Tuesday, April 08, 2008

Reality Stinks

When the elevator door of my mom’s apartment building opened, I came face to face with a hospital gurney which was blocking my exit. It was in a vertical position, but not empty. There was someone on it, in a body bag –it was a first for me. Talk about coming face to face with reality. Just FYI, Mom is Ok, but Rosemary is not.

While elder care has become an important element in so many lives, it has also become an incredibly lucrative business. The people who own and run independent or assisted living facilities, as well as the people who pack nursing homes with people who cannot care for themselves, are generally not in it to do the righteous thing. They are in it to make money. A great deal of money. And they will succeed because there are so many families that can not take care of the elderly relatives for whom they assume responsibility.

Rosemary lived in my mother’s apartment complex. It is not called an assisted living facility. It is called a retirement community. Although there may not be much of a difference in how people are cared for in assisted or retired homes, there is subtle difference between the words and an enormous difference in attitude. Just think about the words assisted and retirement. One indicates an independence and the other a frailty. Here’s a subtle difference. When Mom resided in assisted living, she noticed that there was no salt, pepper or ketchup on the table. The staff seasoned your food — if it was permitted. All the coffee was decaf. There was no discussion about the caffeine and there was no choice about what she preferred. As it happens, she likes regular coffee in the morning. In the place termed assisted, the common rooms were lovely, the staff was nice, but there was no question that the residents were treated like entities in a profit center. The retirement community is less fancy, but the residents are encouraged to make their own decisions. They are treated like adults who have simply aged.

Rosemary sat at her meal table with four other people, but had no friends. I am told she was quiet and had very few visitors. She chose not to participate in activities, they were not what she called “her cup of tea”. So no one forced her to be uncomfortable in a group situation. Unlike Rosemary, my mother is quite social, and when she was in assisted living, the staff insisted she participate in everything that was offered. So she ran from activity to activity until she was exhausted. We think she thought that since she was paying to be there, she had to join in every activity. It was like attendance was mandatory. At the Madison Avenue Retirement Center where she lives now, she sometimes goes to a sing along, a birthday party, or a movie. But she doesn’t feel compelled to do anything. She doesn’t feel the need to pass the time in group commotion. She is calm but not bored spending her time alone in her apartment, watching the Hallmark station or a game show on her cable TV. She seems more at peace. But the most important thing is that she is no longer racing around trying not to be frightened about being alone. She is happy because my brother and sister-in-law live close enough to see her almost every day.

There is hardly a person who doesn’t want to face old age. Consider the alternative. But getting old is not easy on the elderly and it is certainly not easy on the people (unpaid) who are responsible for their care—if there is a person. In too many cases there is no one. Take for example the elderly woman I saw begging on 45th street in NY. At first I passed her by, but there was such a sadness in her eyes that I went back to give her a dollar. Her voice was small and apologetic when she thanked me and she shared a little of her story. “It wasn’t always like this for me. My husband left me years ago. We had a child who was very sick. It was very expensive to care for him. Then he died and I had nothing. My government check was too small to pay for the rent, food, utilities, and medicine. I had to move out of my home and now I live in an overcrowded kind of shelter, but I still don’t have enough money to pay for my medicine. It’s so expensive you know. I hope you are blessed with someone to take care of you.” Then she walked away. The cynic in me said she was making up a story because she wanted to be begging on a NY street corner. But the political philosopher, (some might say hack), added, what does it matter, “there but for God go I.”

Everyone knows there is a health care crisis. The elderly seem especially hard hit. Maybe because they aren’t prepared. (How many of us now young and healthy, even think about buying long term care insurance.) Some of them never expected to live beyond the time they had the means to support themselves. Some just never expected to have to face all the issues of getting old in a nation that doesn’t take care of the people contained within it’s borders.

In Europe, where there is socialized medicine, people may not have a choice of doctors, but if they are sick the costs are not such they have no choice but to die. They can go to the hospital without worrying about having medical insurance and they get the medicine they need to cure them of whatever disease without skipping lunch. If they can’t be cured, the government pays for them to die with dignity. In fact, if you get sick while you are vacationing, don’t call the American Embassy, you are not in their job description. But the country where you are visiting will provide care free of charge. I’m not saying socialized medicine is the route we need to go, but certainly whomever you vote for in the next election needs to make sure something changes. There are simply too many of the aged who now have to decide if they will eat, pay rent, or be well. The nameless woman I met on the street was just a little too close to home.

The next President will need to think about the consequences, not only for the elderly, but for those of us who will be there someday, because the impact on the economy and the culture will be disastrous and unimaginable if they look away. The next election is, unfortunately, not going to matter to Rosemary. But it is going to matter to those of us who want happy and healthy lives for ourselves and our families — without it costing so much that we can’t afford to live. Right now the reality stinks, but the only way it will change it is if we demand that the new President pay attention to all the ways in which we age, and all the positive possibilities that should be made available to do it gracefully. We're just sayin...


Anonymous said...

I'd like to know how many politicians have ownership in or invested money in businesses that care for the elderly or at least in the established health care system we suffer under today.

How many of them have tax payers dollars rolling into their pockets?

Do the politicians fear a change in the system 'cause it would change how those dollars reach their pockets?

Show me the money flow.


Unknown said...

The month I spent in a rehab center learning to walk again taught me a lot. Many of the people there were beyond taking care of themselves and they often would be left in their wheelchairs in front of the nurses' desk so they could be easily watched. It was pitiful. But others were like me--there on a temporary basis and able to speak up for themselves. Even a few who were there permanently because of severe physical issues could and did speak up. The center had regular meetings for residents and boy, did we tell them what was wrong. The man who ran the dining service ducked when he saw me coming in my wheelchair. So encourage the people you meet who can speak up to do so. Take them stamped envelopes with the address of the huge corporation that owns the facility. These people do not want complaints. None of this is easy and I know that your mom and Rosemary are beyond fighting, bless their hearts. But other fighters are there. By the way, I complained so often about getting cold food in my room that the dining director arranged for me to be seated in the main dining room, which was quite a way from my room. I got hot food then, but I kept complaining when the food that reached my hall was cold. We had to take care of each other.