Making Gray Gold: A Book Review
Making Gray Gold: Narratives of Nursing Home Care. Timothy Diamond. Chicago and London: The University of Chicago Press. 1992. 280 pp.
The plight of the elderly in America is wrought with failures and a lack of concern and focus on their wants and needs. In Making Gray Gold, Diamond paints a tragic picture of the lives of those who live and work in a nursing home based on his personal experiences as a nursing assistant and his educational background as a sociologist. In a project that took over ten years time Diamond worked as a nursing assistant while carefully documenting his experiences through his ties to Northwestern University’s Program on Women. The University, the Midwest Council for Social Research in Aging, The Retirement Research Foundation, California State University, and many colleagues, coworkers, and fellow ethnographers also supported him over this ten-year journey.
Diamond’s book is based on many years worth of experience as a sociologist and nursing assistant in multiple types of nursing home settings; from those who cater to the wealthy to those dependent on Medicaid because they were or have become destitute. It is important to note that while Making Gray Gold is a narrative; it is far more than Diamond’s story. Making Gray Gold is a compilation of the complex and interwoven story of the nursing home industry and the colorful tapestry of those under its rule.
Diamond collected data and wrote about his findings through unconventional methods. As he worked as a nursing assistant he wrote notes on scraps of paper that he later assembled. The assembled writings were studied for patterns and written about in a narrative format. While he utilized multiple outside resources in the formation of his theories, he cites them as endnotes rather than including them directly in the book. Diamond believes this helps with the continuity of his story. I must say this was on of my favorite features of this text. Many times when reading research based information it is easy to get distracted and lost in all of the citations. The format Diamond used allows readers to get immersed in the story without getting bogged down outside citation information that can easily be found in the back.
Through sharing personal narratives Diamond defines the problems currently plaguing the nursing home industry. The nursing home industry turns people into patients and the “complex act of caretaking into quantifiable tasks” (p.170). While the nursing home industry works to turn people into patients and caretaking tasks into something quantifiable, Diamond’s storytelling draws the personhood back out of a quagmire of bed numbers and bottom lines.
Concerns from the staff were met with severe admonishment that their job was to care for patients, not criticize. There were very strict boundaries between management and those who provided direct care. This often left Diamond, his colleagues, and patients filling in the gaps left by a system where money is the bottom line. While bureaucracy reigned over the nursing home facilities, it failed to keep the staff and patients from maintaining small pieces of their independence and humanity. From clients helping one another get up to staff accepting tips to help residents feel a sense of autonomy, they all worked together in a give and take fashion. This undercurrent of caring and fights for autonomy bleed through the lines of Diamond’s narrative and left me feeling compassion for those involved. There were moments throughout the story when I felt myself cheering Diamond or other clients on as they fought against the bureaucratic system.
Nursing home patients come in from various levels of social standing, cultures, and backgrounds, yet they end up enmeshed under social policies that “abstract two common characteristics of their lives, disability and impoverishment, and corralled them into the same living space” (p.67). While some who started their time in a nursing home may have had assets and wealth, the structure of the system quickly drained those resources and left the person dependent on Medicaid. Medicare and Medicaid are described as the “twin pillars of long term health care policy” (p.56). A person entering nursing home care is first covered by their private insurance, private pay, or for short-term stays, Medicare. The high cost of care quickly depletes those resources. Patients are eligible for Medicaid only when they have reached the poverty level. Patients are required to “spend down” their assets before they can have any assistance (p.59). By the time patients reach this level; they have become dependent on the care. Many have had to sell their homes and have no other resources to rely on. They come in because they need assistance with their daily living and stay because they have no other place to go.
While Quadango (2014) reports that people who have resources earlier in life continue to have opportunities to accumulate more, the Cumulative Disadvantage Theory is contrary to the experiences reported by Diamond. While some residents in nursing homes may start in private homes where they receive greater care, he reports that many quickly deplete those resources and are moved into homes where resources are few and care is strained. What is important it note is that the quality of care is not at all related to those providing the care, but to the bureaucratic nightmare that governs the home. Overworked staff given too many patients and not enough time simply cannot provide the same level of care as those with lesser patients and more resources.
Making Gray Gold was consistent with other resources reporting about the differences in the gender ratio in nursing homes Both Diamond and Quandrango (2014) report that there are far more female residents in nursing homes than males. Quandrango (2014) reports that this difference is due to the fact that women live longer than men and typically are the caregivers so when they need someone to care for them, there is no one.
Diamond has many lofty suggestions for reformation. He believes that nursing assistants should form unions so that they have the ability to fight against their working conditions. According to Diamond the residents should be involved in planning how the home operates it’s daily schedule. He points to many occasions where the current system fails to meets residents needs such as residents being forced to wake up at 7 am, take showers whether or not warm water was available, and meal times that left them hungry for hours at a time.
Making Gray Gold is a sympathetic portrayal of the lives of those involved in the nursing home care system. From patients to direct care staff, stories encapsulate the struggle between the needs of patients to the resources available, both of which at the mercy of a money driven bureaucracy. This is the most informational and easily read book that I have ever read concerning the care of the elderly. The resources cited allowed me to research any additional information when a question arose. I would highly recommend anyone working with the elderly or their families be required to read this text, especially those in management.
Diamond, T. (1992). Making gray gold: Narratives of nursing home care. Chicago and London, IL: The University of Chicago Press.
Quadango, J. (2014). Aging and the life course: An introduction to social gerontology (6th ed.). New York, New York: McGraw-Hill Companies, Inc.
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