Q&A with Jo Owens, author of A Funny Kind of Paradise

Jo Owens became a nursing home aide in Canada out of a need for money, and came away with her calling. And from that experience, the pain and the human glory, came her debut novel A Funny Kind of Paradise, set in a Canadian nursing home.

The Vancouver Sun wrote “Owens…captures the skill and tenderness of caring for someone at the end of life in direct and unvarnished prose…Each [care aide] …is richly drawn and complex… [and the novel] serves to illuminate a vital profession that has been rarely documented in fiction.”

“Her writing is richly informed by her 20 years working as a care aide in Victoria, British Columbia,” said interviewer Len Fishman, head of the University of Massachusetts Gerontology Institute. And their conversation continues from there. Thanks to Taryn T. Hojlo for the interview transcription.

Author Jo Owens

LF: Let’s start by asking why you became a care aide and what’s kept you in that profession for 20 years?

JO: Actually, desperation drove me there. Much like Molly [a character in the book], an aide suggested that I take this job and that I would be good at it, and I absolutely needed money. That got me over the initial stages when it was terrifying to be doing something so new. What keeps me at it is that I have a calling for this work. I definitely ended up in the right place.

LF: The book’s narrator is Francesca, or Franny. She’s in her late sixties, and a stroke has left her unable to move, walk, talk, or eat, but Franny’s cognition is completely intact. Tell us more about her, and let’s start with you reading a passage.

JO: [reads from A Funny Kind of Paradise – youtube link]

“Franny says, ‘The stroke has left me emotionally labile, and the feelings I’ve struggled so hard to contain (or at least disguise in shrouds of anger) are naked for all the world to see. I literally lack the muscular strength to suppress them.

But here is the gift. I don’t care. I don’t care! My right hand is useless, I can’t speak and more people have seen my bare ass in the last year than if I was a streaker at the opera, because I need my diaper changed, for God’s sake. Do you think I care if you see me cry?’”

LF: Tell us a little more about her.

JO: Francesca was a strong, independent woman who ended up raising her two children on her own. She’s a home-based small business accountant, and she kind of came at life as though…if you attacked it with hammer, you’re going to get the job done. That’s not necessarily the best way to parent children, so like everyone else, she has her own baggage and things to think about. Originally, she was the kind of person who would say to herself, as you often hear people say, “If that happens to me, I would rather die.”

LF: She recalls a time when she accompanied her son’s class to a nursing home around Christmas time. When they leave, she tells him, “I’d rather be dead than have to live in a place like that.” Later she thinks, “I changed my mind when I came here.” What changed?

JO: First of all, I think that the will to live is extremely strong. We think that we can’t tolerate this, but it’s amazing what humans can get used to and even learn to embrace. Partly, that’s what’s going on, but also Franny was fortunate to end up in a good facility where she has loving care and she’s still engaged in life. She enjoys watching the care aides that work around her and gossip freely in front her because Franny can’t repeat what she’s hearing. She thinks about her children and she’s still engaged with her son who comes to see her. There’s enough in her life to make her life meaningful. This is my experience at work. When suffering becomes acute, residents do say they’d rather die. And we do hear that. But generally speaking, I find that people want to live. And they continue to want to live. Much longer than we’d think.

LF: Franny’s got issues – fear and anger are her “left and right crutches” as she puts it – and she’s really trying to work through them. Have you seen residents that you’ve cared for grow emotionally as she does?

JO: Absolutely. Absolutely I have seen people change and grow. We do. Our situations force us to. It was the famous psychologist, Karen Horney, who said, “Life itself remains a very good therapist.” Things happen. We’re forced to change, and life doesn’t stop because you’re forced into care. You’re still going to be changing. For Franny personally, I used my imagination obviously to create what’s happening to her, but as she thinks about what is meaningful in life, thinks about what she can change and what she can’t change – particularly with regard to her son, her missing daughter, and how she behaved in the past – as new residents come into her life, she is adjusting her thinking and she’s moving along in her mind, as people do. And yes, I’ve seen that in care.

LF: So, as you’ve mentioned, Franny’s brain is sharp and because she can’t talk the aides are actually more willing to speak their minds in front of her, even confide in her. What were you hoping we’d learn, through her, about the inner workings of a nursing home?

JO: One of the reasons I set this novel in a five-bed ward is because I wanted to be able to show Franny listening to people talking all the time…I wanted people to see how human your aides are…Every one of your [aides] comes with their own set of baggage. And I wanted to show some of the things that the care givers are trying to balance, some of the things that they have on their plate. The struggle that is part of life, trying to triage six to eight – or in worse scenarios, 12 to 14 – residents. Who eats what, who do you go to first? How can you give everyone good care, not just the ones that can speak up and demand it, but also the ones that are immobile and deserve just as much of your love and attention? I wanted to do that in a way that wasn’t completely preachy, and boring and I really hope that I achieved that goal because what happens in [nursing homes], in that private little world, is frequently not seen, and I wanted to show it.

LF: In Franny’s world, licensed nurses, whether it’s LPNs or RNs, are distant figures and doctors are almost entirely absent; it’s all about the aides. Is this what it looks like on the inside?

JO: I’m sure I showed quite a bit of bias there because I am a care aide, so I think it’s all about me [laughs]. But, in terms of the bulk of time caring, aides are the faces that the residents are going to see the most. I see my people every day, whereas the doctor might see you every two weeks if you have a problem, less if you don’t. The LPNs are going to see you every day also to give you your pills and if you have a dressing change, you’ll see them a little bit more. The RN, as I mentioned to you before, at my facility the RN has one hundred people. They’re going to deal with problems. So, it may be very difficult to even know their name. The care aide is the person that they see. I did an interview with a person in Toronto whose father was in care. He told me that the care aides became his father’s family. Even though I only know a small portion of my resident, the part that they are now – the whole iceberg of their previous life is unknown to me except for a little bio that might be done by a social worker or a family member – I have this tiny little part of this person, right? But they’re still mine. I have them every day. I know how they want their socks pulled up – do you want a little space at the end, or do you want them nice and snug? Do you want your tea spun like this or like that? They’re mine.

LF: I want to ask you about families of nursing home residents, especially those that visit frequently. What qualities do staff most appreciate?

JO: The first thing that’s coming to my mind, Len, is forgiveness. Maybe I’m only speaking for myself, but I want to be forgiven for my imperfections. I’m going to do the very best that I can, and sometimes it’s going to feel like it’s not enough because sometimes it’s not enough – I just run out of time. I forgot to bring your husband down for his visit, which is now going to be downstairs in the village square, or I’m not able to brush your family member’s teeth, their hair isn’t…Yeah, I want to be forgiven for the fact that I can’t do a perfect job. Maybe other care aides would speak differently.

LF: Two aides in your book are talking about the difficult daughter of one of their residents. The mother is pretty difficult, too. And one aide sums up her philosophy as follows, “If we only looked after the people who deserved kindness, it’d be a skinny job.” This is a telling commentary on the challenge of being a good caregiver, so tell us about it.

JO: This reminds me of a fridge magnet I once saw that said, “The staff are human and will react unpredictably when abused,” as opposed to being a robot. Every healthcare worker has a right to be treated like a human being. We have little signs in our elevator saying that if you don’t treat the staff with respect, you will be required to leave. But the people that I’m working with are emotionally labile and sometimes they have difficulty controlling any number of their emotions, whether it’s anger or frustration or – sometimes they yell at us, sometimes they hit us.

LF: In recognizing the time that we’re living in, in the U.S., residents account for about 40 percent of COVID deaths nationally. In Canada, the percentage is even higher. It seems to me that this hasn’t caused as much of an outcry as one might expect. What do you think?

JO: So, this is a question I was asked in the NPR interview and so I gave it a lot of thought, Len, because I had difficulty answering it. And here’s the reason I had difficulty: I do not want to contribute to our phobia of death. There is a time when it is good to die. At the same time, how we treat the more vulnerable members of our population during a pandemic is a measure of our integrity as a society. It’s really important not to get the idea that any group in our society, whether it’s their age, their ethnic background, their financial worth, their sexual orientation, that that group is in any way disposable, because that’s the kind of thinking that Hitler had. It is not acceptable.

LF: What do you want people to know about your job?

JO: Well, I was hoping that with my book I would be able to increase empathy for the people that live and work in care. But what would I want them to know? We’re here and we’re alive and just as important as anybody else – really that’s the only message.

Dean David Cash announces retirement of Institute Director Len Fishman

I write to announce that Len Fishman, after serving seven years as director of the Gerontology Institute at the McCormack Graduate School of Policy and Global Studies, will be retiring on August 31.

Gerontology Institute Director Len Fishman

A nationally recognized leader in health care and aging, Len’s priorities as director were guided by two goals. First, increasing the institute’s relevance, reputation and influence through its research and policy work. Second, boosting external funding.

He achieved both. Thanks to the Institute’s enterprising faculty and fellows, external funding from grants nearly tripled during Fishman’s tenure, and private donations soared. Financial support for students increased two and a half times, opening doors for future scholars and policymakers.

Fishman also helped the Institute become even more prominent in its signature areas of research on older people, including economic insecurity, race- and ethnicity-related health disparities, healthy aging, and age-friendly communities, while striving to bring that work to the attention of policymakers and the general public through robust communication.

The Gerontology Institute also deepened its expertise in long-term services and supports (LTSS) under Fishman by adding a fourth center — the LeadingAge LTSS Center @UMass Boston. This three-way partnership among Community Catalyst, LeadingAge and UMass Boston unites researchers and policy analysts in academic and applied settings, an innovative collaboration illustrative of Len’s knack for building strategic alliances whose whole is greater than the sum of their parts.

Fishman and Gerontology Department Chair Jeff Burr treated their respective units as a united enterprise, resulting in increased productivity of faculty and more opportunities for students to conduct research, be mentored, and earn money for their education. Fishman and Burr led the recent effort to establish the Frank Caro Scholarship for Social Justice in Aging. Named after one of the UMass Boston Gerontology program’s founders, the fund has raised approximately $370,000 thus far. The funds will be used to recruit and support doctoral students from under-served communities.

“The last seven years have been the best years for gerontology at UMass Boston and a lot, a lot, a lot of the credit goes to Len,” Burr said.

Len came to UMass Boston after serving for 12 years as CEO of Hebrew SeniorLife, New England’s largest nonprofit provider of senior housing and health care. Prior to joining HSL, Len was president and CEO of LeadingAge, in Washington, D.C., which represents 6,000 non-profit senior housing and health care providers in the U.S. and Canada, serving over two million older people. Before that, he served in the cabinet of Governor Christine Todd Whitman as commissioner of the New Jersey Department of Health and Senior Services, where he led the governor’s initiative to unite programs serving older people into one cabinet-level department. He previously practiced law as a health-care lawyer in New Jersey and Pennsylvania.

“We are on the cusp of the greatest demographic transformation in history,” said Fishman. “The human lifespan has increased by more than a third, and very soon, one in five Americans will be 65 or older. Yet we are nowhere near ready to meet the challenges or take advantage of the opportunities presented by these changes. Our gerontology program is a beacon of learning and hope.”

“I will, of course, remain involved in the field of aging. As our chancellor, Marcelo Suarez-Orozco recently observed, population aging is one of the three greatest challenges facing humanity. My generation (me included) has not covered itself in glory in dealing with the other two: climate change and racialized inequity. My retirement will allow me to spend more time on both. It’s been an honor to work with the Gerontology program’s talented faculty, fellows, staff and students, and a privilege to work at the nation’s third most diverse university during this most recent racial reckoning. The demographics of UMass Boston’s students are a preview of what our nation is becoming – they are my greatest source of hope for the future.”

Book Investigates the Pandemic and its impact on Older Adults

Journal of Aging and Social Policy special edition examines scope,
impact and lessons drawn from Covid-19 for older adults

A special double-issue of the Journal of Aging and Social Policy (JASP) that focused on Covid-19 has been released as a book. “Older Adults and Covid-19: Implications for Aging Policy and Practice” provides 28 articles written by leading gerontology researchers. The authors offer perspectives from around the globe on a host of issues surrounding the virus and its impact on older adults, their families, caregivers, and communities.

Edward Alan Miller

Editor-in-chief Edward A. Miller

Originally published in June 2020, this issue’s release as a book by Taylor & Francis Publishing indicates that the critical questions raised and the policy changes proposed to protect this vulnerable population moving forward deserve continued attention.

“This book is important because nearly everything addressed in the special issue six months ago is still relevant today which reflects poorly in our response as a nation,” said Edward Alan Miller, PhD, a professor at UMass Boston and editor-in-chief of JASP.

As Miller points out in the book’s introduction, older adults have been hit particularly hard by the pandemic. Exposure to the virus has resulted in older adults dying in disproportionately higher numbers, especially in long-term care facilities. Government-mandated actions to lessen the impact of the virus on older adults have had adverse consequences such as increased social isolation, separation from family members, enhanced economic risk, and challenges getting basic needs met. Continue reading

UMB Gerontologists Tell Legislators Research, Preparation Keys to Helping Older Adults Deal with Impact of COVID-19

Len Fishman, Elizabeth Dugan and Jan Murtchler

Left to right, Gerontology Institute Director Len Fishman, associate professor Elizabeth Dugan and professor Jan Mutchler. Fishman, Dugan and Mutchler appear in photos below.

UMass Boston gerontologists offered legislators two suggestions for state government in the midst of the COVID-19 pandemic: Help researchers better understand what has happened to older adults and get elder Massachusetts residents prepared for a more challenging future.

Gerontology Institute Director Len Fishman, associate professor Elizabeth Dugan and professor Jan Mutchler all appeared individually at a May 15 virtual listening session hosted by the legislature’s Joint Committee on Elder Affairs. They joined a wide range of advocates, policymakers and other members of the public to describe the impact the pandemic has had on older adults and what state government should do to help. Continue reading

Institute Talk: A Conversation with Hospice Physician Joanne Lynn About Nursing Homes Dealing with COVID-19


Joanne Lynn is a nationally recognized expert on issues related to palliative and end-of-life care. A geriatrician and hospice physician, she is the author of hundreds of journal articles and many books on issues concerning long-term services and supports. Very recently, she has written articles offering detailed advice for nursing homes dealing with the coronavirus pandemic and an overview of policy priorities for upcoming COVID-19 related deaths out of hospitals.

Gerontology Institute Director Len Fishman spoke with Lynn on April 3 about the daunting health challenges facing nursing homes and the best ways facilities can respond to them. The following transcript has been edited for length and clarity.

Len Fishman: Let’s start by explaining the particular risk COVID-19 poses to residents of nursing homes and other facilities like assisted living?

 

 

Joanne Lynn: The people who live in nursing homes and other residential facilities tend to be not only in the age group that has high risk but also to have multiple complicating conditions that make it very difficult to survive a serious bout of COVID-19. Still, many people get a mild case and sail through or have very mild flu symptoms and feel sick for a few days but do okay. But a substantial proportion will have a serious illness. And it looks like something on the order of around 20 percent will die from COVID-19 in these conditions. Continue reading

Institute Talk: A Conversation With Vince Mor on Alzheimer’s Care and the State of Nursing Homes

Len Fishman and Vince Mor

Len Fishman, left, and Vince Mor

Vincent Mor is a leading academic expert on eldercare issues and a national authority on research related to nursing homes. The Brown University professor has been principal investigator in more than 40 grants funded by the National Institutes of Health that focus on the use of health services and the outcomes experienced by frail and chronically ill persons.

Mor and Susan Mitchell of Hebrew SeniorLife are leading an ambitious new collaborative research incubator for “pragmatic clinical trials” that test and evaluate interventions for Alzheimer’s disease and related dementias. Last month, they received a grant from the National Institute on Aging expected to total $53.4 million to fund that work over the next five years. It was one of the largest federal grants ever awarded for Alzheimer’s care.

Gerontology Institute Director Len Fishman recently spoke with Mor to talk about his new project and discuss the state of the struggling nursing home industry. The following is an edited version of their conversation. Continue reading

UMass Gerontology Alum Natalie Leland Receives $4.7M Contract for Dementia Care Research

A research team led by UMass Boston Gerontology alumna Dr. Natalie Leland has received a $4.7 million contract to compare the effectiveness of two care delivery models for nursing home residents living with dementia.

The contract from the Patient-Centered Outcomes Research Institute will fund a five-year study comparing care models at 80 nursing homes in 10 geographic regions across the United States. More than 700,000 Americans residing in nursing homes live with Alzheimer’s disease or dementia. Continue reading