Elder Disintegration and Nursing Home Horrors: A Book Review

A review of As We Are Now, by May Sarton (W.W. Norton 1973)

This is not a new book or a cheerful one. When it was first published, I was not aware of it, nor would I have been interested then, more than thirty years ago when I was in my early forties.

This is a book that should still be read by anyone involved in or concerned about the care and treatment of elders and by any senior citizen who dares to explore what wasting away in an old-style nursing home might have been like for a thoughful, sensitive old woman. We can hope that senior care has improved, but somehow, this little 133-page novel still rings true and stirs understanding and concern.

This fictional journal follows 76-year-old Caroline (Caro) Spencer, who, after a heart attack, is placed in Twin Elms, a small, isolated rural nursing home, by her older brother, who can't care for her. She's a former teacher and rugged individualist. She remembers and admires a non-conformist gay college professor aunt. She dreams about a long-ago lover. She never married.

Her fellow Twin Elms residents are elderly men, mostly demented and hopeless, relegated to a shared charity ward. Caro is happy to have her own room. Her perceived enemy is Harriet, the owner and chief caregiver, who seems to treat her harshly and strive to remove all remaining shreds of dignity, or at least that's how it seems to Caro. "I am in a concentration camp for the old, a place where people dump their parents or relatives exactly as though it were an ash can," she writes two weeks after arriving.

What interests me most in this book are the things that have meaning and the power to relieve Caro's depression, at least temporarily: music, poetry, the rural view from the window and occasional opportunities to venture outside, the cat who isn't allowed in, but sometimes creeps into her bed, and most of all, three people who offer hope and kindness. They are a minister, his college-age daughter, and Anna, Harriet's temporary replacement as a caregiver.

Caroline finds comfort in these things and people, but her most reliable sources of hope are her secret journal and her plan to destroy her "prison." Is she driven to madness? Perhaps, but somehow her ultimate protest makes sense.

We can hope that places like Twin Elms and caregivers like Harriet do not exist, but there are lessons here: the importance of human understanding, kindness, and listening to elders; the need to allow old people pets and their favorite possessions; the importance of personal writing.

This book reminds us of the inevitability of aging and death and the immensity of the caregiving responsibility.


Belgian-born May Sarton (1912-1995) published 53 books before her death at age 83.

Copyright 2008 by Marlys Marshall Styne