Nasty, Brutish, and Long: Adventures in Eldercare

Nasty, Brutish, and Long: Adventures in Eldercare

by Ira Rosofsky




Read Ira Rosofsky's posts on the Penguin Blog

A candid, humane, and improbably humorous look at the world of eldercare

In nursing homes across the country, members of the Greatest Generation are living out their last days. Life is a succession of pokes and prods, medications, TV, bingo, and, possibly, talking to Ira Rosofsky. With a compassionate eye but mordant wit, Rosofsky, a psychologist charged with gauging the mental health of his elders, reveals a culture based not in the empathy of caretaking, but rather in the coolly detached bureaucracy of Medicare and Medicaid.

A portrayal of what is increasingly becoming the last slice of life for many, Nasty, Brutish, and Long is also a baby boomer's poignant meditation on mortality, a reflection on his caregiving for his parents' final days, and an examination of the choices that we, as a society, have made about health care for the elderly who are no longer of sound mind and body.

Product Details

ISBN-13: 9781583333778
Publisher: Penguin Publishing Group
Publication date: 03/02/2010
Pages: 224
Product dimensions: 5.40(w) x 8.20(h) x 0.70(d)
Age Range: 18 Years

About the Author

Ira Rosofsky is a psychologist who has years of experience serving residents in nursing homes and assisted-living facilities. He received his Ph.D. from the University of Chicago. His writing has appeared in The New York Times, The Village Voice, and the Advocate newspapers of New England. He lives with his wife and their three children in New Haven, CT.

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Table of Contents

Title Page

Copyright Page




Chapter 1 - DO YOU PLAY CHESS? Overture

Chapter 2 - FINDING YOUR WAY HOMEWelcome to the Rest of Your Life

Chapter 3 - THE RECORDING ANGELSDoing It by the Book

Chapter 4 - OLD AS A STEINWAYCast of Characters

Chapter 5 - BED, BATHS, AND BEYOND BINGO Daily Life at the End of Life

Chapter 6 - YOUNG GIRLS IN SHORT SKIRTS Health Care for the Frail and Old

Chapter 7 - THE FINAL CHAPTERDying and Death





“When it comes to Hell, Dante Alighieri is the definitive tour guide. But for today’s (and quite possibly tomorrow’s) living hell, you’ll want to take Ira Rosofsky’s delightfully wry narrative along for the ride. He accomplishes what few authors are capable of—taking an unnerving topic and turning it into a book so enthralling you won’t want to put it down. Indeed, it’s a meditation worthy of Marcus Aurelius and Jerry Seinfeld.”

—ANDREW D. BLECHMAN, author of Leisureville: Adventures in America’s Retirement Utopias



“In Nasty, Brutish, and Long, Ira Rosofsky provides a rare glimpse into the hearts and minds of the aging. As a psychologist who has worked in nursing homes and an immensely talented and sensitive writer, he manages to find the perfect telling details to bring this often neglected world alive for the reader.”

—GAIL KONOP BAKER, author of Cancer Is a Bitch (Or, I’d Rather Be Having a Midlife Crisis)



“In an intriguing combination of personal story, social commentary, and scientific observation, a psychologist lifts the veil on nursing homes. Ira Rosofsky’s presentation—laced with sharp humor—treats us to the nursing home experience from the variety of these viewpoints. All who have had experiences with nursing homes—whether as residents, relatives of residents, or professionals—should read Nasty, Brutish, and Long, as should anyone interested in a penetrating view of how we as a society care for and care about those too frail or elderly to care for themselves.”

—LAURIE STILLMAN, Director, Public Health Policy and Advocacy Center, The Medical Foundation



Nasty, Brutish, and Long is as much about the last years of life and the meaning of existence during old age as it is about nursing homes. Ira Rosofsky’s personal narrative—along with the tales of the elderly he treats—contributes to a picture of the author as a fully engaged human being who tells his story with style and humor. And the story has an insightful and sensitive perspective on issues as varied as psychotherapy, psychopharmacology, the institutionalization of the aged, and our inevitable mortality.”

—DAVID HALL, former principal, Sonia Shankman Orthogenic School, University of Chicago

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Copyright © 2009 by Ira Rosofsky

All rights reserved. No part of this book may be reproduced, scanned, or distributed in any printed or electronic form without permission. Please do not participate in or encourage piracy of copyrighted materials in violation of the author’s rights. Purchase only authorized editions.
Published simultaneously in Canada


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eISBN : 978-1-101-02869-8




Neither the publisher nor the author is engaged in rendering professional advice or services to the individual reader. The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consulting with a physician. All matters regarding health require medical supervision. Neither the author nor the publisher shall be liable or responsible for any loss or damage allegedly arising from any information or suggestion in this book.


While the author has made every effort to provide accurate telephone numbers and Internet addresses at the time of publication, neither the publisher nor the author assumes any responsibility for errors, or for changes that occur after publication. Further, the publisher does not have any control over and does not assume any responsibility for author or third-party websites or their content.

For Linda, Jonathan, Leah, Sammy, and all our elders

“My brother owns a nursing home in Lakewood, New Jersey, and the things he sees you could make a book out of. If somebody wrote it, it might do the world some good.”


—PHILIP ROTH, The Anatomy Lesson (1983)



Sam Rosen is telling me once again that he was married for seventy-seven years and suddenly he’s all alone.

He is one hundred and two. A year ago, he was still living at home with his one-hundred-and-one-year-old wife. But at ancient ages your life expectancy is limited. She’s buried in the cemetery. He’s buried in the nursing home.

“Fit as a fiddle, and then she catches pneumonia! Then my kids sell the house and put me here. They don’t even visit,” Sam says.

“Seventy-seven years!” he reminds me.

He’s sitting on his bed in the corner of a room considerably smaller than the average middle-class living room. I’m in a chair squeezed beside his bed. Books and magazines—most of them of a left-wing variety—are piled high on the nightstand. This small corner of the universe is all that is left to him after more than a century of living. It is no different from the small corners allotted to the hundred other residents of his nursing home or from the two million corners of similar rooms in the eighteen thousand nursing homes across our nation.

Two million out of a population of three hundred million may seem like a small number, but the nursing home experience will touch almost all. If you are sixty-five, your lifetime chances of spending time in a nursing home are 43 percent. If not you, it could be your parents.

As you age, your chances increase. Only 12 percent of people between sixty-five and seventy-four are in nursing homes, compared to one-third of those between seventy-five and eighty-four. If you live to eighty-five, your chances are better than one in two.

Sam defied the odds. For most of those seventy-seven married years, he lived in a big old Victorian house. It had only a few years on him. Queen Victoria died just a few years before Sam was born.

On the wall is a sepia photo of a cute couple.

“That’s me and my wife,” Sam tells me—the wife with a vintage bob; Sam with wavy hair, looking early Cagney.

Next to that photo is one of Sam, a lifetime later. He and the family are blowing out a one-hundred-candle cake. I idly wonder how they lighted the last candles before the first ones went out.

If you looked up wizened in the dictionary, there might be a picture of Sam. But he’s ambulatory, can still read, and knows he’s unhappy.

“Do you play chess?” Sam asks. “Or Scrabble?”

Every week I see him, I get this invitation along with a reminder that he was married for seventy-seven years.

The other day my daughter was flipping through the Guinness Book of World Records.

Table of Contents

1 Do You Play Chess?: Overture 1

2 Finding Your Way Home: Welcome to the Rest of Your Life 29

3 The Recording Angels: Doing it by the Book 59

4 Old As A Stein Way: Cast of Characters 79

5 Bed, Baths, and Beyond Bingo: Daily Life at the End of Life 105

6 Young Girls In Short Skirts: Health Care for the Frail and Old 143

7 The Final Chapter: Dying and Death 175

Afterword 211

Acknowledgments 213

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