August 14, 2007--Aging In Place
In the old days almost everyone remained at home while growing old and eventually dying.
If the family was fortunate they had a big house with a room upstairs where mom and dad continued to live surrounded by and taken care of by their children and grandchildren. I do not mean to romanticize this. In many cases having aging and sickly parents living with you was a daunting responsibility. At times their presence was so disruptive that it tore families apart, but for most people it was either how they wanted to live or they simply had no other choice.
Now we have so institutionalized old age and elder care that most seniors (even that appellation is a patronizing euphemism) who need assistance have a many-tiered series of places to which to go or be sent. From “retirement communities” to “assisted living facilities” to “nursing homes” to “hospices.” For too many they wind up in all four, what Anne Tyler in a novel that has this title calls “the ladder of years.”
I am of such an age now that I have visited many friends and relatives in such places. Some are clean and cheery and well managed. Others, too many, are so grim and uncaring that it breaks your heart to find a loved one warehoused in such circumstances. In too many cases this indignity is made worse by the guilt and financial burden placed on families. Even if inclined, with everyone needing to work and for most people living in modest-sized places, there is no good alternative to institutional care. And the prohibitive costs of care are such that families are frequently bankrupted in the process. Minimally, before Medicaid kicks in a resident in a nursing home needs to be “pauperized” (that’s literally the official word for this) before she or he become eligible for federal assistance.
Of course this is a national disgrace and needs fixing. No other developed country treats its old folks so cruelly. But we know that there are so many corporate and governmental forces aligned against systemic change that we had better figure out some alternatives to any dream of national health care—what opponents slander with the epithet “socialized medicine.”
There are some encouraging, still small-scale citizen-organized approaches that are reported about in today’s NY Times (article linked below). One has elderly neighbors forming nonprofit corporations that provide for them transportation, home repair, security, and other services so that they can remain where they are. Nine in ten Americans over age 60 say they want to live out their lives in their own homes.
This notion of neighbors coming together to help each other out through good and hard times has its roots in the earlier rural tradition of things such as barn-raising and farming cooperatives--I’ll help you build your place and loan you my harvester if you one day do the same thing for me.
We have gotten used to governments taking care of more and more of our needs while at the same time discovering in frustration that they are not very good at it. Our schools are failing, our infrastructure is crumbling, and when we have a disaster (Katrina) even our first-responders are incompetent and uncaring. Of course we shouldn’t give up on trying to hold public officials accountable; but while waiting for that millennium, figuring out how to take more control of our own lives so we can live the way we want to live sounds smart.
If the family was fortunate they had a big house with a room upstairs where mom and dad continued to live surrounded by and taken care of by their children and grandchildren. I do not mean to romanticize this. In many cases having aging and sickly parents living with you was a daunting responsibility. At times their presence was so disruptive that it tore families apart, but for most people it was either how they wanted to live or they simply had no other choice.
Now we have so institutionalized old age and elder care that most seniors (even that appellation is a patronizing euphemism) who need assistance have a many-tiered series of places to which to go or be sent. From “retirement communities” to “assisted living facilities” to “nursing homes” to “hospices.” For too many they wind up in all four, what Anne Tyler in a novel that has this title calls “the ladder of years.”
I am of such an age now that I have visited many friends and relatives in such places. Some are clean and cheery and well managed. Others, too many, are so grim and uncaring that it breaks your heart to find a loved one warehoused in such circumstances. In too many cases this indignity is made worse by the guilt and financial burden placed on families. Even if inclined, with everyone needing to work and for most people living in modest-sized places, there is no good alternative to institutional care. And the prohibitive costs of care are such that families are frequently bankrupted in the process. Minimally, before Medicaid kicks in a resident in a nursing home needs to be “pauperized” (that’s literally the official word for this) before she or he become eligible for federal assistance.
Of course this is a national disgrace and needs fixing. No other developed country treats its old folks so cruelly. But we know that there are so many corporate and governmental forces aligned against systemic change that we had better figure out some alternatives to any dream of national health care—what opponents slander with the epithet “socialized medicine.”
There are some encouraging, still small-scale citizen-organized approaches that are reported about in today’s NY Times (article linked below). One has elderly neighbors forming nonprofit corporations that provide for them transportation, home repair, security, and other services so that they can remain where they are. Nine in ten Americans over age 60 say they want to live out their lives in their own homes.
This notion of neighbors coming together to help each other out through good and hard times has its roots in the earlier rural tradition of things such as barn-raising and farming cooperatives--I’ll help you build your place and loan you my harvester if you one day do the same thing for me.
We have gotten used to governments taking care of more and more of our needs while at the same time discovering in frustration that they are not very good at it. Our schools are failing, our infrastructure is crumbling, and when we have a disaster (Katrina) even our first-responders are incompetent and uncaring. Of course we shouldn’t give up on trying to hold public officials accountable; but while waiting for that millennium, figuring out how to take more control of our own lives so we can live the way we want to live sounds smart.
posted by Steven Zwerling at
10:16 AM
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