Do you take vitamins? And watch your cholesterol? And exercise? If so, why? To stay healthy? To make sure you feel good and look good? And because life’s a banquet and who doesn’t want to garden or travel or cook or romp with a dog or sit spellbound in a theater or watch a sunset or read a great novel or maybe even write one? We all have our pursuits and pleasures. What’s that famous maxim from Star Trek? We all want to “Live long and prosper.”
And yet. The longer you live the less this society cares about you.
It’s called “ageism” and it means prejudice or discrimination against someone because they’re over a certain age. It can show up in the workplace where older workers are fired and replaced by younger workers. It can show up in media where actresses are “old” at 35 and stories about people over 50 are rarely told. And it’s showing up in the COVID-19 crisis because older people tend to be more susceptible to the virus.
And yes, the older you get, the more likely you are to have “co-morbidities,” i.e. conditions like diabetes or high blood pressure or cancer that make you less resilient. And you can argue that the very fact that we’re shutting schools and businesses and staying six feet apart in many parts of the country is an absolute affirmation of our regard for the more vulnerable among us. But I saw a sign at a rally the other day that read, “Sacrifice the Weak – Open up the Country.” And unfortunately that’s becoming a trend in some circles and it’s extending to how we view nursing homes.
Or I should say “nursing and rehabilitation centers” because that’s what they are. These centers provide long term care for people with ongoing physical challenges. They also provide short term care for patients who have been discharged from hospitals but need rehab/recovery before they can go home. These days that includes COVID-19 patients who no longer need the ICU but still need support.
These humans – because that’s what we’re talking about, human beings – need help. Short term or long term, they can’t make it on their own. And as an advanced society most of us understand that it’s our privilege to support them whether they’re headed home or easing into what is known as a “good death.”
And there it is - the root of the problem – the source of ageism – our fear of death. Old folks remind us that we’re mortal. And rather than face that fear, many are blaming the old and infirm for ruining the economy and bashing nursing homes in particular - as if the fact that the virus has a field day in a nursing home is somehow the nursing home’s fault. And sure, there are bad actors out there as there are in every industry and reforms are needed. But what’s really going on here is that vulnerable people are collected in nursing homes – and nursing homes, like hospitals, are understaffed and lack PPE.
But don’t those folks calling for “sacrificing the weak” or “culling the herd” have a point? Isn’t that how “natural selection” works? The most fit characteristics survive and the least fit die out?
While I hope it’s not necessary to point out how human beings have more to offer than goats or llamas or even genes or chromosomes, I’m happy to do so. Let’s forget the 35-year-old with the bum knee who’s in the nursing home facility for rehab and heading home in a week and focus instead on the long term patient. Why should we take care of Grandma in Room 401? There’s of course her family and friends who still love her and want to spend time with her but haven’t they essentially abdicated responsibility by putting her in a home?
Leaving aside the fact that most families agonize over this decision, I doubt whether anyone without medical training could cope with the medication schedule let alone wrangle IVs or other equipment standard to nursing home care. Then there’s the time involved – estimated at over four hours of direct care per patient per day – and the strength required to lift and turn bed-bound patients. So quite honestly Grandma’s better off in Room 401.
And not just because her physical needs are better met in that setting. A nursing and rehabilitation center is a community. Even if she’s bed-bound, there’s her favorite nurse who’s been giving her baths for the two years she’s been there and the cheerful aide who helps “toilet” her and always wants to know whether it’s worth it to get married or should she go back to school.
There’s the cook who’s added peanut butter cookies to the rotation because Grandma loves them. And the housekeeper who isn’t her favorite but who taped up her cards for her on her birthday. And if she’s ambulatory, there’s her friend down the hall who looks forward to a game of honeymoon bridge when they’re both up to it. And the fella who lost his foot to diabetes whom she cheers on whenever he grumbles his way to PT. In short, Grandma has a life in the center that provides meaningful work for the people who care about her and a boost to the economy.
And who are these people who care for Grandma? The overwhelming majority of the people doing this nursing and supportive work are women and many of them are people of color. Why do they do this work? Most of them really like older folks. They appreciate their stories and their perspective. And most of them are compassionate humans who want to make a difference. The work they do not only elevates us as a society because it exercises our spirituality and compassion but it preserves our history and collective wisdom. No small thing. However as Eleanor Feldman Barbera, a friend who’s a psychologist in a long term care facility, pointed out, these days “they are risking their lives to toilet someone for very low pay.”
Eleanor has worked as a psychologist in group settings in New York for decades, through the AIDS crisis, the 9-11 crisis and now COVID-19, which she says is the worst crisis she has ever faced. Not only are residents at long term care centers who’ve contracted the virus isolated from their families due to the pandemic quarantine, but their caregivers are having to cope with shocking losses, ongoing exposure to the virus, and not nearly enough staff or PPE. And unlike hospital workers who are lauded nightly, workers at these facilities are often maligned.
Think about it for a moment. Our hearts go out to ER nurses - who care for patients for a single shift before they are discharged or moved to a hospital - or to hospital nurses - who care for patients for a few days or weeks. Nurses and staff in long term care centers have often cared for their vulnerable patients for years. They know their histories, their families – they’ve become friends. And now as COVID-19 strikes, they are helpless to save them, sometimes losing dozens of patients they love.
Eleanor tells me that the trauma these nurses and support staff are experiencing is devastating, resulting in depression, anxiety and insomnia, and making them more vulnerable themselves to COVID-19. It’s a terrible situation and they need our help right now.
Why should we help what are often “private” businesses? Frankly it’s always a partnership if they accept Medicare and Medicaid and the truth is they are overwhelmed and getting very little support. And bottom line we need them to stay in business because if we are lucky and live long and prosper, at some point we are likely to need their help and support.
So I hope that we can all support the reforms being called for that will make these centers better. And while we work for that to happen, I hope that right now, in the midst of this crisis, we can take a moment to reach out to the caregivers in these settings. Just like the staff at hospitals, they’d appreciate cards and letters, posters thanking them for their help, pretty chalk drawings on the sidewalks, flowers delivered to nursing stations and best of all, meals packaged and delivered for them to take home to their families.
Because at the end of the day, after taking care of Grandma and perhaps holding her hand while she takes her last breath, our nurse has very little left to give to her family. And having a tasty hot meal to take home to them will help her immeasurably.
Please reach out to the nursing and rehabilitation centers near you and ask how you can help and when and where you can send cards, letters, flowers and food. And for more information about life at a nursing and rehabilitation center, please see my friend Eleanor’s posts: