The Icarian

THE NURSING HOME CONFESSIONAL, A NURSING HOME TALE

By Karen Strickholm 05/01/2025

THE NURSING HOME CONFESSIONAL

Here is a powerful nursing home story I will never, ever forget. Please allow me to set the stage for you…

Day-to-day nursing home reality is alien territory for most folks. The early days “on the inside” are a particularly disjointed time. The new “resident” has just come through a medical crisis that spit them out into this strange new land. The psychological vertigo is very real, inviting deep reflection.

Maybe that’s why there can, early on, be the phenomenon of a “confessional” – a raw telling of one’s life story to another. This event has a formal, structured quality, akin to the telling of tribal tales around campfires of old, or the laying bare of truths with a priest. It is distinctly sacred.

The nursing home resident’s role is to tell their story.

My job is to powerfully listen. It can take minutes, or hours.

THE NURSING HOME CONFESSIONAL

Created special for you, a video of Depression-era photography set to the famed Carter Family song, “No Depression”

My new roommate and I are sitting on our beds in hospital gowns, across from each other.

Betsy, an 85 year old Anglo lady, begins to speak.

I know what is coming, and settle in.

Betsy’s tale is one of triumph over soul-crushing extreme poverty in the early 20th century.

She was born into a dirt poor rural southern family in the 1930’s, the heart of the Great Depression.

The nation is decimated, the New Deal has not yet rolled out, and Hoover’s tariffs have been an abject failure.It is a dark time in America.

The family lurches from farm to farm across the deep south and Texas, working the fields. A step beneath sharecropper and above total vagabond, whites, blacks and Mexicans labor in these backbreaking jobs together, too poor even for segregation.

All children help, from the moment they can walk. School is an occasional event. They are rooted to no place, no community. The extended family – more of a fractured clan – is flung across the south and west.

Betsy’s family crams into temporary rentals – usually a run-down shack, procured by the mostly-absent father, who shows up mainly to impregnate his wife and book their next quasi-slave labor gigs.

Mother and eight kids move from shack to shack, sometimes departing in the dead of night, because they can’t pay the rent. There is no such thing as medical care. The pregnancies continue, and when the baby comes, Betsy and her siblings deliver the child.

Against this backdrop, Betsy is the most functional one. Even now, all these years later, she exudes a down-to-earth practicality.

Then disaster strikes – her mother dies. How much can a woman’s body take, after all? The children are scattered to the winds, sent to various relatives to live. At age 12, Betsy is sent to live with the grandparents, and a new chapter, a fresh hell, begins.

Trigger warning…

THE NURSING HOME CONFESSIONAL

Each night, Betsy is required to share the bed with her grandmother.

With regularity, the grandfather climbs in, raping first the grandmother, then Betsy. This goes on for over a year.

It reminds me of a perverse variation of “droit du seigneur,” in which a lord held sexual rights over his female vassals. The absolute entitlement of it all. It’s staggering, the violence and complete destruction of norms which all too often accompanies poverty in America.

Betsy finally manages to get away when the grandfather falls ill. Barely 14 and lying about her age, she flees, providing her own food and shelter. She gravitates towards clerical work, ending up somewhere in southern California.

One day in that first year out, she doubles over in pain, passes out. She is rushed to the hospital, the first formal medical care of her life. It’s appendicitis. While still recovering from surgery, she learns the grandfather has died up north.

Righteous hatred can be a fuel, and it is thus for Betsy. She yanks out the IV tubes, dresses herself in her pre-collapse clothing, and heads immediately for the train station, an abdominal drainage tube still sticking out of her surgical wound.

She makes the hours-long trip to her grandfather’s grave site, arriving in time for the ceremony.

In front of the ragtag assembly of extended family members, Betsy marches to the graveside. In front of them all, she emphatically spits on his coffin, turns on her heel, does not look back. This is her moment of demarcation, her grand gesture, in which she severs her “then” from her “now.” With this act, she has declared to the family and universe that his abuses will not pass unmarked. His sins will not be buried with his body. And her horrific childhood will not dictate her life moving forward.

With that, Betsy begins to fully live her new life. She holds down jobs, meets a good man, marries, has a daughter. But this kind of trauma lingers, an indelible mark is left. It forged her, and it becomes fuel.

That is the heart of her life tale, told in the nursing home confessional.

A bitter-sweet monumental triumph, it is.

Betsy is a hero, no doubt.

This strong woman has accomplished the near impossible – She has lifted herself out of abject poverty and a life of abuse at a time when there were few choices or models and no such thing as social services.

All these decades later, she has chosen to share her life story with me in this sacred retelling. I recognize it for the tremendous honor it is. In this recitation, Betsy is teaching me – life goes on. Next chapters are possible. Good things happen.

You, too, will find yourself in a similar circumstance in your own journey into aging.

Your role will be to attentively receive the tale, with open ears and open heart, recognizing you have been endowed to receive and mark this sacred telling. It seems that when we carry a piece of it, the burden is eased for the teller.

“I was here. This is what happened. By speaking it aloud, I confirm it. Remember with me.”

Thank you for allowing me to share. With much love, Karen 💞🥰💞

PS: Here is your Amuse Bouche – a riveting interview with the godfather of AI and Nobel Laureate winner Geoffrey Hinton, who shares his perspective on this norm-shattering new capacity.

Next Episode:

MARIA & WHY, A NURSING HOME TALE

Previously:

Dying… Or Not. How People Die. Better Days

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About this series…
Karen Strickholm had a hidden brain tumor on her pituitary gland. The tumor she didn’t know she had until she was about 50, wound up taking her health and all she had built in life. Her tumor, diagnosed in 2008, caused a tsunami of symptoms and eventually forced her into long-term care in a nursing home and a series of hospitals.

This is America, the only developed nation that does not have universal healthcare, and the only developed nation where medical debt can force you into bankruptcy.

Karen became one of the financial statistics due to her medical debt, and the fact that she couldn’t get Medicare unless she was literally penniless.

What made Karen different from many other people was her relentless optimism and belief that she was going to get better, would walk out of the nursing home to build a new life. She was smart, a good writer and she left behind a number of digital artifacts, which have been collected into this series. Karen relates, in her own words, her journey through the American healthcare system and the reality living penniless in a nursing home long term.

Karen Strickholm died 6 April 2026 in a hospital in Albuquerque, New Mexico, of sepsis and pneumonia. She was 67.

This multimedia documentary series is her story.

Medical bankruptcy
• Approximately 66.5% of non-business personal bankruptcies in the U.S. were attributed to medical reasons in 2019.
• 1 in 10 U.S. adults (10.5 million) have experienced medical bankruptcy since 2001.
• 78% of bankrupt individuals in 2022 cited medical expenses as their primary cause.
• Medical bankruptcy rates increased by 21% from 2010 to 2020, even as overall bankruptcy rates declined
• The average interest rate on medical debt from bankruptcies is 21% (2022)
https://worldmetrics.org/medical-bankruptcies-statistics/
Nursing home stats
• On any given day, more than 1.3 million individuals receive care in a nursing home or skilled nursing facility, and a total of more than 4 million receive care each year.
• 6 out of 10 residents (64%) are short-stay patients who remain in a skilled nursing facility for an average of 25 days.
• Nearly four out of 10 residents (36%) are long-stay residents. These individuals often have multiple health conditions. Their average age is 76.
• Nursing homes employ about 1.5 million people.
• Nearly 90% are women, and 60% are people of color.
• One out of every five nursing home workers is an immigrant.
• There are around 15,000 nursing homes in the United States.
• The average size of a nursing home is 109 beds.
• Medicaid covers the cost of care for nearly two out of every three residents (63%).
https://www.ahcancal.org/Data-and-Research/facts/Pages/default.aspx