HBO's unusual comedy 'Getting On' tackles aging and death

The creators of 'Big Love' and a cast of glamour-free actresses shine a light on elder care

Actresses Alex Borstein, Laurie Metcalf and Niecy Nash star in the HBO show "Getting On," now concluding its first season.

When it comes to shows about aging, it’s a shame — or perhaps a blessing — that our highest in high-tech TVs still cannot transmit odor. On the new HBO docu-comedy “Getting On,” set in the dreary extended-care unit of a hospital in Long Beach, Calif., viewers are spared some authenticity: the smell of feces left on an armchair, the stench of an unwashed homeless patient wearing layers of old coats.

“Getting On” is an unglamorous, deadpan series shot in muted Instagram tones, featuring middle-aged and elderly actresses without makeup. (It passes the Bechdel test with flying colors.) Through six first-season episodes, the last of which airs Sunday, it has proved to be a medical drama free of the genre’s tropes — constant emergencies, surgical miracles, high-tech equipment and break-room sex — that instead puts the labor of caretaking front and center.

As Americans debate Obamacare and aging baby boomers plan their twilight years, the show highlights an essential labor force and a senior demographic mostly absent from primetime TV. It simultaneously critiques medical bureaucracy, the high cost of American health care, union dispute-resolution and the callousness of patients’ grown children (one played by a petulant Molly Shannon). It is funny and painful, often at the same time.

The show stars Alex Borstein (of “Family Guy” fame) as Dawn Forchette, an insecure and occasionally ineffective nurse who tries hard to do right by her patients. Nurse Dawn supervises nurse DiDi Ortley (Niecy Nash from “Reno 911!”), who is less experienced but more capable and naturally empathetic.

The women report to their mostly inept superiors: Jenna James, a neurotic, ambitious doctor (Laurie Metcalf from “Roseanne”), and head nurse Patsy De La Serda (Mel Rodriguez from “Community”), who busies himself with consumer-satisfaction surveys, decorations and happy slogans instead of patient care.

Seniors at the Lifelong Medical Marin Adult Day Health Care Center in Novato, Calif., 2011.
Justin Sullivan/Getty Images

While staff members are the show’s focus, patients and visiting family members are also portrayed, often with tender hilarity. There’s the disoriented Asian patient whose loud monologue Dawn and DiDi — in a sidesplitting scene critics love — imitate in an effort to get “something Chinese-y” (Khmer, it turns out) translated via a telephone language line.

There’s the mentally ill, high-strung bully who hurls racist epithets at the nurses, only to have her vomit wiped up by DiDi, who is African-American. And longtime patient Birdy gets caught fellating and having sex with her octogenarian boyfriend, after which she suffers the humiliation of having to get consent from her adult sons.

"Getting On" creators Will Scheffer and Mark V. Olsen, the married couple and team behind HBO’s “Big Love,” based the show on a BBC program of the same name and their own experiences. In a recent interview with NPR’s Terri Gross, Olsen said, “Both Will and I have, over the course of the last 5 to 10 years, been devoted to the care of our mothers, who are aging.… An additional item for me on this show is going through my mother’s care and going through it with her extended team of caregivers. There’s such a value to the work that those people do.”

To train for her role as Nurse DiDi, Nash spent two weeks doing rounds with real nurses at hospitals and senior centers. “I got a chance to see up close the lifestyle, the conditions, the sickness, the inevitability,” she said in a phone interview. Working on the show led her and her husband to visit a Screen Actors Guild senior home and decide to retire there, so as not to burden their children.

As Americans debate Obamacare and aging baby boomers plan their twilight years, 'Getting On' highlights an essential labor force and a senior demographic mostly absent from primetime TV.

Mike Smith, a real-life Nurse DiDi, has worked at a California extended-care facility for about three years. (Unlike on the TV show, most “LTACs,” for “long term acute care,” are separate from general hospitals.) During hectic 12-hour shifts, Smith — who asked that his name be changed in this story for fear of losing his job — tends to patients, instructs family members on end-of-life decision-making, covers for other nurses and navigates the red tape of Medicare and private insurance. 

“I thought (the job) was going to be, ‘Hey, Mrs. Jones, do you want some ice chips?’ but it’s a lot of poop and death,” Smith said. “Quite a few of the patients are elderly and have multiple, heavy-duty problems. For many people, it’s their last stop.” Elders at a neighboring retirement home call his workplace “heaven’s waiting room,” he said.

The emotional and physical labor of LTACs is relentless, as depicted in episode four of “Getting On,” when Nurse DiDi works the night shift all alone. And yet, “Generally, these extended-cares pay very poorly,” said Margie Keenan, 64, secretary of the California Nurses Association. “I don’t know if our society really values our seniors,” and the same goes for their caretakers, she said.

On the show, Nurses DiDi and Dawn belong to a union, but this is still rare for extended-care and nursing-home employees, whose wages and benefits are, on average, much lower than those of comparable hospital workers. Several weeks ago, Kindred Hospital Westminster, in Westminster, Calif., became the first regional LTAC to join the California Nurses Association, by an overwhelming vote.

Keenan, a fan of “Getting On,” sees the show as very realistic, despite its slapstick moments. The bonding between nurses and patients, hospitals’ “dumping” patients on clinics and long-term facilities, the pressure to discharge them as soon as possible, understaffing, superficially cheery messaging and occupational hazards like exhaustion and heavy lifting — they are all a daily reality, she said. 

In "Derek," available on Netflix, Ricky Gervais plays a worker at a nursing home.
Netflix/Everett Collection

Elder care is a pressing national concern. The Congressional Budget Office estimates that by 2050 one-fifth of the population will be 65 or older, with a rapidly growing segment older than 85. In 2010, the average cost of a semiprivate room in a nursing home exceeded $6,200 per month, according to the Department of Health and Human Services. And the Pew Research Center found last year that nearly half of adults in their 40s and 50s face “sandwich generation” duties: While raising or supporting a child, they also have a parent aged 65 or older.

“Getting On” captures and transforms these anxieties through the power of comedy. It has been well received by critics and fans, as much for its complex acting and writing as for the issues it takes on, though HBO has not announced whether there will be a second season. It belongs to the same docu-comedy genre as the British series “Derek” (on Netflix, streaming in the U.S.), starring Ricky Gervais as an autistic helper-saint in a low-budget English nursing home. But “Getting On” avoids “Derek’s” sentimentality and its long flashback sequences set to sad indie rock.

Nurses Dawn and DiDi are compassionate but imperfect and often overwhelmed. Their deadpan expressions mask the absurd, hilarious interactions that drive the show and save viewers from despair.

In the face of dying and death, the surreal becomes a salve, both on TV and in real life. “Every day, I’m going in and watching people prepare to say goodbye to each other forever,” said Smith, the RN in California. “With my wife and me, too, it’s going to be like that. One day, all of a sudden, I’ll just blink — now we’re at the end of our lives!”

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