Rethinking Old Age

[alocispepraluger102]

(giving up my way of life is one of my most frightening thoughts.)

Guest Columnist

Rethinking Old Age

By ATUL GAWANDE

At some point in life, you can’t live on your own anymore. We don’t like thinking about it, but after retirement age, about half of us eventually move into a nursing home, usually around age 80. It remains your most likely final address outside of a hospital.

To the extent that there is much public discussion about this phase of life, it’s about getting more control over our deaths (with living wills and the like). But we don’t much talk about getting more control over our lives in such places. It’s as if we’ve given up on the idea. And that’s a problem.

This week, I visited a woman who just moved into a nursing home. She is 89 years old with congestive heart failure, disabling arthritis, and after a series of falls, little choice but to leave her condominium. Usually, it’s the children who push for a change, but in this case, she was the one who did. “I fell twice in one week, and I told my daughter I don’t belong at home anymore,” she said.

She moved in a month ago. She picked the facility herself. It has excellent ratings, friendly staff, and her daughter lives nearby. She’s glad to be in a safe place — if there’s anything a decent nursing home is built for, it is safety. But she is struggling.

The trouble is — and it’s a possibility we’ve mostly ignored for the very old — she expects more from life than safety. “I know I can’t do what I used to,” she said, “but this feels like a hospital, not a home.” And that is in fact the near-universal reality.

Nursing home priorities are matters like avoiding bedsores and maintaining weight — important goals, but they are means, not ends. She left an airy apartment she furnished herself for a small beige hospital-like room with a stranger for a roommate. Her belongings were stripped down to what she could fit into the one cupboard and shelf they gave her. Basic matters, like when she goes to bed, wakes up, dresses, and eats were put under the rigid schedule of institutional life. Her main activities have become bingo, movies, and other forms of group entertainment. Is it any wonder most people dread nursing homes?

The things she misses most, she told me, are her friendships, her privacy, and the purpose in her days. She’s not alone. Surveys of nursing home residents reveal chronic boredom, loneliness, and lack of meaning — results not fundamentally different from prisoners, actually.

Certainly, nursing homes have come a long way from the fire-trap warehouses they used to be. But it seems we’ve settled on a belief that a life of worth and engagement is not possible once you lose independence.

There has been, however, a small band of renegades who disagree. They’ve created alternatives with names like the Green House Project, the Pioneer Network, and the Eden Alternative — all aiming to replace institutions for the disabled elderly with genuine homes. Bill Thomas, for example, is a geriatrician who calls himself a “nursing home abolitionist” and built the first Green Houses in Tupelo, Miss. These are houses for no more than 10 residents, equipped with a kitchen and living room at its center, not a nurse’s station, and personal furnishings. The bedrooms are private. Residents help one another with cooking and other work as they are able. Staff members provide not just nursing care but also mentoring for engaging in daily life, even for Alzheimer’s patients. And the homes meet all federal safety guidelines and work within state-reimbursement levels.

They have been a great success. Dr. Thomas is now building Green Houses in every state in the country with funds from the Robert Wood Johnson Foundation. Such experiments, however, represent only a tiny fraction of the 18,000 nursing homes nationwide.

“The No. 1 problem I see,” Dr. Thomas told me, “is that people believe what we have in old age is as good as we can expect.” As a result, families don’t press nursing homes with hard questions like, “How do you plan to change in the next year?” But we should, if we want to hope for something more than safety in our old age.

“This is my last hurrah,” the woman I met said. “This room is where I’ll die. But it won’t be anytime soon.” And indeed, physically she’s done well. All she needs now is a life worth living for.

Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston and a New Yorker staff writer, is the author of the new book “Better.” He is a guest columnist this month.

Edited May 25, 2007 by alocispepraluger102

[The Magnificent Goldberg]

This looks pretty reasonable. I look forward to the old folks home that will handle my 78s, 45s, LPs, K7s and CDs.

MG

[porcy62]

Never thought I will reach such age. The males of my family died well before nursing home. Genetic, not pessimism.

[ghost of miles]

Some older folks I know have opted for "assisted-living" situations, in which they're part of a senior community, but still in their own apartment or home... and a nurse checks in on them several times a day.

My grandmother, an 88-year-old ragtime pianist, is still living on her own, though she now needs others to drive her to her gigs and social get-togethers.

[Peter Johnson]

My grandmother, an 88-year-old ragtime pianist, is still living on her own,

Don't want to hijack the (very good) thread, but damn, Ghost, that's totally cool. Can you tell us more about her? Makes me smile just thinking about her!

[Tim McG]

Old age sucks....I'm here to tell you.

[brownie]

I'ld rather die than go to a nursing home

That's my attitude so far. I may change my mind if I finally grow up!

[Tim McG]

I may never change my mind.

[sidewinder]

As long ast they can take care of the Mosaics and change the LPs for me on the deck once in a while as I slurp my tea, I don't care..

[brownie]

As long ast they can take care of the Mosaics and change the LPs for me on the deck once in a while as I slurp my tea, I don't care..

but then you will be in trouble when time comes to replace the stylus!

[sidewinder]

As long ast they can take care of the Mosaics and change the LPs for me on the deck once in a while as I slurp my tea, I don't care..

but then you will be in trouble when time comes to replace the stylus!

I'll place an indefinite contract with my hi-fi dealer to periodically service the deck etc. every few years before senility sets in.

[Free For All]

Clark Terry's current line (these days he requires assistance to his place on stage) is:

"The Golden Years SUCK"!

[J.A.W.]

I'ld rather die than go to a nursing home

Same here.

Edited May 26, 2007 by J.A.W.

[porcy62]

As long ast they can take care of the Mosaics and change the LPs for me on the deck once in a while as I slurp my tea, I don't care..

but then you will be in trouble when time comes to replace the stylus!

I'll place an indefinite contract with my hi-fi dealer to periodically service the deck etc. every few years before senility sets in.

It would be nice, but what about if your dealer is older then you?

[The Magnificent Goldberg]

As long ast they can take care of the Mosaics and change the LPs for me on the deck once in a while as I slurp my tea, I don't care..

but then you will be in trouble when time comes to replace the stylus!

I'll place an indefinite contract with my hi-fi dealer to periodically service the deck etc. every few years before senility sets in.

It would be nice, but what about if your dealer is older then you?

Three no trumps.

MG

[Tom Storer]

Personally, I'd rather go to a nursing home than die, but who knows how I'll feel when the time comes.

My father, in his late 70's but still pretty valiant, was going through a perfectly understandable period of depression and self-pity after his wife passed away about a year-and-a-half ago. He was a little unsteady on his pins and had been forgetting things, so he decided the time had come to go to an assisted living place--to us it seemed clear he just wanted to give up the fight and be looked after.

A relative took him to check out one such place, and that was enough. Creeped him right out. "I'm not ready for that yet!" he declared. Hasn't mentioned it since.

[Jazzmoose]

I'ld rather die than go to a nursing home

Same here.

At this point in time (nearing fifty) I'd have to agree. Frankly, it sounds a lot like prison. Hell, might as well go out in a blaze of glory and rob a bank if I'm going to be institutionalized anyway. Anyone know how to mount an automatic weapon on a walker?

[Shrdlu]

Well I can't let this go by without saying that the Lord Jesus Christ gives everlasting life (John 3:36) if you accept him as Saviour, and also you get a new, indestructible body when you go to be with him. It's all a gift, so why not do so?

There might still be a spell in a nursing home before leaving this world, but what's that compared with eternity? And God takes care of all your needs here on earth, too.

Jesus said "I am come that they might have life, and that more abundantly". Check it out!

[Hot Ptah]

In the afterlife, we will all have a complete set of all Mosaics ever issued, or to be issued.

[The Magnificent Goldberg]

In the afterlife, we will all have a complete set of all Mosaics ever issued, or to be issued.

I could do without the T-Bone Walker as I have all but a couple of tracks. Will it be compulsory?

MG

[jazzypaul]

Fuck the nursing home thing and the assisted living thing. And, except for the cases where severe medical care is necessary, fuck the kids that would put their parents in these places.

Call me old fashioned, but I WANT my parents living with me when they're old. I WANT them around my kids to give advice, keep them entertained, and pass on their wisdom. I WANT my kids to get grandparently love for more than simply the holidays. Not to mention, what's better: being around a whole bunch of old people waiting to die, or around a bunch of young people that want to live life?

[alocispepraluger102]

Fuck the nursing home thing and the assisted living thing. And, except for the cases where severe medical care is necessary, fuck the kids that would put their parents in these places.

Call me old fashioned, but I WANT my parents living with me when they're old. I WANT them around my kids to give advice, keep them entertained, and pass on their wisdom. I WANT my kids to get grandparently love for more than simply the holidays. Not to mention, what's better: being around a whole bunch of old people waiting to die, or around a bunch of young people that want to live life?

beautiful uncommon natural thoughts.

a couple of my friends from india feel the same as you, but no one else i can think of today.

[sal]

Well I can't let this go by without saying that the Lord Jesus Christ gives everlasting life (John 3:36) if you accept him as Saviour, and also you get a new, indestructible body when you go to be with him. It's all a gift, so why not do so?

There might still be a spell in a nursing home before leaving this world, but what's that compared with eternity? And God takes care of all your needs here on earth, too.

Jesus said "I am come that they might have life, and that more abundantly". Check it out!

I hate writing this, Shrdlu, becuase I normaly really enjoy reading your posts and I think you're a great member of this board and are probably a really nice person, but you should really stop to consider if posting stuff like this might offend some board members. If it needs to be posted, there are pleanty of religion threads in the Politics forum.

Carry on.

[jazzypaul]

Well I can't let this go by without saying that the Lord Jesus Christ gives everlasting life (John 3:36) if you accept him as Saviour, and also you get a new, indestructible body when you go to be with him. It's all a gift, so why not do so?

There might still be a spell in a nursing home before leaving this world, but what's that compared with eternity? And God takes care of all your needs here on earth, too.

Jesus said "I am come that they might have life, and that more abundantly". Check it out!

I hate writing this, Shrdlu, becuase I normaly really enjoy reading your posts and I think you're a great member of this board and are probably a really nice person, but you should really stop to consider if posting stuff like this might offend some board members. If it needs to be posted, there are pleanty of religion threads in the Politics forum.

Carry on.

Sal,

when you make this exact same statement to some of the people who post anti-religious remarks, you'll be righteous in doing so. Until then, this has been the single most hypocritical thing I've seen in at least 3 or 4 hours.

Carry on.

P.S. I'm out in Aurora often (my parents live out that way). We should grab a drink some time.

[Jim Alfredson]

Please keep religious discussions in the political forum. Thanks!