Survival tips for the nursing home

When psychologist Ira Rosofsky isn’t assessing depression in old folks in nursing homes, he sometimes plays a game in his head with strangers he sees on the street. He looks at passersby and guesses what ailment will land them prematurely in a nursing home.

Rosofsky views being 70 years old and in a nursing home as a bitter failure. His book is called Nasty, Brutish and Long: Adventures in Old Age and the World of Eldercare. (The title is a play on Thomas Hobbes’ musing that life in the 16th century was nasty, brutish and short. Now, with science and pills, Rosofsky’s take is that life is nasty, brutish and long.)

He writes of seeing a woman at a convenience store: “In the line in front of me is a fortysomething woman, much fatter than I am, and at least a foot shorter. She asks for a couple of packs of Marlboros. On the counter she has placed a Milky Way, a family-size bag of chips, a non-diet Pepsi, a half-gallon of whole milk and a loaf of Wonderbread. Doctors, I’ve heard, play a variation of this game. They might look at me hanging onto a strap on the bus, see the way I’m standing, and guess that I have lower-back pain. I’m looking at the woman in front of me and guessing that she’ll be lucky to make it to 70 without being in a nursing home, probably with type 2, non-insulin-dependent diabetes, hypertension, high cholesterol, and chronic obstructive pulmonary disease.” Then, as he watches the woman drive off in her battered Chevette, he notices a runner go by. “He’s making good time. He’s imperially slim and I estimate that barring any disease unrelated to fitness—Parkinson’s or Alzheimer’s—he’s good for a lifetime outside the nursing home.”

Rosofsky is in his sixties but sometimes thinks about the possibility that he might one day be in a nursing home himself. The expert knows exactly what he’d ask for. “If I couldn’t swing a private room, I’d try for a bed by the window,” he writes. “Staff wouldn’t always be walking by my bed to tend to the guy by the window. I’d want a roommate with moderate dementia—pleasantly confused. I’d want him to be what we call re-directable. I’d tell him to wander off, giving me some privacy. Too much profound dementia and he’d be too high-maintenance—plenty of staff in the room diapering, feeding, medicating, restraining. Mild dementia and he’d talk nonsense all the time.”

Rosofsky also knows how he’d “work the system—nobody would bother me, because I’d be a nice and compliant unsqueaky wheel. Lots of yes sirs and yes ma’ams. I’d mouth the heavy tranquilizers and spit them in the toilet.”

Rosofsky says all the suffering in nursing homes reminds him of a scene from a Mastroianni movie in which a dinner party host displays a bouquet of cut flowers but doesn’t put them in water, explaining it only prolongs their agony. Alzheimer’s drugs do the same thing for the elderly, he says. “These drugs put cut flowers in water—prolonging the agony.” In an email interview, he writes, “I hope I’d have the good sense to reject any Alzheimer’s medication since they are useless. I’m educating my children about that.” Rosofsky is married with three kids.

Rosofsky likes his privacy and enjoys a bourbon at home but notes that at nursing homes, “it’s hard to get a simple drink.” In fact, he adds, “your doc has to prescribe an alcoholic beverage.” He writes, “Our elders have entered a new age of Prohibition—one more infantilization. No doubt a doctor would say, ‘I have to be careful with alcohol because of all the drugs they’re taking’—without any sense of irony.” The average number of pills for a nursing home resident is nine, he explains. “Smoking is never a problem, though. Tobacco, that most dangerous drug, is rampantly not prohibited,” he writes in the book. “Nursing homes often call themselves ‘health centres’ yet they are the last-gasp holdouts of the cigarette . . . Over the PA, I hear, ‘All smokers meet at the nursing station,’ and that lights the smoking lamp—a ritual tucked between medication and moving the bowels. Outside in the courtyard, an aide, also smoking, sits beside a cabinet from which she dispenses the cigarettes one by one as the wheelchairs roll by.”

In Rosofsky’s own little fantasy of nursing home life, he confesses he’s tempted to take up smoking again. “I’ll add that I want to be in a Canadian nursing home so that when I’m in my wheelchair smoking, it’s Cuban cigars.”