Harvest Moon: Portrait of a Nursing Home

Harvest Moon tells us about the realities of daily life in a nursing home. It concerns all of us!

Category: Healthcare

Of Interest:

Dynamics of Institutional Change: The Hospital in Transition

Hospitals, Health and People

The White Labyrinth: Guide to the Health Care System

Long-Term Care in Transition: The Regulation of Nursing Homes

In her portrait of a nursing home, Sallie Tisdale brings to life a unique community and all its idiosyncratic members. The nursing home is a kind of tribal village with a culture of its own, its own language, ritual, and hierarchy. With extraordinary eloquence she tells the day-to-day story of Harvest Moon Care Center, much like many other nursing homes in the United States. With lucidity, insight, and compassion, she explores the complex problems facing nursing homes, patients, and their families. Sallie Tisdale brings the issues into focus. Sometimes grim, often inspiring, Harvest Moon is unforgettable.

Brings to life a unique community and all of its idiosyncratic members with lucidity, insight and compassion. Tisdale explores complex problems and brings them into focus with astonishing power.

Sallie Tisdale uses her vantage point as a registered nurse to present an intriguing look at the structure, operations, staff, and patients of a typical nursing home named Harvest Moon. The privacy of the people she encounters at work has been protected with pseudonyms, but her descriptions of physical facilities, the behavior of individual patients, the commitment of nurses, and other varied issues and relationships encountered in nursing homes will be recognized as true by anyone familiar with this area of healthcare.

Harvest Moon is, in the main, a humanistic portrait of a nursing home. Tisdale takes no political position, nor does she offer solutions to the problems of nursing homes and the larger social problem of providing quality healthcare for the elderly. In keeping with the book's humanistic tone, the author is also not critical of any of the many individuals who appear in her fictionalized, but true-to-life, nursing home.

Harvest Moon, like the large majority of nursing homes that have a limited number of patients, staff, and administrators and a singular focus on care for the elderly, adopts a kind of tribal village approach (rather than a corporate approach) to providing healthcare for the aged. Without going into the causes of problems in the nursing home industry, Tisdale does nonetheless note that the shift "undeniably and inexorably toward profit" in this field has created a situation where the "demands of profit-oriented budgets are made worse by the shortage of help." Staffing issues have long been a problem in an industry where the annual turnover rate is sixty percent. Although the "boom" of the nursing home industry has run its course since the book was first published in 1987, conditions in nursing homes are still more or less the same, and the same problems remain. The author's observations that the cost of nursing-home care sometimes causes "impoverishment" for individuals and their families is familiar.
With scenes, dialog, recurring characters, and a loose story line, the book reads like a novel. Tisdale's remark, "It is a beautiful and perfectly clear day, a day of short sleeves and no clouds," draws a sharp contrast with the atmosphere of the nursing home with its fluorescent lights that illuminate the same no matter what kind of day it is. A relative of one of the patients comes in with "a shiny pink raincoat." Her hair "falls lankly below her stooped shoulders" as she "steps up to the counter like a Fate." In another place, "smells of kitchen steam and urine, mop buckets and laundry, and disinfectant...mingle together in the halls." These and other vivid descriptions draw the reader into the experience of having entered a nursing home.

Unlike most other books that look into the healthcare industry, Harvest Moon does not delve into issues of organizational structure, present cost analyses, opine about government intervention, or offer a laundry list of solutions. Yet all of this can be plainly inferred by any reader with knowledge of the recognized problems of modern-day healthcare and the debates on dealing with those problems.

In places, Tisdale cites numbers and other facts of the nursing-home field - for example, "…there are almost 24,000 nursing homes in the United States….Nursing homes house two million people at a cost of over $30 billion dollars annually - about eight percent of all the dollars spent nationally on health care." In other places, she uses settings, situations, and individuals to bring in background material on the nursing home industry. Such techniques do not take away from the author's aim of conveying just what things are like in a nursing home - rather they supplement her objective. For example, her vivid description, "[t]he third hall, C Wing, is a sickly orange, and has room for forty patients requiring professional nursing, or 'skilled care'", is followed in the same paragraph with an explanation of what "skilled care" means and how it differs from the care provided in hospitals. She continues on to further explain how the skilled care of modern healthcare for "patients who would have never left the hospital" in previous decades but now must do so because of the crushing costs of hospital stays is part of the reason for the growth of nursing homes and the problems they try to deal with. But, as always, Tisdale returns to the illustrative examples of Harvest Moon. For example, a paragraph begins, "The patients on C Wing are notable most of all for variety in condition and disease," followed by the naming of these.

There is no better book than Harvest Moon for getting a true picture of a nursing home. It is an exemplary humanitarian tale, while also relating the fundamentals of the business and healthcare issues that have to be taken into account for problems with nursing homes to be alleviated and perhaps some day remedied.

A registered nurse, Sallie Tisdale is the well-known author of six books and many articles and also a contributing editor of the magazine Tricycle. Her work and interests in the healthcare field have been recognized with awards and fellowships, including an NEA Fellowship.

[A] vivid account... a description of how professionalism and human decency combine to make a nursing home a livable world of its own

"It is unlikely that anyone else will lead us into the nursing home with as much wisdom and beauty of craft...we are in her debt." (Richard Selzer)

"A rare combination of candor, compassion and deft art. I recommend this book to anyone seriously intending to grow old." (Josh Greenfield)

"A tough book, written with tenderness and warmth...It certainly should be read by anyone who has a loved one in a nursing home. The rest of us should read it just because it is an honest book. Honesty is a rare find these days."

This is a benign depiction of the nursing home for which the author works as a nurse. We are introduced to the nurses, aides, and administrators devoted and not so devoted who do a difficult job with difficult and unappreciative patients. There is a valuable chapter on the limitations of Medicare and the consequent negative effect on health care.

Ms. Tisdale speaks knowledgeably about reforming Medicare and Medicaid regulations that bewilder patients and frustrate administrators. She also tackles tough ethical questions involved in caring for the terminally ill, and she even shares her thoughts about why she and others were drawn toward working in a nursing home. In her narrative, a young nurse's aide suggests that everyone in high school do her kind of work for one month, saying, 'They'd look at elderly people in a different way, they would know more about themselves and how life really goes.' Short of that, there is 'Harvest Moon.'

'I have written a kind of travel guide, a gentle introduction to a foreign land,' writes Sallie Tisdale in her introduction to this accurate but poignantly beautiful description of life in nursing homes. . . . Stories of resident/patients are told with sensitivity and with respect for their individual dignities. The staff who run Harvest Moon, or who provide professional care, receive equally careful attention. Tisdale interlaces tender narrative with descriptions of rules and regulations. She tells what average nursing homes are like, emphasizes the team work that keeps them running, and lists criteria that must be met before the various needed services can be paid for. This is an ideal introduction to nursing home activities.

Sallie Tisdale, the winner of several literary awards, is the author of four nonfiction books, including, most recently, Stepping Westward. Her outspoken personal exploration of sexuality, Talk Dirty to Me, was published in 1994. Ms. Tisdale worked as a registered nurse from 1983 until 1990. During this time, she drew upon her nursing experiences for her book, Harvest Moon: A Portrait of a Nursing Home (1987); in it she portrays an adult care facility in the pacific Northwest, describing in particular the bonds between staff members and residents.

Ms. Tisdale has contributed to numerous publications, including Vogue, The New York Times, Harper's, The New Republic, and The New Yorker. She writes a column for Salon, the online magazine.

Ms. Tisdale received the James T. Phelan Award in 1986, and a national Endowment for the Arts Fellowship in 1989. She lives in the Northwest.