Green House, Blue Valentine, and the way people talk about long-term care

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Staff Writer Tim Mullaney
Staff Writer Tim Mullaney

Last week, NPR ran a story lauding The Green House Project — and slamming traditional nursing homes. The piece began with this summary of people's fears:

"One thing just about everyone dreads as they age is the possibility of ending up in a nursing home. We all think we know what that's like: sharing a room with strangers, sitting slumped in a wheelchair all day, rigid schedules, bad smells. And for more than 1 million Americans, this is home."

I balked at this casual claim that 1 million people are living in bad nursing homes, which ignores that long-term care is quickly evolving and quality has markedly improved in recent years.

But what really got me thinking was the idea that everyone dreads going into a nursing home. This statement was still rattling around in my head when I sat down Friday night to watch the 2010 movie “Blue Valentine.” To my surprise, the movie addressed many of the issues I was mulling, about traditional versus new models of long-term care and people's perceptions of nursing homes.

The movie was not at all advertised as about aging. In one typical summary, a blogger described it as “a superbly acted indie drama about a middle-class nurse [Michelle Williams] falling out of love with her working-class house-painter husband [Ryan Gosling].”

That description sounds pretty heavy, and the movie is a tough watch, but I found it a very rewarding one. (And if you're planning to see it, note that there will be some mild spoilers below.)

The characters played by Williams and Gosling — Cindy and Dean — meet in a nursing home. Dean, who at this point is working as a mover, has just helped a new resident unpack and get settled in his room. Cindy is visiting her grandmother across the hall. She and Dean have a brief exchange and then part ways.

A month later, Dean is back in the nursing home. He's there to deliver something to Walter, the man he helped move, but Walter has died. Riding the bus afterward, Dean again sees Cindy and they talk.

“What do you expect?” Cindy says, about Walter's death. “They're old. Do you want to live like that?”

“Like what, in that home?” Dean replies. “Well, no.”

Cindy's question and Dean's answer surprised me because I had been impressed with the nursing home in the movie, with its spacious private rooms and cozy, sedate dining room. And it was far better than the alternatives. Walter had been living independently in a house so squalid that Dean practically had to don a Hazmat suit to move him out. And in another scene, we see Cindy's grandmother having dinner with Cindy and her parents, at which her father spews vile abuse and hurls his food onto the table. Give me the nursing home dining room any day.

It occurred to me that we all might do what Cindy and Dean do: They seem to ignore the very real and much worse living options for the seniors they know, and think of the nursing home as a poor substitute for some ideal way of aging. Perhaps that ideal is living totally independently, cooking gourmet meals and playing tennis to a ripe old age. Or perhaps it's living with family members, spending our golden years doting on grandchildren and dispensing pearls of wisdom.

The movie pokes a hole in that last fantasy. Cindy's father ends up living alone and is on oxygen. No longer so abusive, he's reaping what he sowed — the viewer doubts Cindy will ever want him to move in. Perhaps he'll live alone in his house and become another version of Walter.

The film is dark but it is not cynical about the power of family love and devotion; arguably, the healthiest relationship in the movie is between Cindy and her grandmother. Cindy's visits to the home inform her decision to pursue a nursing career, and they also keep her grandmother going — without Cindy, perhaps she would have been like Walter, who was so quick to slip away after being admitted.

And this brought me back around to thinking about The Green House. The NPR story did not use the word “family,” but this is what it describes — living in a Green House residence creates a family-like environment that balances communal activity and support with individual autonomy. “Blue Valentine” shows just how tenuous family connections can be, even for good people who try hard to make things work. Maybe, for seniors who find themselves alone, a Green House family could be a literal lifesaver.

But for as quickly as the Green House is catching on, it's still not the dominant long-term care model, and I think we should resist praising the Green House by making other types of nursing homes seem awful by comparison. Whatever the future holds, these nursing homes will be around for a while, and many are adapting to a changing marketplace, providing their residents a vastly better quality of life than they would have elsewhere — even if the Cindys and Deans of the world can't fully appreciate that.  

Tim Mullaney is the staff writer at McKnight's. Follow him on Twitter at @TimMullaneyLTC.

Daily Editors' Notes

McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Marty Stempniak.

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