There's No Place like Home: Place and Care in an Ageing Society

By Brickner, Philip W. | Care Management Journals, April 1, 2011 | Go to article overview

There's No Place like Home: Place and Care in an Ageing Society


Brickner, Philip W., Care Management Journals


THERE'S NO PLACE LIKE HOME: PLACE AND CARE IN AN AGEING SOCIETY Christine Milligan (Editor) Burlington, VT: Ashgate Publishers, 2009, 176 pp. (hardcover), $99.95

Christine Milligan was stimulated to research the field of care at home by experiences within her own family in England. How true it is that real life experience forces attention on major issues that otherwise are passed over as of vague concern only to society at large. Troubles in advanced age for both her in-laws revealed "support from the formal care services at that time can, at best, be described as disorganized and chaotic" (preface, p. ix).

Milligan has written a substantial, thorough analysis of the home care and institutional status in Great Britain today, as these resources function in care for the frail aged. Good and bad are noted, but the overall sense that flows from this work is that sustaining care at home is best.

We all are aware that this is true, of course, and aware as well that numerous forces exist that make care at home difficult. Readers of this review don't need elaboration.

Milligan's work attempts to cover similar concerns elsewhere in the world, a subject she terms International and Transnational Perspectives (Chapter 4). Definitions are "highly cultural" and there are "varying perceptions of rights and responsibilities" (p. 44), of course; and the author covers briefly the situation in sub-Saharan Africa, Malaysia, Singapore, the Philippines, Brazil, Argentina, Central America, and the "postsocialist countries."

THE UNITED STATES: OMITTED FROM THIS BOOK

It is quite odd, however, that Milligan fails to consider the situation in the United States (at least I found no mention of such). Why is this odd? Because home care, in any formal sense, was initiated in the United States in 1909, through the work of Lillian Wald. Wald founded the Visiting Nurse Service of New York to provide care at home for young and inexperienced mothers and their newborns. From this original effort has grown an important network of care at home for other age groups, particularly the aged. For these older men and women, the key point is avoiding nursing home placement and preserving the choice of survival at home, in the best possible state of health and independence.

In the United States, it is well recognized that aged, homebound people are at risk of being among the medically unreached unless included in a home care program. Many families strive on their own, and fail, in organizing and sustaining the effort to keep older relatives at home. Other aged individuals, on their own and without a caring family, often impoverished, living in single rooms of old walk-up buildings, are likely to be out of contact with the medical care system. They are often too disabled, frightened, or bewildered to reach out nor does assistance usually go to them. …

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