“A Shift from Nursing Homes to Managed Care at Home” is the title of a recent article by Joseph Berger. The title denotes a movement across New York State away from the traditional facility institutions and toward care at home. “Nationally, the number of nursing homes has declined by nearly 350 in the past six years,” according to the American Health Care Association and Joseph Berger. The new adult-day-care centers, known as PACE, that will take up the patients removed from nursing homes, provide the same services as the nursing home, such as examinations by doctors and nurses, social activities, physical therapy and daily meals. The plus side for the patients is that they sleep in their own beds at night, often with a health care aide or relative nearby. “Most elderly people want to live out their lives at home” Berger writes. Edna Blandon, 74, notes in the article that “My spirits would drop if I went to a nursing home…I love the fact that I can go home at night. There’s no place like home. I can sit down, look at the TV and go to bed when I want.” The article is telling in that in shows that even those who require a large amount of aide in daily living would prefer to sleep in their own beds at night. Obviously, most people prefer to keep their independence, and would not like to sleep in a hospital-type setting or be forced to keep the schedule of everyone else. So what makes living at home and going to PACE every day any different from staying at the nursing home? The difference is only during the nighttime, when one is asleep. But even this small luxury of time alone is what those in nursing homes would prefer to have.
Erving Goffman explains perhaps a part of this human-nature to want to live at home. In his writings, Goffman explains the difference between the backstage and the front. The backstage is where a person’s “performance” is unobserved by members of the audience. This is where a person is free to be him or herself without impression management. The impression management refers to the verbal/nonverbal practices that humans employ in order to present themselves as acceptable to other people. When an elderly person with full cognitive function is at a nursing home, he may feel the need to keep up his impression, by talking to the aides, following along with activities or being kind to the other patients. When at home, the elderly person does not have to keep up appearances by managing his emotions and feelings. Instead, he can be free to not worry about others. This is backstage. On the other hand, his time in front of others, such as at the nursing home, is the front, the performance.
The nursing home can be considered a “total institution”. A total institution is a place where people live 24/7 and all spheres of life are regulated. There is no backstage, or place to be refreshed. Those who are at the nursing home will be less likely to have a backstage because of the constant number of people together in one “living-room” or dining-room or even sleeping in the same vicinity of on another. The inhabitants of total institutions, according to Goffman, are subjected to the “mortification of self,” the process of killing off the other selves a person may have had prior to the entrance of the total institution. To a nursing-home patients, this may look like deciding what personal belongings to bring and giving away/relocating the rest, or using the nursing home clothing instead of one’s personal clothing.
Naturally, the elderly nursing home patients seem happy about the change. And it seems like the country is understanding the need for the backstage and moving toward lower nursing homes and higher in-home care.
the article: http://www.nytimes.com/2012/02/24/nyregion/managed-care-keeps-the-frail-out-of-nursing-homes.html?pagewanted=all&_r=0