33 (1).indd Anthropology & Aging Quarterly 2012: 33 (1) 18 Book Reviews McLean, Athena. The Person in Dementia: A Study of Nursing Home Care in the U.S. Peterborough, Ont: Broadview Press. 2007. ISBN – 13: 978-1-55111-606-8. 312 pp., $27.95 (USD and CAD) Using the comparative method, Athena McLean beautifully illustrates the sharp contrasts between two distinct models of “care” for cognitively-impaired adults in a large, multi-unit nursing home on the eastern U.S. coast. In this book – which won the New Millenium Book Award from the Society for Medical Anthropology – McLean uses ethnographic techniques, case studies, and robust theoretical and historical framing to describe and explain the care philosophies and practices employed in the two nursing home units she studied. One of the units is characterized by a regimented, task-oriented approach to elder care that ignores the resident’s remaining cognitive and relational abilities. In the other unit, a holistic, person- centered approach is in place in which attention is paid to resident needs, desires, and overall well-being. McLean successfully demonstrates the success of the person-centered care model in terms of resident outcomes, as well as employee and family satisfaction. The six case studies focus on the resident-staff microcosm as a way to explore personhood and illustrate differences in nursing home unit culture. McLean identifies and explains key unit differences as a function of the autonomy, background and approach of each unit’s head nurse. The unit of analysis, the resident-staff dyad, frames the presentation of the data to capture her theoretical and empirical interests with precision. Readers from many walks of life will find this book compelling. Some chapters will appeal to social scientists and gerontologists, while others will attract health care and aging professionals and/or those interested generally in the elderly in American culture. In many ways, this book is a work advocating for solutions to the deficiencies in the long term care system in the U.S. Indeed, the book’s strong conclusion about respect for the whole person recommends a particular path for dementia care in the future. As someone with a new and growing interest in long term care, but engaged in organizational issues throughout my career, this book prompted me to think about alternate ways of exploring the culture of McLean’s field setting. I believe that her priority and focus on particular roles (e.g., nursing home resident and caregiving staff) could be enhanced and extended by researchers who bring an organizational-culture lens and an applied orientation to long-term care organizations. This dual emphasis might include an analysis of roles, but would likely explore roles in relation to organizational relationships, strategies, and functioning. For example, I kept wondering why the two systems of care co-existed, why there was little to no transfer of knowledge or personnel across the two units, and whether the presumed efficiencies of the regimented, task- oriented approach collided with the described superiority of the person- centered approach. McLean is clearly interested in policy – changing the way older persons with dementia are treated. She offers a whole section of recommendations for change. Yet the absence of an organizational research component and an approach to organizational change diminishes, to a certain extent, the effectiveness and practicality of her recommendations. An organizational research design ideally would have included an examination of the larger nursing home administrative structure, ideology, and behavior. That vantage point would have illuminated the cultural patterns, skillfully described by McLean, within the context of rules and resources available to the larger organizational entity. Organizational researchers would have focused on those factors that allowed the variation in unit care to continue, thereby shedding light on broader nursing home goals, decision making, and internal conflict. Moreover, the metrics used to evaluate the performance of all roles within the nursing home hierarchy – including those in the management chain – would have been gathered to compare unit behavior with overall organizational expectations and effectiveness. In McLean’s study, nursing home management appears not to have been actively involved in the study or in its output. An ability to fully learn from the two-unit comparison, and innovate based on the results, seem to have been lost. These criticisms are actually compliments to the author. She has powerfully shown how the culture of nursing homes and the treatment of older adults with dementia need to change. Her important, insightful, and well-written book is a call to action – but that action may in part require a different approach and orientation for the anthropologist or gerontologist, not just the nursing home. Elizabeth K. Briody, Ph.D. Founder and Principal Cultural Keys LLC Anthropology & Aging Quarterly 2012: 33 (1) 19 Book Reviews Jacoby, Michael. Ten More Good Years. New York, NY: Look Out Films, 2008. 71 min. $15.95 (home version) $195 (Institution with educator guide), $75 (Community groups and non-profit organizations with educator guide) “I’d like to know would you really like to show me where you live, I’d like to know were you really ever there and when it all goes down I hope you’ll still be there.” These lyrics from the opening song in ten more good years, performed by Sorenson & Mechlowicz, speak to the often misunderstood experiences of gay elders in America—a segment of our population whom social science scholars often call “invisible”. In this documentary, Michael Jacoby presents views of growing old in the gay community through ethnographic interviews with four LGBT (lesbian, gay, bisexual, transgender) elders. Why does the aging experience of gays merit an in-depth look? In his article, Honoring our Pioneers, Jacoby relates that in his younger years, after forming a friendship with an elder gay man he learned about the plight of “a whole generation of men and women out there who had been left behind and forgotten . . . . They came out of the closet at a time when they could lose their jobs, family, and friends and even get arrested for doing so. They are the men and women who survived the AIDS crisis, battled government, and built LGBT- friendly communities in major cities across America . . . . It boggled my mind that so many of our heroes were facing such an onslaught of so many unfair circumstances with so little support and so few resources to turn to” (The Advocate, Sept. 12, 2009). Contemporaneously incorporating some of the commonalities and challenges of aging experiences in America, the film also explores some important particular realities of aging for gay elders. Jacoby presents a tapestry of personal stories, media clips, and factual data with an interweaving of expert testimony and commentary from what he offers as a series of reputable sources. Included are representatives of SAGE, NY (Service and Advocacy for GLBT Elders); New Leaf Services, San Francisco; The Task Force, NY; Brian deVries, PhD, Director of Gerontology at San Francisco State University; NCLR, San Francisco, (National Center for Lesbian Rights); and the NY Chapter of NOW (National Organization of Women), among others. Commentaries by these experts highlight numerous injustices facing members of the gay community as they traverse the unknown terrain of growing old, shedding light on some unique challenges facing gay elders. Terry Kaebler (SAGE) explains why aging experiences can be different and present some particular challenges for those in the gay community. These challenges include an erroneous assumption by some care providers that all elderly are straight. This scenario can lead to difficulties or even an inability for some gay elders to access programs and services. Other evidence shows how social service agencies, even those which receive federal dollars for senior services, too frequently indicate that “they are not accepting of gay elders.” Jacoby’s sensitive exploration into the lived experiences of gay elders often speaks to the loneliness, isolation, and many losses—of life partners, financial security, health, and housing. He documents how some gay seniors, who were at the forefront of the Gay Rights Movement in the 1970s, now find themselves, in their “golden years” returning to the closet—to secure housing, access community resources, and find acceptance. This film reveals a compelling truth: despite these harsh realities of what it means to be gay and old, there is often resilience among gay elders, an understanding of what it means to be different. A common thread among those interviewed is one that confirms, “we will take care of our own.” Jacoby’s portrayal of being old and gay demonstrates their determination, survival, and pride in identity—giving voice to an often- overlooked segment of the American population. A strength of ten more good years is its inclusion of personal life stories of gay elders and testimony by gerontologists and LGBT experts. A weakness is its primary focus on aging gay males’ experiences, too often “hiding” aging lesbians’ experiences and perspectives. A more accurate portrayal of the lived experience of gay American elders would also have more diversity represented in terms of socioeconomic differences, rural vs. urban experiences and so forth. As a gerontologist, novice anthropologist, and member of the aging gay community, Jacobys’ film opens the dialogue for continued exploration into what it means to age in America, and what it means to be human. This is an important film for anyone interested in LGBT, gender, and aging studies. ten more good years raises societal awareness, answers questions, and calls for programs and services that are sensitive to the needs of all elders, including those within the gay community. Terri Ann Liller, MBA, PhD Student Department of Anthropology Wayne State University