I had to read this book for 1 of my final assignments for my BA. Since there are readers and writers here, I thought that you may enjoy it.
A Book Review of Another Country
It is interesting to note that from a historical perspective, growing old is a relatively recent phenomenon. In the 17th century, it was rare that someone lived beyond thirty years. He or she probably did not have wrinkles and gray hair. There were huge advances in medical care in the late 19th and early 20th century and going forward. For example, doctors began learning about germs and started washing their hands. In spite of these advances, there is no doubt that the oldest in our country were born and grew up in a very different era than in present day. In the 1920’s and 1930’s. Automobiles were not parked at everyone’s home, telephones did not inhabit everybody’s’ kitchen, the family gathered around the radio, and not the television.
If someone had told them that there would be personal computers and mobile smart phones in sixty to seventy years, they may have thought that that person had been into the whiskey or the moonshine too much. The thought of flying across the country or the world would have been a terrifying prospect to most people. Many grew the majority of their own food, unless they lived in the big cities. Although the demographics began to change dramatically in the 1920’s and ‘30’s, more people began to live in cities, as opposed to small farming communities. In order for an area had to contain one to two thousand people. While more people lived on the farm, there tended to be big families with multiple generations needed to work the farm (U.S. Census Bureau, n.d.).
More Historical Context
However, history tells that it started many decades before when pioneers left their extended families to travel westward. This coincided with the growth of the industrial revolution. Many men took jobs, largely away from home on the railroads and other places. Farming has always been a hard way to make a living. It is worth noting that the places described in Another Country could also describe small town Wisconsin, or any small Midwestern town. It almost seems like time stands still – there is still a sense of community and neighbor helping neighbor. Most people have moved to the big city these days; only about sixteen percent of the U.S. population lives in a rural area versus thirty percent in 1973 (Haber, 2013). The smaller families, who more often tend to work outside the home, have led to fewer family caregivers over time. In the early 20th century, an urban area meant that the population was greater than 1,000 persons (U.S. Census Bureau, n.d.).
How is Old Age Defined?
Age is usually understood and defined by the numbers, especially when we are young. However, as we turn forty, it starts to become murky. People as young as forty are legally protected against age discrimination. Haber defines young-old as between sixty-five and seventy-five. Old-age is loosely defined as over seventy-five, possibly even eighty-five (Haber, 2013). Conversely, Pipher has two definitions that make an impression on the reader, and both have to do with life circumstances, the death of spouses and the loss of health. It is surprising that finances were not mentioned here as well. Income loss can also play a huge part in older people’s quality of life. If they lost a spouse, got divorced or were never married, women especially tend to have less disposable income. Therefore, they may not have money for leisure activities, regular doctor visits etc. After all, there is still a pay gender gap that persists today. Loss of health or finances can also mean that older persons have to move away from their beloved home (Pipher, 2000).
Pros and Cons of City Life for the Older Adult
There are undeniable advantages to bigger city life, especially for older people. The biggest one is probably easier access to goods, services and medical care. Larger places have senior activity centers that offer a variety of things to do. The one in Bellingham allow people to participate as young as fifty. They offer a number of health/wellness and other programs: immunizations, dance, exercise, computer skills, current events, and playing games/cards etc. (Bellingham Senior Center, 2016). As pointed out in the book with Gladys and Roger, loneliness can cause as many problems as physical, chronic illness. It definitely often leads to severe depression. Like Roger, Gladys also missed Nell’s companionship. Several things happened to improve her quality of life: a nice girl came in to work as a caregiver, Gladys began to participate in social activities outside the home and Roger along with his new girlfriend began to spend more enjoyable, quality time with her. Another thing that was so important to Gladys was that she was able to cook with her caregiver, and she wanted and needed to pass on years of cooking advice, recipes, and some wisdom along the way.
There is usually at least one hospital and a complex of different medical offices nearby In tiny in a larger city, towns, one may have to travel hundreds of miles for specialty medical care. For example, Bellingham has a hospital, but any acute or specialized care is done in Seattle. That is about ninety miles away. An older person, who may not be able to drive anymore, may have a particularly hard time getting there. In addition, if she/he needs to use assistive equipment, wheelchairs, power chairs or walkers, this makes traveling great distances even more difficult.
In cities, there are more housing options. Caregivers can be hired so that the person can remain in the place that s/he is most familiar and comfortable with – home. There are assisted living homes: these are a hybrid between living in a skilled nursing facility, nursing home, and living independently. Both of these options are very costly and not covered by Medicare. Nursing homes are often thought as the option of last resort. They can be rather unpleasant places, and as illustrated in the book, the resident has little autonomy; she may not even be able to open a curtain without disturbing the resident on the other side of the room. There are few private rooms, and those that are available are reserved for those few who can afford them. Some of them are trying to do better, making them more like home and less like a hospital. They also need pleasant areas outdoors with trees and flowers. People with carpentry skills can make plant or flower boxes up high enough so that people that use wheelchairs can help with the gardening. There is something almost spiritual and healing about getting the hands into the soil that gives life to flowers and plants; it is very therapeutic for many people. Yet, is possible to be alone in a crowd.
However, a sense of community may well be lost. A rural setting offers opportunities for solitude allows for reflection and life review. There is also something to be said for the rural country life and its far slower pace. The noisy hustle and bustle does not exist. Housing tends to be cheaper as well, so it may be worth it to be farther away.
What is Cohousing?
As more baby boomers age, there is a need to come up with innovative ideas to take care of them in the future. Cohousing is a possible answer. These home communities are designed to provide both privacy and community. Each resident may own or share a home, but they have common areas. One such area may be a community house. All the residents share chores like housework, laundry, lawn mowing, driving and cooking. Cohousing developments usually have a communal garden. The cohousing option in Bellingham is quite a bit costlier than the average cost of housing for the area. The median cost of a home today is $330,000 in Bellingham (Zillow, 2016). The cohousing option in Bellingham ranges from $350,000-$560,000. It also makes very clear that it is not a housing option for people who need “therapeutic care.” However, this neighborhood is for all ages, not only the elders (Bellingham Cohousing, 2016). There is also a requirement to devote twenty hours per month to community activities and committee meetings. It is also necessary to give up some level of autonomy because the majority rules when it comes to decisions involving the community. For example, should pesticides be used on the garden? The idea behind cohousing is good, but it is expensive to get old – too expensive like the other options for many older people.
The Gift of Hospice
It is not an overstatement to say that that hospice is a blessing. It is very difficult to make wise decisions in the midst of grief. The hospice program gives comfort, palliative care for the person in the last six months, (as estimated by a physician) of life. It is not uncommon for family members to disagree about how care should be handled. The hospice nurse will act as an advocate for the ill person. The physician and the nurse collaborate together for the care of the patient. The wonderful thing about hospice is that the person does not have to go to the doctor’s office or to the hospital nearly as often. The hospice team will guide the family through the most difficult choices that involve the end of life. It is especially hard to know what the loved wants if he or she does not express the wishes in an advance directive, living will or last will and testament (Haber, 2013). Hospice was involved with the care of my grandparents and my mother. It was a blessing each time because it takes some of the burden of decision making away while giving comfort to my loved ones.
The More Personal Side – Relationships
The heart and soul of the book, however, is its personal stories – poignant, heartwarming and Kleenex worthy stories. It is impossible to read the book without being flooded with this author’s own personal memories. The guilt and the uncertainty are all very real. When away from the loved one, it is easy to feel guilty for not doing enough to help. It is a heart breaking agony to watch a once vibrant person leave this earth inch by inch. The book begins with Mary Pipher talking about the mixed feelings she experienced when her own mother was going through the last days of her life. It was a wonderful, touching and difficult time for her. Every moment became more precious than the last because it may be the last one, at least for a long time, (if one believes in an afterlife). Most everyone who has lost loved ones can relate to her experience, and/or relate to someone in the book (Pipher, 2000).
The end of life can be something quite different in some families Fractures in relationships that have existed and have been strained for years between family members can crumble with the stress of a sick and needy loved one. This was illustrated in the case of Granny Zella Mae, daughter Beverly and her teenage daughter Abby. Beverly had a lot of stress in her work environment, and she has been in the middle of her aging, head strong mother and her equally stubborn daughter. It is clear that this three generational living arrangement is not working out well for anyone in the home.
Zella and Abby did not even come to the next therapy session; they were so angry about it. However, Beverly and Ms. Pipher came up with a plan to find a nice assisted living situation for Zella. This turned out to be a win-win situation for all three of them because Beverly did not have the stress of being a caregiver to her aging and critical mother, yet she visited her daily. Abby even visited her Grandma. Zella was in a situation where she was getting better care and not complaining as much (Pipher, 2000).
Another example is the older father dying of tongue cancer. The mother needed help, but none of the adult children had the free time to devote to his care, except the gay daughter who was a freelance writer. Her family had made her an outcast after she came out as gay, but she did keep in touch with one or two of her sisters. When she learned of her father’s cancer, she returned home to help her parents and care for her dad. It took some time for all of the family members to come around, but they saw the love and compassion she showed to their father. The fact that she was gay no longer mattered. Her father said that he was glad that cancer had brought them together again. It is tragic that it took cancer and the father’s impending passing to bring the family back together once again, but it would have been even more tragic if the chance for the family to mend its hurts had ever come at all. The daughter/sister had a great capacity for empathy and forgiveness (Pipher, 2000).
Concluding and Personal Thoughts
This book was a beautiful one, but it was very hard to get through it. There are parts that reminded me of my Grandfather who was taken by cancer in 1985 when he was only sixty years old. He did not even make to the young-old stage. He faced it with grace, dignity and courage. Ironically, Grandma was a nurse in the oncology unit. I do not know how she was able to manage dealing with cancer, illness and death both at work and at home. Grandpa made sure to tell us how much he loved us. Just as Pipher talked about, Grandma felt guilty about going to work yet she had to keep the insurance going to pay for his care and medicine, otherwise, she would have taken a leave of absence. This was an impossible choice. Mom and her sister took turns caring for him.
There were sections that reminded me of Dad. He was taken in 2010 by COPD. I wish that he and my step-mother had wanted hospice to come, but I do not think Dad could face his own mortality. He made no end of life plans. My step-mother made all of the decisions; she did not allow my brother or I to be a part of the decision making process, even though I offered my help in the past. Like some in the book, I was uncertain as to what to do. He and my mother were both in the young-old category. Neither of them made it seventy.
Mom was the only one who did not pass away at home, but she died alone in a nursing home. She was debilitated by strokes, diabetes and vascular dementia. This made her even more stubborn and irritable than she was before her chronic conditions. She would not listen to anybody, unless that person agreed with her. Like Dad, she had made no type of will, although she did have an advance directive. It was up to my brother and I to make after death decisions for her. I was angry with her for leaving it to us. Grandma died this year; she was the only one to make it to old-old age, ninety-one years old, and die of natural causes. Aunt Rose lived with her.
However, Pipher gives me and every other reader permission to have our feelings because I and most everyone else are doing the best we can under very trying circumstances. As long as we handle old-age and its pitfalls with love and empathy, we should not beat ourselves about it. She poses interesting different definitions regarding old age. Does a death of a spouse or disease make a person age? It depends on a person’s perspective. I have always had Cerebral Palsy, CP. It and other comorbidities have always been a part of my daily life. Lack of mobility is something that is usually associated with older age, but I have always had to ask for help with ADL’s, Activities of Daily Living. I am used to it. Now, it is time to answer the question that this paper began with; what happens that transforms anyone from the young-old to the old-old? Losing health is serious, but losing people that I love is worse. However, reasonable minds may disagree.
Bellingham Cohousing (2014) Aging in cohousing Retrieved from
Bellingham Senior Activities Center (2016) Health & wellness Retrieved from
Haber, D. (2013). Health promotion and aging: Practical applications for health
professionals (6th ed.). New York: Springer Pub.
Pipher, M. B. (2000). Another country: Navigating the emotional terrain of our elders. New
York: Riverhead Books.
- S. Census Bureau, (n.d.) Urban and rural areas Retrieved from
Zillow (2016) Bellingham home prices & values Retrie