Dear Nursing Home,
This is a hard letter to write. We have been together almost 30 years. That is a long time. But I need to tell you something.
I don’t think this is working. I can’t do this anymore.
It’s not you, it’s me.
Well, that is not true. It is you.
But I can’t blame you for who you are. I know how you were raised. “Be a medical model!” they told you. “Just worry about the body, not the spirit!” they said.
“Remember, safety first!” was burned into your brain.
“Don’t worry about what people want. Worry about what the rules say they should have!”
“The most important thing is to be efficient!”
It must have been difficult to have heard this over and over again. How could you not become what you are?
Of course you don’t know how to have joy, to live well, to focus on meaning and purpose. Of course you don’t value normalcy and community and connectedness. No one probably gave that to you when you were growing up. They tried to make you compliant, hard, sterile.
You are exactly what you were raised to be. How can we fault you?
Yet I do. I have. It breaks my heart.
I can’t watch you treat the people around you like this anymore. Don’t you see how people give their heart and soul to you? You barely acknowledge this.
You see people for everything wrong with them and you want to fix them – but not because it is what they want. I think it is because you are afraid. Afraid to see people for who they are – complicated, vulnerable, mortal, self-determining, full of risks. Yet also full of possibilities and life.
It is never you. It is always “them” – the people who live with you, the people who work for you, the people who visit you, the people who make the rules, the people who pay you. But it IS you!
I am at a point where I don’t think you can change. I guess I have to accept that.
But I am so angry about it. And sad.
I mean, do you really want to be this way?
No one wants to go to you, you know.
Why would they? You are not going to give them what they really need.
Why can’t you be the nursing home I want you to be?
There were good times, of course.
I sometimes still think I can change you. Because I see glimmers of hope in who you can be.
But I have been fooled by you before. You get a different “look” and try to trick me that you are different because you look different. You change your name. You tell me you are doing a new “program”, like that sticks around!
You start using different words to describe yourself. By the way, just because you use these words to say you are doing something different doesn’t mean you are doing something different.
I guess you think you are doing the best you can with what you have. Maybe that is true. But I don’t believe it. I know you could be better. But I am not sure you want to be. I am not sure you know how.
So, what is a person to do? Stand by and watch you self-destruct?
Just don’t take down everyone with you. These are good people. They deserve better.
I deserve better.
That is the reason why I have trouble letting you go.
With love (and many other emotions),
Sonya
Being Heard 
Sonya. Fantastic letter. You are right on the money about Nursing Homes. But what to do? That is the question. Many of us, as you note, have been trying to get the Nursing Home to change, but with limited success. I believe that until we can find something different, that people want, this letter will be as relevant ten years from now as it is today. Keep up the good fight.
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Thank you so much for chiming in Elroy. There are so many changes that need to be made. On one hand, I think we do know some of the changes that need to be made, including paying direct care professionals more. On the other hand, we altogether need to do something different, as you pointed out!
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Sonya this is beautiful and powerful! I can’t help but think that nursing homes are largely a reflection of the policy and regulatory framework from which they have emerged and in which they currently exist. If that framework changed, nursing homes would have to change. So I blame the parents (the regulators and policy makers).
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I don’t know who said first but I’ve heard that if you want to know where someone’s priorities are, take a look in their checkbook. Thank you for being a fearless champion!
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Sonya this is powerful. Nursing facilities mirror our values and priorities. Our culture does not value the people who live there or the people who work there. Period. Nursing facilities are a microcosm of all societal “isms”. And they mirror who we are and our attitudes and values. We don’t like what we see in the mirror so we blame the nursing facilities. We must persevere as champions for change.. BTW I call them FACILITIES until they earn the right to be called a HOME.
Final note: Readers Let’s circulate this and get a dialogue going.
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Yup. And we need a whole new paradigm that we have to adopt in order to create something new. We have to agree, or at least consider, the fundamental idea that people deserve to LIVE well. A focus on living. What does that mean to us? What would that look like? I think we have some examples of what it can look like….
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Sonya, you have captured the grief I feel over having tried for so many years, doing the actual transformation work in nursing homes that thought they wanted to change, and seeing most of them revert to old behaviors once the strongest change agents retire or are driven out by management. The few that have managed to thrive over time serve as models for the next generation of leaders who have the passion and vision and backbone. But until we change the payment system, only the wealthy will be able to afford it. It may not happen in this country in our lifetimes. But as Rose Marie, one of the founding mothers of the Pioneer Network, reminds us, we must persevere.
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Thanks, Bev. When I think of all those living and working in nursing homes, I know too that they deserve something different. The people who have fought so hard for change deserve something different. I think many of us feel that we are just plugging holes when we need something more. I agree that funding needs to change, and I also think it has to fund a whole new paradigm, otherwise we are just funding the same system differently. Thank you for all your work in creating change!
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Powerfully said, Sonya! Very validating for those who have tried to push for change, and those still trying. I hope this starts the next wave…onward…
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Thank you, Donna, It seems that this has resonated with many, and I can only hope that our collective outrage will lead us to creating something new.
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I love your almost break up letter. So much here and yet it remains difficult to talk about, feels almost impossible to do anything about. The pandemic, our changing social and economic landscape are all contributing to this lack of change. We used to think the boomer influx would change things. We( baby boomers) were going to demand better. Seems to work if you have means. Otherwise, boomers, we are an increased burden in numbers with less people who are able and willing to support this wave. Further contributing to your point Sonya, change still has not come.
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As long as the “bottom line” remains the guiding principle, and nursing homes are staffed by the lowest paid health care workers in the US, your observations remain akin to a voice crying in the wilderness. Although, if we all cry loudly enough together, we may be heard.
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