Dignity and the aging poor or Getting old is a bitch

Dignity and the aging poor        

or Getting old is a bitch

 

Recently a friend of mine and her family were faced with a difficult decision. Her mother has been in and out of hospital in the last couple of years and has some mobility issues. At the hospital they claim she can no longer live on her own. The family relative who has been taking care of her and my friend’s dad who is also in poor health can no longer care full time for them. Her mother was pushed into a permanent nursing home residence while undergoing rehab. It’s not that clear that she understood what was entailed in that. While some might see this as okay she will end up separated her from her husband, in far less than ideal circumstances and cause difficulties in the family. Splitting up the couple seems cruel, but that is the nature of contemporary health care. It too often follows a medical model and not a model that stresses the dignity and autonomy of the aging person. This is doubly true if you are poor. The poor person who needs care is often just a throwaway. They cannot get the resources they need to stay at home and when they must be in a home the kind of setting that makes life worth living. They don’t even have the basics of privacy. More than just the reduction of the person to a medical patient without dignity being poor makes one more open to coercion and loss of autonomy in decision making and subject to conditions that are depressing and sometimes dangerous.

 

Too often healthcare providers use manipulative tactics to get older folks into nursing homes. They threaten them with sanctions or legal action if they want to keep their relatives at home. In this case the family was threatened with the loss of health services. They said if her mother wanted to live at home against their wishes they would cut off health care to her. I am not sure what that means, since they cannot actually cut off all care, but obviously some services are involved. It is the threat however, that is at issue. The attempt to coerce compliance through threats seems unacceptable. It goes against our sense that people ought to make decisions freely and with due consideration. It is not even clear in this case that my friend’s mom actually realizes that she has committed to live in the nursing home on a permanent basis. She keeps asking when she is going home.

 

 Often however these decisions are made in circumstances in which alternatives are not available or presented. My aunt for example faced a similar problem when her husband had a stroke and could no longer take care of himself. She too was coerced into placing him in a local nursing facility which was not very good. I wouldn’t wish the treatment he received on my worst enemy. He lived out his life often medicated and sometimes restrained because he was sometimes agitated and unable to communicate his needs. He lived without dignity or much compassion or care at the nursing home. It was only because his wife came to the nursing home every day and cared for him that he had any quality of life at all. It is a lousy way to end your life. My father used to call the homes where the poorer elderly were forced to live chicken coops, He wasn’t far from the truth. We ought to wherever possible help people to live in their own homes. Many nursing homes don’t do the job.

 

The decision to place him was however, not simply a medical one, he had problems but did not require or get constant medical monitoring. It was largely an economic one that is one of supple and cost. Although my aunt and her husband were not poor they lacked the resources to get any of the nursing care reserved for the rich they simply had to place him where space was available whatever the quality. And nursing homes seem anxious to fill beds to capacity without much concerns for the person and her dignity/

 

The situation with my friends mom seems little different. The social workers say she can’t live alone without almost 24 hour care. They live in a semi-rural area and the options are limited. The family had to take that nursing home otherwise the family would have to travel many miles to see their mom. The nursing home where she will stay will put her in a double room with another person she does not know. She has no TV and no access to the recliner she has at home is not available. Once she is a patient in the home she will not even be getting physical therapy she is basically left alone with little contact except family visits. In short she has little or no privacy. Getting a phone and TV is extra money that the family really can’t afford. You have to wonder whether the situation is really in her best interests. From what I can tell she is not going to get much attention there. The risks of such institutional neglect seem worse than dangers she might face at home where at least her husband is there. The nursing home has made little attempt to provide a place where both could stay together.

 

Dealing with an ill and aging parent is stressful in itself. But being in a nursing home that is less than optimal can divide families. Some see no choice, while others find the ill treatment and indignity of the conditions heart breaking, In any case even those who see the necessity of institutional care, are affected by the decline of their relative under poor conditions. Of course the conditions of home care are often stressful too. Caregivers often sacrifice and find that the area care without enough help can be very difficult. Yet as people live longer and with more chronic diseases these choices are going to be more a part of the lives of children and parents. But really it is the economic situation that is driving the problem. As our society is characterized by greater inequality and as the middle classes disappear Fewer and fewer elderly will have the resources to deal with the challenges of old age. The burden then falls on their children who are themselves are struggling economically and socially. As with other social issues the risks are being pushed downward onto those who are least capable of carrying further burdens. We are creating a major crisis in the care of the elderly.  THe children and relatives of the elderly should not have to risk financial ruin or bankruptcy to provide their parents a dignified life,

As with most goods in our society the divide between the access of the well off and he weaker in will increase.  Few will have the resources for quality elder care. Like our children who are being ill served by an education system that is breaking down the elderly are in the process of becoming another throwaway generation. The children of the family don’t have the resources they need to deal with the situation. They all work and at jobs that don’t pay enough IF their children have to quit jobs or work part time to take care of them then they too will suffer. They face financial ruin and emotional turmoil just to provide a dignified life for their parents.

 

Perhaps there are some better solutions and more help available but the family isn't aware of that they have met with social workers to attempt to get more help. Getting information on available resources is a big problem. When possible the best thing is try to keep elderly in their homes. There are a few programs that help a bit when elderly are not too bad, but there needs to be more what they start to decline. If the choice is a chicken coop, separated from your spouse and family or living at home, the answer seems simple. Yet families will need help to keep parents at home when their health problems increase. Those resources are not really available.

 

We need to rethink the way we treat the elderly in several areas. First we need to take seriously a transition away from a strictly medical model to a human flourishing one, the aim should not be simply following the judgments of doctors and the medical community about the health of an elderly person, but the wellbeing of the individual taken broadly. Ethical and moral issues such and dignity and autonomy of the elderly need to be emphasized. Second we need to provide more resources, yes public resources toward keeping the elderly at home or in places where their care and needs are paramount. Third we need to provide more resources to caregivers if they find they have to stay with parents who are in declining health these include economic support and emotional ones as well.