MAKING GRAY GOLD

Another strong plea for change in America's health-care system, this time with nursing homes under the spotlight. The graying of America has provided a gold-making opportunity to some, according to Diamond (Sociology/California State Univ.), who says that caretaking is a nationally subsidized business in which governments dispense enormous sums of Social Security, Medicare, and Medicaid moneys to corporations that pay workers sub- poverty-level wages and dehumanize patients into units called ``beds.'' To get the inside story, Diamond became a certified nursing assistant and for over a year worked in three Chicago-area nursing homes, with both private-pay and Medicaid patients. An astute observer, he describes how vocational schools prepare—or rather fail to prepare—nursing assistants for ``the firing line of health care,'' and how this care is administered in nursing homes. His fellow workers were almost entirely women of color from Third World countries, forced to hold down two jobs to survive. Diamond reports on how patients, 80 percent of whom are women, are gradually pauperized under the government's spend-down policy, whereby individuals must exhaust their own resources before becoming eligible for Medicaid. By inspecting and certifying nursing homes, the state, Diamond says, implicitly endorses poverty wages for workers and the pauperization of patients. In such a dynamic, he contends, quality care is unlikely if not impossible. The picture Diamond paints is not a pleasant one, but there is a note of optimism in his final ``I-have-a-dream'' chapter, where he sees the road to change through unionization of nursing-home workers and greater input into care issues by residents and their families. Revelatory eyewitness descriptions, plus sobering analysis, add up to a commendable addition to the growing literature on what's wrong with our health-care system.