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Preface

Old, Alone, and Neglected is concerned with the care of the institutionalized aged in the United States. It was written because I believe that, despite earlier reports of conditions in nursing homes, many Americans either are unaware of or refuse to acknowledge that many of the institutionalized elderly receive inadequate care and are often subjected to inhumane treatment during the last years of their lives.

Perhaps it is well that we do not know what lies ahead of us in our old age. However, this inability or reluctance on the part of the younger generations to consider the possible infirmities of old age may in part contribute to the problems encountered by the elders in our society. It seems that when we are young we cannot imagine that we will ever be old and helpless. As we reach middle age, we know intellectually that we too will become old. But at this period in our lives, surrounded by friends, involved in our work, and enjoying good health, we find it difficult to envision old age as a time when we may be devoid of friends and property, lonely, and dependent on others for care. Unfortunately, when old age is upon us, and if institutionalization becomes necessary, it is often too late to change the unpleasant conditions of our existence. So it is that when placed in an institution, some of the elderly cope with the hostile environment by withdrawing, others accept their fate with complacency, and a few display great courage and nobility in an effort to hold onto their individuality and humanity.


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In this book I have attempted to describe through the eyes of the elderly what it is like to be old, disabled, and institutionalized. Through personal interviews with the aged, I have learned how it feels for them to be dependent on others for their basic needs and how dehumanizing it is to be deprived not only of essential care but of many of the amenities that give humaneness, warmth, and meaning to their lives. This book compares care in one institution in Scotland (which I shall call "Scottsdale") and one in the United States (which I shall call "Pacific Manor"). Scottsdale is a model institution in which the elderly appear to be content and happy, whereas at Pacific Manor the elderly residents express much discontent and unhappiness with their care.

It is now two years since I completed the research upon which this book is based, but I can still vividly remember my personal feelings when visiting the two institutions. I distinctly recall feeling happy each day as I went to Scottsdale to collect data; and when I left in the evening, I went away with a feeling of peace. I knew the elderly people were well cared for and basically content. By comparison, I found it difficult many times to continue my field work at Pacific Manor. As I entered the nursing home, I could hear some patients calling out for help; others, poorly groomed and clad only in brief hospital gowns, were restrained in chairs. Many would call to me for help, and consequently it took me longer to collect the data in the American nursing home. As a medical anthropologist who is also a nurse, I frequently had to step out of my role as a research scientist and attend to the needs of the elderly. On some occasions, conditions within the nursing home overwhelmed me and I had to leave and return another day. I can well imagine how painful it must be for families to visit their relatives and for conscientious staff to care for the elderly in such an environment.

I believe this book will be of interest to a wide audience, and it is my hope that it will be read by gerontologists, social scientists, health care providers, and those involved in health care policy at both the academic and governmental levels. Additionally, I hope that it will be read by students in the health and social sciences and by laymen as well. The impetus for change in institutional care may come only as a result of pressure from groups outside the health profession and from idealistic young students who will not be content with the present status of geriatric care in the United States.

The findings of this research, along with other research studies, provide


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us with solutions to many of the problems in institutional care of the aged. We have identified the problems, we have the resources, we need only the motivation to change the structures that will provide incentives to deliver quality care to the institutionalized aged.

The facts in this book are true; the names of people, places, and institutions have been changed. Additionally, specific details of the institutions and individuals have been modified to ensure anonymity.

JEANIE SCHMIT KAYSER-JONES
SAN FRANCISCO
MAY 1980


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