Being Mortal

by

Atul Gawande

A nursing home is a facility in which elderly people both live and receive healthcare. People usually enter nursing homes when they can no longer live independently and need help with basics such as eating, dressing, and bathing. Gawande describes how nursing homes grew out of hospitals, because as the population aged, the elderly took up too much space in hospital beds and so they lobbied the government for separate facilities to house them. Gawande argues that the problem with nursing homes is that they focus on safety to the detriment of things that make life meaningful, such as a sense of purpose, time with family, and the ability to control one’s schedule.

Nursing Home Quotes in Being Mortal

The Being Mortal quotes below are all either spoken by Nursing Home or refer to Nursing Home. For each quote, you can also see the other terms and themes related to it (each theme is indicated by its own dot and icon, like this one:
Medicine, Survival, and Well-being Theme Icon
).
Introduction Quotes

You don’t have to spend much time with the elderly or those with terminal illness to see how often medicine fails the people it is supposed to help. The waning days of our lives are given over to treatments that addle our brains and sap our bodies for a sliver’s chance of benefit. They are spent in institutions—nursing homes and intensive care units—where regimented, anonymous routines cut us off from all the things that matter to us in life. Our reluctance to honestly examine the experience of aging and dying has increased the harm we inflict on people and denied them the basic comforts they most need. Lacking a coherent view of how people might live successfully all the way to their very end, we have allowed our fates to be controlled by the imperatives of medicine, technology, and strangers.

Related Characters: Dr. Atul Gawande (speaker), Joseph Lazaroff
Page Number: 9
Explanation and Analysis:
Chapter 3 Quotes

Their apartment was only a floor away. But somehow that made all the difference. Exactly why can be hard to pinpoint. Felix still ended up hiring an around-the-clock staff of nurses and aides. And the remaining six weeks until the casts could come off were physically exhausting for him. Yet he was relieved. He and Bella felt more control over her life. She was in her own place, in her own bed, with him beside her. And that mattered tremendously to him. Because four days after the casts came off, four days after she’d begun walking again, she died.

Related Characters: Dr. Atul Gawande (speaker), Felix Silverstone, Bella Silverstone
Page Number: 58-59
Explanation and Analysis:

But hospitals couldn’t solve the debilities of chronic illness and advancing age, and they began to fill up with people who had nowhere to go. The hospitals lobbied the government for help, and in 1954 lawmakers provided funding to enable them to build separate custodial units for patients needing an extended period of “recovery.” That was the beginning of the modern nursing home. They were never created to help people facing dependency in old age. They were created to clear out hospital beds—which is why they were called “nursing” homes.

Related Characters: Dr. Atul Gawande (speaker)
Related Symbols: Hospital
Page Number: 70-71
Explanation and Analysis:

This is the consequence of a society that faces the final phase of the human life cycle by trying not to think about it. We end up with institutions that address any number of societal goals—from freeing up hospital beds to taking burdens off families’ hands to coping with poverty among the elderly—but never the goal that matters to the people who reside in them: how to make life worth living when we’re weak and frail and can’t fend for ourselves anymore.

Related Characters: Dr. Atul Gawande (speaker)
Related Symbols: Hospital
Page Number: 76-77
Explanation and Analysis:
Chapter 4 Quotes

Taking care of a debilitated, elderly person in our medicalized era is an overwhelming combination of the technological and the custodial. […] The burdens for today’s caregiver have actually increased from what they would have been a century ago. Shelley had become a round-the-clock concierge/chauffeur/schedule manager/medication-and-technology troubleshooter, in addition to cook/maid/attendant, not to mention income earner. Last-minute cancellations by health aides and changes in medical appointments played havoc with her performance at work, and everything played havoc with her emotions at home. Just to take an overnight trip with her family, she had to hire someone to stay with Lou, and even then a crisis would scuttle the plans. One time, she went on a Caribbean vacation with her husband and kids but had to return after just three days. Lou needed her.

Related Characters: Dr. Atul Gawande (speaker), Lou Sanders, Shelley
Page Number: 85-86
Explanation and Analysis:

Fifteen years later, when she was a scholar, the experience led her to formulate a hypothesis: how we seek to spend our time may depend on how much time we perceive ourselves to have. When you are young and healthy, you believe you will live forever. […] When horizons are measured in decades, which might as well be infinity to human beings, you most desire all that stuff at the top of Maslow’s pyramid—achievement, creativity and other attributes of “self-actualization.” But as your horizons contract—when you see the future ahead of you as finite and uncertain—your focus shifts to the here and now, to everyday pleasures and the people closest to you.

Related Characters: Dr. Atul Gawande (speaker), Laura Carstensen
Page Number: 96
Explanation and Analysis:
Chapter 5 Quotes

“He agreed, with the indifference of a person who knows he will soon be gone,” Thomas said. But he began to change. “The changes were subtle at first. Mr. L. would position himself in bed so that he could watch the activities of his new charges.” He began to advise the staff who came to care for his birds about what they liked and how they were doing. The birds were drawing him out. For Thomas, it was the perfect demonstration of his theory about what living things provide. In place of boredom, they offer spontaneity. In place of loneliness, they offer companionship. In place of helplessness, they offer a chance to take care of another being. […] Three months later, he moved out and back into his home. Thomas is convinced the program saved his life.

Related Characters: Dr. Atul Gawande (speaker), Bill Thomas (speaker), Alice Hobson
Page Number: 124-125
Explanation and Analysis:

The problem with medicine and the institutions it has spawned for the care of the sick and the old is not that they have had an incorrect view of what makes life significant. The problem is that they have had almost no view at all. Medicine’s focus is narrow. Medical professionals concentrate on repair of health, not sustenance of the soul. Yet—and this is the painful paradox—we have decided that they should be the ones who largely define how we live in our waning days. For more than half a century now, we have treated the trials of sickness, aging, and mortality as medical concerns. It’s been an experiment in social engineering, putting our fates in the hands of people valued more for their technical prowess than for their understanding of human needs.

Related Characters: Dr. Atul Gawande (speaker), Bill Thomas
Related Symbols: Hospital
Page Number: 128
Explanation and Analysis:
Epilogue Quotes

If to be human is to be limited, then the role of caring professions and institutions—from surgeons to nursing homes—ought to be aiding people in their struggle with those limits. Sometimes we can offer a cure, sometimes only a salve, sometimes not even that. But whatever we can offer, our interventions, and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict can be barbaric. When we remember it, the good we do can be breathtaking.

Related Characters: Dr. Atul Gawande (speaker)
Related Symbols: Hospital
Page Number: 260
Explanation and Analysis:
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Being Mortal PDF

Nursing Home Term Timeline in Being Mortal

The timeline below shows where the term Nursing Home appears in Being Mortal. The colored dots and icons indicate which themes are associated with that appearance.
Introduction
Medicine, Survival, and Well-being Theme Icon
The Evolution of End-of-Life Care Theme Icon
...only 17 percent did. The experience of aging and death has shifted to hospitals and nursing homes . When Gawande became a doctor, he did so to explore how medicine could pull... (full context)
Medicine, Survival, and Well-being Theme Icon
Destigmatizing Death and Illness Theme Icon
The Evolution of End-of-Life Care Theme Icon
...and sap their energies for the smallest hope of a benefit. They are spent in nursing homes , where people are cut off from all the things that mattered to them in... (full context)
Chapter 1
Safety vs. Autonomy Theme Icon
In America, Sitaram would likely have lived in a nursing home . If a person can’t use the toilet, eat, dress, bathe, groom, get out of... (full context)
Safety vs. Autonomy Theme Icon
...at 100. Had he lived in the West, doctors would insist he live in a nursing home , but in Sitaram’s world, he lived how he wanted to live and the family... (full context)
Chapter 2
The Evolution of End-of-Life Care Theme Icon
...and have to go on government assistance to afford it. Ultimately, many Americans go to nursing homes , which Felix hopes to avoid. He is most concerned about the changes in his... (full context)
Chapter 3
Safety vs. Autonomy Theme Icon
...things are confusing. Felix doesn’t know what to do, but before they transfer to a nursing home floor, Bella’s right eardrum mends, and they are able to communicate again. Felix doesn’t know... (full context)
Safety vs. Autonomy Theme Icon
...day, Bella falls and snaps her fibula in both legs—she has to move to the nursing home floor for round-the-clock care. The staff is professional and lifts some of their burdens, but... (full context)
The Evolution of End-of-Life Care Theme Icon
...developing countries, poorhouses remain common, but in the United States, even poor people can expect nursing homes with meals, health services, physical therapy, and activities. (full context)
Medicine, Survival, and Well-being Theme Icon
The Evolution of End-of-Life Care Theme Icon
The modern nursing home developed in the middle of the 20th century, when medicine underwent rapid and historic transformations.... (full context)
Safety vs. Autonomy Theme Icon
The Evolution of End-of-Life Care Theme Icon
...units for patients needing care over an extended period of time. This created the modern nursing homes , which were meant to clear out hospital beds. This is the problem of how... (full context)
The Evolution of End-of-Life Care Theme Icon
The next spur to nursing home growth came in 1965 when Medicare was enacted. The law specified that Medicare, the United... (full context)
Safety vs. Autonomy Theme Icon
...and broke her hip. Alice was left with no choice but to move into the nursing home , and she needed help with all her daily activities. Her privacy and control were... (full context)
Safety vs. Autonomy Theme Icon
Though the official aim of nursing homes is to care for people, being under this form of care doesn’t bear any resemblance... (full context)
Safety vs. Autonomy Theme Icon
...they arranged for a Do Not Resuscitate order to be put on record at the nursing home . One day the following April, Alice developed abdominal pains and vomited blood, but she... (full context)
Chapter 4
Safety vs. Autonomy Theme Icon
The Evolution of End-of-Life Care Theme Icon
Nursing homes still exist because people haven’t found anything better—living with family still remains the primary other... (full context)
Safety vs. Autonomy Theme Icon
...facility, which many believe is an intermediate stop between independent living and life in a nursing home . But Keren Brown Wilson, one of the originators of the concept, wanted to create... (full context)
Safety vs. Autonomy Theme Icon
The Evolution of End-of-Life Care Theme Icon
...was a college student with no income, and there was nowhere for Jessie but a nursing home . But Jessie hated it. As a result, Wilson became interested in policy for the... (full context)
Safety vs. Autonomy Theme Icon
...And the cost for those on government support was 20 percent lower than in a nursing home . The program was successful. (full context)
Safety vs. Autonomy Theme Icon
...was evolving, as assisted living often became a stepping stone on the way to a nursing home , rather than an alternative. Concern about safety and lawsuits limited what people could have... (full context)
Safety vs. Autonomy Theme Icon
...knows he wouldn’t want this, she feels that she has to put him in a nursing home . When Gawande presses Shelley on why she does this, she doesn’t know how to... (full context)
Chapter 5
Medicine, Survival, and Well-being Theme Icon
...as a chance to do something different. With fresh eyes, Thomas sees how depressing the nursing home is. At first, he tries to find a doctor’s solution, examining the residents and investigating... (full context)
Medicine, Survival, and Well-being Theme Icon
Safety vs. Autonomy Theme Icon
...small New York State grant for innovations. He wants to attack the “Three Plagues of nursing home ” life: boredom, loneliness, and helplessness. He suggests two dogs, four cats, and 100 birds.... (full context)
Safety vs. Autonomy Theme Icon
...the number of prescriptions required per resident fell to half of that of a control nursing home —particularly drugs for agitation. Thomas posits that this is because of the fundamental human need... (full context)
Safety vs. Autonomy Theme Icon
Thomas recalls meeting a man named Mr. L., who was admitted to the nursing home after a suspected suicide attempt. He gave up walking and refused to eat. But when... (full context)
Safety vs. Autonomy Theme Icon
...lived alone and was happy. But then when she started falling, she moved into a nursing home . She was there for a year before moving to NewBridge and said there was... (full context)
Safety vs. Autonomy Theme Icon
...he became his first resident. Three decades later, when a fall put Ruth in a nursing home , Carson worked out how to take Ruth in so she could be with her... (full context)
Safety vs. Autonomy Theme Icon
Gawande finds many places trying to change the traditional nursing home model. While these places often look extremely different from one another, the people in charge... (full context)
Safety vs. Autonomy Theme Icon
The Evolution of End-of-Life Care Theme Icon
Lou is soon to go to a nursing home when Shelley hears about a new place opening: the Leonard Florence Center. Lou is impressed... (full context)
Chapter 6
Destigmatizing Death and Illness Theme Icon
...doctors and patients to discuss end-of-life wishes. It became routine for all patients in hospitals, nursing homes , or assisted living facilities to be asked four questions about severe medical interventions to... (full context)
Chapter 7
The Evolution of End-of-Life Care Theme Icon
...percent of Americans died in hospice care—either at home or at a hospice facility or nursing home . (full context)