This page has a few bits, but, there are better descriptions: WBUR Interview and Brain Pickings
Insights so far:
1) Nursing homes were institutions set up by a huge grant system from congress in order to get the elderly and infirm out of hospital beds.
2) There were not conceived with the elderly in mind.
3) “Three Plagues” of nursing home life: “boredom, loneliness, helplessness.”
4) Newer residence create "households/homes" 12-16 inhabitants per household. Staff are generalists. Each one does everything - except gives meds - still need the nurse for that.
. . . lots this train of thought
IN 1908. A Harvard philosopher named Josiah Royce wrote a book with the title The Philosophy of Loyalty. Royce was not concerned with the trials of aging. But he was concerned with a puzzle that is fundamental to anyone contemplating his or her mortality. Royce wanted to understand why simply existing why being merely housed and fed and safe and alive seems empty and meaningless to us. What more is it that we need in order to feel that life is worthwhile?
The answer, he believed, is that we all seek a cause beyond ourselves. This was, to him, an intrinsic human need. The cause could be large (family, country, principle) or small (a building project, the care of a pet). The important thing was that, in ascribing value to the cause and seeing it as worth making sacrifices for, we give our lives meaning.
Royce called this dedication to a cause beyond oneself loyalty. He regarded it as the opposite of individualism. The individualist puts self-interest first, seeing his own pain, pleasure, and existence as his greatest concern. For an individualist, loyalty to causes that have nothing to do with self-interest is strange. When such loyalty encourages self-sacrifice, it can even be alarming a mistaken and irrational tendency that leaves people open to the exploitation of tyrants. Nothing could matter more than self-interest, and because when you die you are gone, self-sacrifice makes no sense.
Royce had no sympathy for the individualist view. "The selfish we had always with us," he wrote. "But the divine right to be selfish was never more ingeniously defended." In fact, he argued, human beings need loyalty. It does not necessarily produce happiness, and can even be painful, but we all require devotion to something more than ourselves for our lives to be endurable. Without it, we have only our desires to guide us, and they are fleeting, capricious, and insatiable. They provide, ultimately, only torment. "By nature, I am a sort of meeting place of countless streams of ancestral tendency. From moment to moment ... I am a collection of impulses," Royce observed. "We cannot see the inner light. Let us try the outer one."
And we do. Consider the fact that we care deeply about what happens to the world after we die. If self-interest were the primary source of meaning in life, then it wouldn't matter to people if an hour after their death everyone they know were to be wiped from the face of the earth. Yet it matters greatly to most people. We feel that such an occurrence would make our lives meaningless.
The only way death is not meaningless is to see yourself as part of something greater: a family, a community, a society. If you don't, mortality is only a horror. But if you do, it is not. Loyalty, said Royce, "solves the paradox of our ordinary existence by showing us outside of ourselves the cause which is to be served, and inside of ourselves the will which delights to do this service, and which is not thwarted but enriched and expressed in such service." In more recent times, psychologists have used the term "transcendence" for a version of this idea. Above the level of self-actualization in Maslow's hierarchy of needs, they suggest the existence in people of a transcendent desire to see and help other beings achieve their potential.
As our time winds down, we all seek comfort in simple pleasures companionship, everyday routines, the taste of good food, the warmth of sunlight on our faces. We become less interested in the rewards of achieving and accumulating, and more interested in the rewards of simply being. Yet while we may feel less ambitious, we also become concerned for our legacy. And we have a deep need to identify purposes outside ourselves that make living feel meaningful and worthwhile.
2015.01.31 draft jch