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School of Social Work College of Human Ecology East Carolina University Greenville, NC 27858 jenkinsca{at}ecu.edu

Gert's Secret. Video/2004/60 min. Directed and produced by John Kastner, in association with CBC and the Documentary Channel. Distributed by Filmakers, Inc., 124 East 40th Street, New York, NY, 10016. 212-808-4980. Online: www.filmakers.com. E-mail: info{at}filmakers.com. Rental, $85 (90-minute version, $100). Purchase, $295.

This video is the second in the three-part Rage Against the Darkness series, produced by Emmy-award winning John Kastner. The series explores issues surrounding the necessity of moving a frail older person into a nursing home. Most of the issues are troubling: older people's determination to avoid the move at all costs, including jeopardizing their very lives; family members' guilt at their inability to find feasible care arrangements other than a nursing home; and the despair and hopelessness so many older people experience when the move is made. Gert's Secret shows these aspects as well, but also provides an alternative picture, that of someone who seems to have adjusted relatively well to life in a nursing home. The title implies that we will learn the "secret" of her adjustment to nursing home living—a lesson that could prove helpful to future nursing home residents as well as their families and staff members in such facilities. Gert has seen many changes over the 15 years she has lived in this facility, including its evolution from a senior retirement home into a skilled nursing facility, the concurrent increase in residents' disability, and encounters with new roommates on a fairly regular basis. The video uses footage of Gert's experiences in the nursing home as well as interviews with Gert, several of her family members, and nursing home staff members to address the question of how she has successfully survived so many years of nursing home living.

A strength of the video is that it presents positive aspects of nursing home living that help to temper the many negative features that so immediately come to mind. The video begins by following Ave Burgess, the home's acting administrator, as she walks through the halls of the home. She stops often to talk with residents, frequently giving them hugs, always ready with a cheerful or sympathetic word. A later segment depicts the recreation director visiting various rooms in an attempt to convince residents to participate in a planned event—although many refuse her invitation. She notes that residents are "not here because they want to be, but because they have to be." In spite of their lack of interest, she recognizes that staff members are actually the residents' "family for the last years of their lives." She creates a memorial to residents who have died over the 10 years she has worked at the home, compiling a volume of their pictures so they will be remembered. These two women demonstrate how caring staff members can help to ease the loneliness of residents. At the same time, there is no escaping the sad truth of nursing home living: no one actually wants to be there. Not even in this "nice home with nice people on staff," as the narrator notes. He goes on to state that older people share a common dread that their children will "abandon" them, putting them "at the mercy of uncaring strangers." Ms. Burgess describes her own mother's fear of being "dumped" in a nursing home.

The video also uses Gert's experience to show the positives and negatives of nursing home living. Early in the video she is shown being taken to the horse races, accompanied by a staff member from the home. She obviously enjoys her outing and talks delightedly about the money she has won. She laughs easily, enjoying her own jokes and the banter with other residents as well as staff. Gert is always well groomed, taking pride in her appearance. We see her getting a manicure, and the narrator states that she sometimes changes her clothes three times a day. While she cannot walk by herself, she gets around by using foot motion to move the wheelchair in which she sits. She is vocal when she has complaints, making them clear to her daughter, Norma, and to the nursing home staff. Norma visits Gert on a regular basis and does all of her personal laundry. She tells the administrator that she thinks Gert has survived 15 years of living in the home through "just plain stubbornness. Nothing's going to beat [her]." Gert's grandson alludes to this side of Gert's character as well when he states, "She's been fairly feisty all her life."

We then see a change in Gert, following a serious fall that results in her losing much of her independence. The video shows her in bed and in pain, needing help from the staff to move about. Once she is up, she can no longer get around easily in her wheelchair. When she is in bed, she must have the bedrails up; and this confinement is a real sore point with Gert. As she shakes the rail, she complains bitterly, "I can't stand this thing. It drives me nuts." Ultimately she finds herself sharing the room with a woman who has dementia. One downside of living in a nursing home is the inability to choose one's roommate. Gert has readily adjusted to new roommates in the past, most likely, notes Norma, because she is friendly to them without becoming a friend. Her new roommate's presence, as well as her confusion and inability to carry on a conversation, annoy Gert, and leave her feeling frightened. She begins to look less happy. Gert doesn't smile anymore as her health seems to deteriorate further.

Then something surprising happens: Gert begins to improve. She increases her independence, learning to move her wheelchair by turning the wheels with her hands. We see her dressing for an outing with her daughter and son-in-law, who drive her around their old neighborhood. Gert begins to smile again. Finally, we see her celebrating her 103^rd birthday at a party in the nursing home; she is laughing and joking with relatives and staff just as she used to do.

It is disappointing, and a weakness of the video, that it ends at this point, leaving the viewer to speculate about the reasons for Gert's revival. The secret of her survival over 15 years of living in the home has been addressed specifically a few times during the video: her "feisty" personality, her "stubbornness," even the caregiving support still provided by her daughter Norma. There is implicit evidence that Gert's ability to cope is affected to a great extent by her health, although no direct correlation is documented. When her health deteriorates after her fall, she concurrently loses much of her independence, leaving her unhappy and seemingly without hope. Was it her "feisty" personality that made her determined to gain back her strength, to learn to mobilize her wheelchair by new means and thus gain some independence—ultimately improving her mental health and ability to cope? Was it Norma's caring and support, her determination to get Gert out of the nursing home at least briefly that gave Gert hope again? Was it simply an improvement in health that gave her renewed physical and mental strength? Viewers are left to draw their own conclusions about these questions.

Overall, Gert's Secret provides a thought-provoking picture of living in a nursing home. It addresses issues related to family caregiving, nursing home administration, quality of life, and psychological aspects of aging. It would be an excellent video for students in programs related to gerontology, geriatrics, allied health sciences, nursing, and health care administration. The video comes with discussion questions and a sample worksheet (unavailable to author) that should enhance the learning experience.

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