Last Stop

Drawing on first-hand experience as a participant-observer in a skilled nursing facility Last Stop records the vicissitudes of care in an institutional setting for people with advanced dementia and Parkinson's. The erosion of mind and memory is mirrored in the nursing home's location, a small town in Upstate New York hollowed out by the loss of its economic base.Snapshots of interactions between residents and staff, residents and their partners, are at times comic or touching, but at times a poignant record of failed communication and unmet needs. Underlying Last Stop is a sense of the limits of institutional aspiration-and imagination--in the face of staff burn-out, organizational glitches, and aging buildings.Elegy is at the heart of Last Stop-collective elegy for dementia sufferers who have lost their homes and are moving inexorably toward death; and individual elegy for a partner whose mind and body have been eroded by the catastrophe of Lewy Body dementia. The inside life of an average nursing home includes not only people with dementia, but their partners-grieving and ambivalent, confronting a painfully diminished relationship while attempting to salvage their own lives. Last Stop conveys the psychic situation of dementia as a two-body condition that necessarily implicates the observer/participant in the face of helplessness and fear of abandonment. This book-underpinned by psychoanalytic approaches to both later life and organizations--will resonate with anyone living or working with people with dementia, at home or in an institutional setting.