Review by Eleanor J. Bader
When Lillian Deutsch was 87, she was hospitalized with pneumonia. Although she’d previously been active — she’d been a corporate executive, done stand-up comedy, and led numerous organizations in her Florida community — the respiratory illness led to other maladies, and she ultimately agreed to move to Wisconsin to be closer to her daughter, Judy Karofsky.
For the next seven years, Deutsch was relatively independent. Then, in 2013, she began having frequent ischemic attacks (mini strokes). That same year, a massive stroke impaired her mobility and speech. This was followed by a broken hip.
Independent living quickly segued into assisted living, and DisElderly Conduct traces Deutsch’s experiences at six different facilities over the next five years. She was sexually assaulted in one, and was handled so roughly in another that her arm was badly bruised. At still another, she was left on the floor for hours following a middle-of-the-night fall. In addition, her dietary preferences were ignored, and both she and Karofsky were deemed pests for asserting themselves.
Karofsky blames several factors for this mistreatment. Unlike skilled nursing facilities, neither assisted living nor memory care units — 70 percent of them owned by for-profit entities – are federally regulated and most receive minimal state oversight. Despite high monthly fees ($5000 to $20,000), Karofsky writes that shoddy care, often from barely-trained and badly-paid Certified Nursing Assistants, is common.
Then there’s hospice, which, like assisted living, is also run for profit. Gone are the days of palliative care volunteers helping the dying cross over. Instead, unregulated and unscrupulous providers have cashed in and Karofsky charges that “fraud and exploitation” are endemic.
DisElderly Conduct provides a disturbing and enraging glimpse into these elder-care industries. And while the book offers only bare-bones policy recommendations for federal and state monitoring, it is nonetheless essential reading for aging adults and their loved ones. Indeed, it’s a clear and impassioned call to action.
DisElderly Conduct: The Flawed Business of Assisted Living and Hospice by Judy Karofsky. New Village Press, May 2025.
Reviewer bio: Eleanor J. Bader is a Brooklyn, NY-based journalist who writes about books and domestic social issues for Truthout, Rain Taxi, The Progressive, Ms. Magazine, the Los Angeles Review of Books, and The Indypendent.
