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Sandra Gaffney entered her first nursing home for long-term care at the unusually young age of fifty. Fourteen years earlier she had been diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease. Over the next sixteen years, Gaffney lived in nursing homes in Florida, Virginia, and Minnesota, as the ways she could be close to family changed.


She describes her situation in these words: "As a nursing home resident, I require total or maximum care. I have limited use of my hands and arms. With special splints, I am able to turn the pages of my books, use the telephone and TV/VCR/FM radio remote control. When my cup is positioned properly, I can drink independently. I am able to walk with a platform walker and the help of two nursing assistants. My walking is not functional; it is only for exercise. After I moved into my third nursing home, I learned to operate a power wheelchair by using an adaptive switch between my knees. ... All other areas of physical care have to be done for me. My speech is impaired. If people listen carefully, they can understand what I am saying. ... I am able to eat regular food and breathe on my own."


Gaffney became an acute observer and strategist about how to live in a nursing home. Her first-person account, dictated to family members and assistants, covers making the decision to enter a nursing home, choosing the right one, and understanding its culture. She talks about how to furnish your room and about all the issues that arise in a resident's typical day. She has much to say about communication with staff and family about "how to help others help me." Gaffney's daughters, Amy and Bridget, and her friend Ellen Potter provide additional perspectives on the caregiving experience.

On investigative visits to nursing homes across the nation, Beth Baker has witnessed profound changes. Culture change leaders are tearing up everything—the floor plans, the flow charts, the schedules, the lousy menus, the attitudes, the rules—and starting from scratch. They are creating extraordinary places where people live in dignity and greet the day with contentment, assisted by employees who feel valued and appreciated. Perhaps most surprising, these homes prove that a high quality of life does not have to cost more. Some of the best homes in the nation serve primarily low-income people who are on Medicaid.

In Old Age in a New Age, Baker tell the story of a better way to live in old age. Although each home is different, they share common values: respecting individual choices; empowering staff; fostering a strong community of elders, staff, family members, and volunteers; redesigning buildings from a hospital model to a home (where pets and children are part of everyday life); and honoring people when they die. Her visits to more than two dozen facilities include those associated with the Eden Alternative, Green House, Kendal, and the Pioneer Network. Whether these transformational homes become the norm or the domain of a lucky few is the question that faces the next generation of elders, the baby boomers.