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Nobody's Home: Candid Reflections of a Nursing Home Aide
"At present nursing homes are designed... like outmoded zoos. Residents are kept in small rooms, emotionally isolated. Occasionally they are visited by family members who reach through the bars and offer them treats. Aides keep their bodies clean and presentable.... America invests huge amounts of money to maintain the body while leaving the person to languish, cut off from all they love."―From Nobody's Home After caring for his mother at the end of her life, Thomas Edward Gass felt drawn to serve the elderly. He took a job as a nursing home aide but was not prepared for the reality that he found at his new place of employment, a for-profit long-term-care facility. In a book that is by turns chilling and graphic, poignant and funny, Gass describes America's system of warehousing its oldest citizens. Gass brings the reader into the sterile home with its flat metal roof and concrete block walls. Like an industrial park complex, it is clean, efficient, and functional. He is blunt about the institution's keep those faint hearts pumping and the life savings and Medicaid dollars rolling in. With 130 beds in the facility, the owner grosses about three million dollars annually. As a relatively well-paid aide, Gass made $6.90 an hour. Seventeen of the twenty-six residents on Gass's hall were incontinent, and much of his initiation to the work was learning to care for them in the most intimate ways. One of the many challenges was the limited time that he had available for each of his charges―17.3 minutes per day by his calculation. Even as he learned to ignore all but the most pressing demands of the residents, he discovered the remarkable lengths to which aides and their patients will go to relieve the constant ache of loneliness at the nursing home. With Americans living longer than ever before, elder care is among the fastest growing occupations. This book makes clear that there is a systemic conflict between profit and extent of care. Instead of controlling costs and maximizing profits, what if long-term care focused on our basic need to lead meaningful and connected lives until our deaths? What if staff members dropped the feigned hope of forestalling the inevitable and concentrated on making their charges comfortable and respected? These and other questions raised by this powerful book will cause Americans to rethink how nursing homes are run, staffed, and financed―as well as the circumstances under which we hope to meet our end.
Hardcover
First published March 1, 2004
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Displaying 1 - 12 of 12 reviews
June 29, 2018
I paused in my reading of this book for many weeks. It rubbed me the wrong way and I thought a break might help me come back to it with fresh eyes. But picking this book back up this week I realize my eyes aren’t the problem.
I think the intent of the author was to write a book that would humanize folks who live in skilled nursing facilities and give a raw, “not-PC” look into life in one of these homes. I’m always suspect of people who think “non-PC” is cool or even a thing. So that was a rough place to start.
Where I decided to stop was when the author talked about facilities over-feeding residents. He likened his theory about over-feeding to the sensibilities of zoo keepers who he says feed the mammals on a 2 days on, one day off schedule. He thinks this would be better for the residents. He also purports to have a superior understanding of the physical needs of the residents, patting himself on the back for getting into their space to force physical contact with them, often against their interests. I’d offer that this is a gross violation of the residents very real boundaries.
The author also writes about these residents in totally dehumanizing ways. His offer of a raw look into skilled nursing facilities is at the expense of the humanity of the residents. As someone who has worked in SNFs and visited loved ones in these types of facilities, I know how awful they can be. But this book did nothing to shed light and humanize the painful way we warehouse our cast-offs. He merely sensationalizes it.
(SPL 2018 book bingo: finish a book you started and put down)
I think the intent of the author was to write a book that would humanize folks who live in skilled nursing facilities and give a raw, “not-PC” look into life in one of these homes. I’m always suspect of people who think “non-PC” is cool or even a thing. So that was a rough place to start.
Where I decided to stop was when the author talked about facilities over-feeding residents. He likened his theory about over-feeding to the sensibilities of zoo keepers who he says feed the mammals on a 2 days on, one day off schedule. He thinks this would be better for the residents. He also purports to have a superior understanding of the physical needs of the residents, patting himself on the back for getting into their space to force physical contact with them, often against their interests. I’d offer that this is a gross violation of the residents very real boundaries.
The author also writes about these residents in totally dehumanizing ways. His offer of a raw look into skilled nursing facilities is at the expense of the humanity of the residents. As someone who has worked in SNFs and visited loved ones in these types of facilities, I know how awful they can be. But this book did nothing to shed light and humanize the painful way we warehouse our cast-offs. He merely sensationalizes it.
(SPL 2018 book bingo: finish a book you started and put down)
July 5, 2008
Brilliant! Humanizing. Contains great examples of person-centered care
July 4, 2017
I'm not sure when Tom was a CNA, but the state of things in our nursing homes concerns me. It's not for lack of trying on the employees' part, they just constantly find themselves in a state of being short-staffed and over worked. I don't think they get paid enough to do what they do, and they really should because they would probably find they have more people available willing to do this work.
This book made me laugh out loud at times even though many topics are grim. Especially interesting for those going into the nursing home business.
This book made me laugh out loud at times even though many topics are grim. Especially interesting for those going into the nursing home business.
October 28, 2019
There were good moments in this book, but overall I was disappointed. As a nursing aide, this is far from my experience. Yes, we do feed and bathe and care for residents 24/7, but the state of things he describes is awful. My nursing facility is not a “zoo” or a “jail,” it’s a home. We care for our residents and love them, we don’t treat them like numbers. Obviously Tom was working in a not-so-great place, and that’s awful, but I think this book spreads the wrong message to people about the kind of work we do.
June 27, 2018
Remarkably telling. My heart breaks to see family members accusing aides of neglect - yes, the residents are suffering, but the aides are working as hard as they can against all odds. Tom's dry humor in the face of raw humanity is exactly what healthcare professionals need to keep going each day.
February 14, 2018
A must-read for anyone who works in the medical field (especially in long-term care) and for anyone who has a family member in a nursing home or long-term care facility
April 29, 2025
Just reveled too much in the scatalogical; thought narrator was too flippant and got weirdly personal with and about the nursing home residents.
November 14, 2007
Tom Gass describes his experience as a certified nursing assistant (CNA) and the struggle to provide the most basic care needs in the best way possible to an assigned group (oftimes overwhelmingly large) of elderly residents. CNAs are the staff members who assist residents with dining, toileting, dressing, etc. They provide the most intimate care (cleaning up urine/bowel incontinence) that would be unthinkable to many. Gass points out that while the companies that own nursing homes are rolling in it (some of them are), CNAs themselves make little more than minimum wage, and to add insult to injury are often treated with disdain by nurses, family members, some residents, administration, and society as a whole. One message the reader should take away is that, given how the system works, CNAs are in an untenable position to provide the best-quality care and nursing home residents are vulnerable to abuse and neglect. And the very people who have sustained great losses in their lives lose more when the person they trust with their care doesn't stick around. Gass thinks we need to stop focusing on physical needs and concentrate on providing companionship and dignity in the final years.
As someone who works in long-term care, and a former nursing assistant, Gass' account is pretty accurate. Many are drawn to the CNA role because they love the elderly, but to others it's just a job. In urban areas, many CNAs are immigrants, which adds the unique challenges of English as a Second language and different cultural mores.
As someone who works in long-term care, and a former nursing assistant, Gass' account is pretty accurate. Many are drawn to the CNA role because they love the elderly, but to others it's just a job. In urban areas, many CNAs are immigrants, which adds the unique challenges of English as a Second language and different cultural mores.
December 2, 2013
3 1/2 really.
It was a hard read. I have been reading and thinking a lot about long-term care since I worked in a facility. Gass describes all parts of the experience, the deep connection with residents, the shit the aides deal with (literally and figuratively), the questions of is this how we are supposed to treat those who are dying?
It is very poetic. At times A little slow. He does invite you to contemplate bigger questions in the epilogue, which I appreciate and have been doing for awhile. What a hard job to have and a hard thing to write about.
It was a hard read. I have been reading and thinking a lot about long-term care since I worked in a facility. Gass describes all parts of the experience, the deep connection with residents, the shit the aides deal with (literally and figuratively), the questions of is this how we are supposed to treat those who are dying?
It is very poetic. At times A little slow. He does invite you to contemplate bigger questions in the epilogue, which I appreciate and have been doing for awhile. What a hard job to have and a hard thing to write about.
November 2, 2016
I have to admit that I only read this because an employee of my husband wrote it. I was pleasantly surprised. It should be a must read for all of those in the industry. Tom has great insights into this. He doesn’t presume to have the answers he just provides information. It is hard to think about the realities of nursing home life, especially when it is what is happening within your family and may be in your personal future as well. This is a book that will stick with me for some time to come.
February 19, 2014
Gass takes a snapshot of what it is like to work as a nursing home aide. He holds nothing back--absolutely nothing. As someone who has worked in lower level healthcare jobs, it's a breath of fresh air to finally read a book about "us".
October 5, 2010
As a hopeful future nursing home LPN, I enjoyed this book. It gives some info as to the living situation in homes, as well as highlighting the shortage of nursing home providers.
Displaying 1 - 12 of 12 reviews