—for their well-being, their dignity, and their future.

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Old and Sick in America: The Journey through the Health Care System
Table of contents

Table of contents

  • Title Page iii
  • Contents vii
  • Prelude ix
  • Abbreviations in the Text xxi
  • Part I - The Office 1
  • Chapter One - Going to the Doctor 3
  • Chapter Two - The Lay of the Land 23
  • Chapter Three - From the outside in 41
  • Chapter Four - The March of Time, 1965–2015 61
  • Part II - The Hospital 79
  • Chapter Five - Entering the Palace of Technology 81
  • Chapter Six - The Varieties of Hospital Experience 97
  • Chapter Seven - The Hospital through Other Eyes 113
  • Chapter Eight - The Transformation of the American Hospital, 1965–2015 133
  • Part III - The Skilled Nursing Facility 151
  • Chapter Nine - Going to Rehab 153
  • Chapter Ten - Different Snfs, Different Miffs 169
  • Chapter Eleven - Movers and Shapers 184
  • Chapter Twelve - Now and Then 202
  • Finale 223
  • Acknowledgments 245
  • Notes 247
  • Bibliography 267
  • Index 293
  • Studies in Social Medicine 301
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