SW. Sri. Med. Vol. 30. No. 7. pp. 837-838. 1990 Pergamon Press pie. Printed in Great Britain

BOOK REVIEWS

Dying and Disabled Children: Dealing with Loss and GrieJ Edited by H. M. DICK, D. P. ROYE, P. R. BUSCHMAN, A. H. KUTSCHER, B. RUBENSTEIN and F. K. FORSTENZER. The Haworth Press, New York, 1988.524.95 (hardback), 153 pp.

This short monograph was published simultaneously as Loss. Grief and Care, Vol. 2, Nos 314. There are 17 contributors including orthopaedic surgeons, nurses, social workers, psychiatrists, a psychologist, a bereaved parent and a funeral director. Only 3 of the 6 editors have con- tributed to the text, which begins abruptly with a contri- bution by Denton, a paediatric orthopaedic surgeon, on traumatic amputation in childhood, considering the func- tional and psychosocial aspects. Several of the chapters deal only with the surgical or medical aspects of a chronically disabling condition; limb amputation, scoliosis, sarcoma and muscular dystrophy. One of the few research studies reported here is on the advantage of early spinal stabilisation and fusion in patients with Duchenne Muscular Dystrophy. It seems to have nothing to do with dealing with loss and grief, the sub-title of the book. The other chapters are describing in one way or another the psychological reactions of children and adolescents who are chronically disabled or dying and the effects on their parents. There is little or no mention of siblings and very little attempt to review the literature on the incidence of the various phenomena or to detail the interventions that could be helpful.

Many chapters have no references at all, and the large literature on the psychosocial aspects of disablement and death is barely addressed by any of the authors. The one chapter by a psychiatrist (not, I think, a child psychiatrist) is 3 pages long, and addresses inadequately the subject of emotional reactions to the loss of the body part. Some chapters appear to have strayed here by accident. For example Kaiser, in a chapter entitled ‘The needs of sarcoma patients, from diagnosis through follow-up’ is clearly talking about adults. Children are never mentioned. It would be helpful to know what credentials a Professor of Gerontol- ogy has for writing in a book on dying and disabled children.

Nowhere in this book is it clearly set out what are the general effects on children, their siblings and their parents of chronic disease and of life-threatening disease and how they differ, how family members respond to bereavement and most importantly, how can they best be helped? The editors have failed to do the job. They have written no editorial overview to help us to understand for whom this book is intended, and they have failed to edit out and at the same time have not ensured that what needs to be covered in a book of this title, has been covered. It should have been the task of one of the writers to have surveyed the world literature on this subject. One is used to American writers’ parochialism, but modern electronic library aids now provide no excuse for a public display of it. For example Wilson’s statement that her hospital has developed “a unique program, the Palliative Care Center.. .*’ is not tenable in the light of Domenica’s description of Helen House [I] to which reference is not made.

It is difficult to know for whom this book was conceived and written. The surgeons’ accounts of their practice might be helpful for non-medical people working with their patients, and the lists of psychological reactions might be useful for surgeons. It is however, unlikely that surgeons will turn to the surgical chapters for new information or that psychologists, psychiatrists and social workers will find much to help in the other chapters. For me, the most refreshing and helpful chapter is the pragmatic account by Schaefer, a funeral director, of how he talked with his children about death and how he helps his clients to do so.

REFERENCE

I. Domenica F. Helen House-a hospice for children. In Hospice Approaches to Paediatric Care. Springer, New York, 1985.

DOR\ BLACK Consultant Child & Adolescent Psychiatrist Royal Free Hospital London NW3

Quality Impact of Home Base for the Elderly, by F. G. BARRO and A. E. BLANK. Haworth Press, New York.

Home Health Care Programme available to all citizens whose income precludes them from providing services for themselves.

Impending legislation relating both to the health service and to community care mean that, in the United Kingdom, there are likely to be major changes to the managment of disabled elderly people living at home. It is particularly opportune, therefore, that a book should be published on the commu- nity care of the elderly in a society with a health care and social service structure radically different from our own. The society in question is New York, and the reason for the book is that the city has led the way in the United States in developing an effective home care programme for old people. Its main thrust is the report of a survey which attempted to audit the effectiveness of the service.

837

The first chapter sets the scene by reviewing home care in the United States. It would appear that the administration of this is even more complex than in the United Kingdom in that sources of funding include Medicare, Medicaid and Title IIIB Provision under the Older Americans Act. The New York City Department for Aging has navigated through this morass of legislation to produce a Long Term

A major economic impetus to developing home care programmes in the United States has been the proliferation of nursing home places. These are expensive and have been a considerable drain on public funds. Particular concerns are that in many areas the number of places exceeds local need, and that many residents have been admitted with a level of disability which could readily have been managed in their own home. Those of us coping with a similar expansion in Great Britain. will be interested to note that the United States is beginning to tackle the problem by introducing rigorous preadmission screening programmes for potential residents, and by compelling potential nursing homes to apply for a Certificate of Need before they open in a particular locality.

There is a brief account of the home care service in New York. The key individuals are the housekeeper, and the home attendant. The former provides support with house- hold activities and shopping, while the latter is primarily concerned with helping in self care activities such as