Published on: December 8, 2014

Atul Gawande’s latest book, Being Mortal, is listed among the “Ten Must-Read Books” by several newspapers and websites. We feel it must also be made compulsory reading for any palliative care person – in fact, for anyone associated with medical or allied healthcare.

In Being Mortal, one of the points that Dr Atul Gawande deals with is the clear distinction between nursing homes and assisted living centres which, in the event of the elderly becoming too frail, take over the person’s life. In a typical nursing home, what the person desires or what he wishes to do becomes irrelevant in the hurry to get some order and regimentation. A change in the order of things came with a Stanford Professor named Carstensen, who took the trouble to research into what people want and need, and developed the concept of assisted living. In an assisted living home, the person has independence in one’s own unit, which would include a kitchen. They have the right to lock the door, if they want to. Or they have the freedom to walk if that’s what they desire, even at the risk of incurring a fall and a fracture. The positive difference it makes to the elderly has been proved to be phenomenal. We need to remember this when, in our anxiety to control symptoms, we expect people to get admitted to hospitals or palliative care inpatient units, especially for end of life care.

And when such an admission becomes absolutely unavoidable, we must remember to make that place of stay as like home as possible, and to permit as much independence to the person as feasible.