Pearson and Stubbs recognize that there is no magic solution for the frequent despair felt by an inexperienced family care giver. Their chief recommendations include providing the lay care giver with more information on and better preparation for the often ugly realities of death and dying, improving communication between the care giver and the professionals involved, and increasing understanding of the term "palliative care," with more emphasis placed on pain management.
All of this is good advice, but what is missing is a greater recognition of the underlying role of demographic and economic factors. A century ago, a dying patient rarely lived more than a few days or weeks. Today, patients with stroke and other chronic illnesses may require extensive care for months or even years. Also, many, if not most, wives and daughters are now working outside the home -- a factor that causes them to assume a double burden if they are handling much of the care of the patient.
The authors' well-documented and justifiable cri de coeur regarding the burden that is too often placed on the care giver has been reinforced by the findings of a recent study sponsored by the Metropolitan Life Insurance Company of the financial toll exacted from care givers as well as threats to their health (Sara Rimer, "Study Details Sacrifices in Caring for Elderly Kin," New York Times, Nov. 27, 1999). Too recent to be noted in the book, but coming almost as an answer to their plea, is the plan of the Journal of the American Medical Association to devote an issue in November to care at the end of life.
What we also need are some realistic proposals for the financing of long-term care. Meanwhile, we should build on whatever practical approaches exist. In my opinion, the authors condemn home care much too broadly, although the value of home care is often oversold for sentimental as well as financial reasons. Hospice care is undervalued. Continuing-care retirement communities, which combine long-term professional care of dying patients who are older than 65 years with extensive support for spouses and families, are not mentioned, nor are the pioneering initiatives supported by the Robert Wood Johnson Foundation's Last Acts campaign, which seeks to increase awareness of the need to improve care at the end of life.
Despite these omissions, Parting Company is a substantial contribution to the growing literature on death and dying. It would be a useful addition to required-reading lists in medical and other schools of the health professions.
Reviewed by Anne R. Somers, D.Sc.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
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Most Helpful Customer Reviews
3 of 3 people found the following review helpful:
5.0 out of 5 stars
I have truly benefitted from reading Parting Company,
By Sophia Nilsson (Pennsylvania) - See all my reviews
This review is from: Parting Company: Understanding the Loss of a Loved One: The Caregiver's Journey (Paperback)
This book is full if insights and important information for those of us experiencing the deterioration of loved ones. Before I read it, I was feeling pangs of guilt for not becoming my parents' full-time caregiver. From the the book's accounts of this, I realized that I didn't have the physical or emotional energy or the resources necessary to care for them at home. The guilt pangs for not doing more are much farther apart and less compelling. Now I'm hoping for a sequel about trying to manage professional health care for a loved one...
1 of 1 people found the following review helpful:
5.0 out of 5 stars
Compelling reading for everyone.,
By Barbara N. (Boston, MA) - See all my reviews
This review is from: Parting Company: Understanding the Loss of a Loved One: The Caregiver's Journey (Paperback)
This book describes the process of caring for dying family and/or friends - something that more of us are likely to do in the future for various reasons. Every story is unique and gripping. This book is really helpful to those of us to have to deal with the physical and emotional needs of our loved ones, and have to take care of the healthy at the same time.
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