Lovely (background)

Sunday, August 22, 2010

Where are we all going?

I heard a story on NPR this week about a pastor from a church in Virginia, Kenneth Dupin, who is believed to be revolutionizing life for the elderly who are facing nursing home placement. He is the founder of the MEDCOTTAGE, or as the kids are calling it the “Granny Pod.” It’s basically a home on wheels (portable) with “advanced health monitoring equipment” that is intended to be placed in a family’s backyard where mom and dad or grandpa and/or grandma can live when they are no longer safe or able to remain in their own homes. Instead of facing institutional life, i.e. the nursing home, for a mere $2,000 a month, one can bring mom or dad home to live within arm’s length, and still offer some form of independence.

Albeit a great concept, Dupin has overlooked several factors that affect a person’s need for a nursing home. Like, how is mom, who is no longer ambulatory, supposed to get to the bathroom on her own during the day when daughter and son-in-law are at work from 8-5pm (sounds like a broken hip if you ask me). And, what about our beloved Alzheimer's patient who will (and I promise THEY WILL) wander out of that MEDCOTTAGE in a state of confusion while looking for ‘their home.’ Or, I love this one, how many seniors and their families can realistically afford $2000 a month for, essentially, rent? Not including monthly food, medicines, supplies, etc. The reality is such a concept may very well appeal to only a very small portion of the population; a portion who can, financially and physically, afford to have options. Of the “million and a half” seniors currently living in nursing homes across America, I doubt this concept will affect even 1% of them.

Let me tell you a little about why the typical nursing home resident goes into the nursing home: 1) their health is so severe that they require 24/hour nursing care simply to maintain; 2) their cognitive status is so lacking, due to some form of dementia, that they no longer recognize their family members, nor are they able to eat on their own, and they spend their days displaying obscene childlike behaviors or unsafe wandering; and 3) their family and loved ones live states away, or for whatever reason are not able or willing to take them in. I’d wage my bet that #3 is in fact the #1 reason any senior is institutionalized.

The sad fact is we live in a society (specifically white American society) that does not value caring for ‘our own.’ Rather than planning how we will care for our parents when they can no longer care for themselves, we PLAN on them going somewhere to live, where OTHER people will take care of them, where we don’t have to worry about it… or perhaps we avoid the subject all together. Because let’s face it, we simply don’t have the time or resources. Rather than handle the stress, the financial burden, or finding the time, we put them away!
But, did you know, in almost every other culture in the world, nursing homes are rare!... even a disgrace! Even in America, I find very few people of Hispanic, Asian, etc., dissents in a nursing home. And, during my master’s degree I had several classes with a girl from Russia, who was specializing in gerontology in order to take back what she learned to Russia, where nursing homes were just surfacing. She told me how in Russia, nursing homes were like 3rd world care, and no one wanted to send their loved ones to one because it was seen as shameful. It was a last resort, often for people without children. I’ll tell you from experience, most (and I say most to be pc, but I’d personally tell you ALL) nursing homes are basically 3rd world care. Compared to the care that one could receive from their own family, from people who actually know and love them… how could it truly compare?

In my practice, I make it a habit of comforting and relating to caregivers and family members who make the decision to place their loved ones in a nursing home. In fact, I am likely the one educating them about their option to do so. And, I especially empathize with the senior who is being placed, as this is not something any person at any time in their life hopes for. Although, I recognize this as the main reason we as a society can plan on life sucking after 70, I realize that society made its choice decades ago. When the family unit changed, i.e. divorce rates sky rocketed, fathers AND mothers began working full time, retirement age breached 73 years, etc., we also began to see the grandparent forgotten. And what decades ago did to produce such a mainstream phenomenon, I am not going to overturn by berating an overwhelmed caregiver for their choice to place their loved one at a facility. I respect this decision and do my best to ensure some quality of life from then on for that senior.

For myself, although my parents are only in their 40s, I am already thinking about how I and my siblings will plan to care for them as part of our individual families. I do hope that in some way, this will validate my parents’ lives as something meaningful… with something to look forward to beyond their retirement years… beyond the time when they can no longer give to society, or produce….. and give them continued hope… where one day they will die not alone in a stale room with unfamiliar things, but with those they love, and who love them… and where they are offered joy even at the end.

Otherwise… what are we all living for?

6 comments:

  1. I apologize for the length of this post... I feel this is the quintessential issue with aging, and thus I was unable to shut up sooner. I promise the future posts will not be as lengthy, and I do appreciate you reading despite the fact.

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  2. Preach on, Desiree! It is such a sad thing to see family members placing their loved ones in nursing homes because it's convenient. I understand that it's a "burden" to have them, but family is family. Would it be as socially acceptable to place a child in a children's home because raising them coincided with ones work schedule and it was too expensive to have them at home?
    I always joke with my mom to enjoy having me live on my own because once she gets old she's gonna have to live with me and cook for me and raise my children (which I guess is not really me taking care of her, but she knows I'm kidding).

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  3. For us, it was solely #2, even though #3 was true in part. my grandmother can't be alone all day, can't remember to eat, brush teeth, drink water or milk, let alone take her own medicine. she doesn't know if it's night or day, are you coming home in an hour or a week. she also can't remember what you said to her two sentences ago, so being with her 24 hours a day would put anyone in a nursing home themselves. she also demands her own independence, and gets a bit nasty if any of us try to remind her to take her meds etc. however she's quite responsive to the staff at her assisted living facility, even though she accuses them of stealing things.

    What you've said is fair considering the point you are making, it IS sad that people stick their family members in nursing homes because it is merely convenient, but they certainly can't be "3rd world" standards (running water, hello!).
    There is also something to be said for the dignity of the elderly, not wanting to be reduced to a second childhood in front of their own child (diapers changed, etc) and this puts so much strain on a relationship...sigh. i could go on... i guess i am just trying to argue that what seems "right" might not always be "best," for the grandparent, or the children.

    Here's my point: there is room to argue that the way we care for peoples' health (and what we consider to be health) needs to change, as this generation is "living" well past what their minds and bodies (and families) can handle. i think this is in fact the quintessential issue with aging: we're not prepared to be this old!!! (the word prepared is key here)

    How you plan for your care as you age is a huge part of how you manage your health and well being. The fact is, it's just another thing we are forgetting when we provide health care.

    There might not be anything we can do about the current generation going through this, but we certainly can begin planning with our own parents, and for ourselves as well, as I feel it horribly unfair to place this burden solely on the child, when it was the adult freely making choices for most of their lives regarding their health and lifestyle.

    Good luck in your work, I admire what you do, and have considered it myself, were it not for the education required. Try to stay positive, avoid blame, just love and offer joy, as you recommend. :)

    <3
    kelly


    ps i'd be interested to see the statistics on aging and care for the elderly in other cultures, as the pain of taking insults, changing diapers, and forcing meds into your darling loved one's mouth i'm sure crosses many cultural lines.

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  4. Kelly, you are absolutely right... we ARE living too long!

    To that point, you may find this article interesting. It's lengthy, but totally worth the read:

    http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande

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  5. Dez, this is so close to home for me this week! My dad's mom is 94, she is in good health and still has a very good mental state. She is as sharp as a thumb nail. Her problem is that with no one living with her to help her remember what meds she has and hasn't taken she has been over dosing herself and falling from the dopiness. Two weeks ago we moved her to live with my dad, step-mom, and high school daughter (Hard transition for everyone, including Nanny). She just wants her own independence and freedom. "I am not a child," is her favorite sentence. Last week, there was small scare and she had to be taken to the hospital. The doctor informed my 6 ft 2 dad that the medicine that she is prescribed would knock my dad out for days if he took it. This led my dad to make the decision that this move is a permanent one for her. He had to sit down with her and tell her that she would not be going home. This past Sunday we went to her house that she has lived in since before the depression and gathered some of her belongings, cleaned out all of the perishable items, turned everything off, and locked up the doors. It was very emotional and hard to see and do. She won't be going to a nursing home or any home but my dad's for that matter. When she is a little more OK with this new chapter of her life, we will take her back to the house to go through things. Thanks for the post it makes everything that we are going through seem more like we aren't the only people.

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  6. Leighann, in a society that values independence, production, and success as some very core values, growing old is a devastating part of life for everyone. It demands change, but change that we ALL avoid! Then, one day, something happens (med overdosing is not an uncommon way to go) which forces that change. But, nanny differs from many seniors out there; she is fortunate to have a supportive family willing and able to help. In situations like this I often tell my clients "wow, you're family loves you VERY much!" Although nanny would prefer to remain in her own home (who wouldn't) she isn't all that bad off. Considering all of the options, she's got one of the best. I wish your dad and Nanny all the best.

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