Tuesday, March 21, 2006

A Fate Worse than Death

A fate worse than death - I remember this cliché from my childhood - it connotes some horrible suffering, in that death would be the ultimate misery, so this fate alluded to must be worse.  

We all want to live long, but we don’t want to get old.  Or, in the baby boomer generation, we are even more concerned with not looking old.  It’s so ironic that we diligently exercise and watch our diets, some of us anyway, hoping against hope that we can extend our youth - perhaps stretch our forties another ten years.  Then we start to consider “having some work done” whereby we look like sixty year olds with face-lifts.  I saw a woman in the grocery checkout line, obviously a wealthy woman from her dress and her jewelry.  She had a sleek reddish pageboy hairstyle and the windswept smooth complexion that women with face-lifts have.  She was slim and well dressed, but looked strange nonetheless.  She was probably around 70, which is not old really, but her hair and her face were attempts to stay in her forties.  

My Dad recently celebrated his 96th birthday.  Now that is unabashedly old.  No more senior citizen, no more sugar coating.  96 is getting up there.  Still, there are those who are so amazing.  Right here in our community, there is a 96-year old woman who plays golf every day.  A TV station did a segment on her, and she was as alert and agile as a person many years younger.  No cosmetic surgery for this gal!  She was proud of her age, and lucky to live a full and active life.

But what about those who have not been so lucky?  Age is not always kind.  People, even in midlife are struck down by disabilities.  When a person gets past 85, the chances of their being able to live the life they lived in the past is greatly diminished due to physical or mental impairment.  This is where the gray clouds start to blow over old age.  How do they cope with the inevitable losses, and we aren’t talking about a few extra pounds, or an earlier bedtime here.  How do people live when they are disabled by old age?  They enter into the system.

The system is a dirty little secret, known only to the elderly, the disabled and those who love them.  The system is comprised of hospitals, skilled nursing facilities (“nursing homes” to a lay person), assisted living facilities (and all euphemisms marketing departments can come up with).  Being placed in assisted living or a nursing home is no one’s idea of aging gracefully.  Few will move into long term residential care voluntarily.

Why, in a country where we enjoy arguably the highest standard of living on the planet, is our treatment of our elders so bad?   We warehouse people in long-term care facilities, provide the residents minimal care and pay the people who actually provide the direct care a pittance.  It is a downward spiral for the frail elder, despite perhaps decades invested in trying to live a long life.  This is the payoff, a bitter pill.  They are confused and frightened surrounded by a chaotic environment full of many marginally educated people, often recent immigrants, who would be considered the working poor.  Low pay and other operational difficulties in facilities result in constant turnover, poor communication, mistakes and general lack of personal attention.  None of this nurtures the elder, or is even a pathetic substitute for a home life.  It is a result of a watchful eye on the bottom line by an administrator or corporate parent who has cultivated “disassociation”.  There are some exceptions, some caring wonderful people involved in facilities, and more power to them, very literally.  

We need to re-write this final chapter in people’s lives.  We baby boomers may have a better handle on why this can occur in our country.  We understand the goals of corporate America, and those who look to corporate America as their business model.  Their mantra - lower operating costs, maximize profit and shareholder return.  But this isn’t manufacturing widgets; this is people’s lives, the frail and the disabled.     We understand that employers are getting killed over Workers’ Comp and liability insurance.  We understand that “there are some jobs Americans don’t want” as our illustrious president George Bush said recently.  We understand the disparity between the salaries of people who sit in meetings all day and the people who are changing a diaper at midnight on a Saturday on a long weekend.  Let’s upgrade the salaries, educational opportunities, benefits and working conditions of these direct care jobs, lower profits and executive compensation, and then see if the standards of care are raised.

What else, besides pay the bottom-rung employees more, can we do to make it right?  Or will moving into a nursing home remain, 30, 40 years from now, a fate worse than death?