When I’m 84


I’ve heard this before, and over the weekend I heard it again.

“I have to be good to my children because they’re the ones who will choose my nursing home.”

I suppose this statement is supposed to be funny, but really I find it rather sad.

Does this line of reasoning indicate that if we are “mean” to our children (or if they feel that we slighted them in some way when they were six years old), they will take their sweet revenge in our dotage by summarily shoving us into a subpar nursing facility paid for with discount coupons and MyPoints?  And does the expression of this sentiment summarily reject the possibility of adult children participating in the care of their elderly parents in favor of sloughing off such duties to institutional care?

I like to think that when I reach a place in life at which I am no longer able to fend for myself, I will still be in possession of sufficient mental faculties to make informed decisions as to my own care.  And I hope that among my options will be remaining in the comforts of home and being cared for by my nieces and nephews, because they want to even though they don’t have to.

The very concept of a “nursing home” is rather ghastly, despite good intentions.

So let’s say you have no family willing to care for you and therefore have no choice but to reside in a skilled care facility.  While I have never investigated the subject, I have no doubt that those with more money to spend are able to purchase better quality of care (or at least more frills and amenities) than those with fewer funds available.  Still, one would hope that our elected legislators and our taxpayer dollars would enforce at least a modicum of standards even upon the lower-cost facilities.  There might not be dancing, speakers and musical performances every evening, but we do expect regulatory protection from the worst ravages of neglect and malfeasance.

And, let’s face it, is there really any such thing as a “good” nursing home?  The very concept smacks of a pretty façade and a coat of paint concealing interior horrors.  Even in places with decent standards of care, with staff who are committed to providing quality of life, there are lights on 24 hours a day, medication being dispensed, people and carts moving up and down the hallways all day and all night and a constant cacophony of nurses, visitors and disoriented patients yelling and crying.

I will never forget my wife’s grandmother, who resided in one of the better assisted care facilities, begging over and over again to be brought home.  Eventually, we were able to grant her that wish.

Even if our children agree that we have been their guardian angels and generous to a fault, I don’t see how the attendant hazards of institutional care can be avoided.  Life in even the best facility can never be the same as living at home among loved ones.

There is, of course, the option of skipping the nursing facility altogether.  This means relying on adult children to assume the responsibility of caring for aging parents.  While anecdotal evidence indicates that this may have once been a more common state of affairs than it is today, the demands of the nuclear family frequently make such arrangements impractical, if not close to impossible.  Even in an “intact” family composed of two adults and minor children, chances are that both adults will need to be in the workforce to keep the family afloat economically.  Thus, even if adult children are inclined to take aging parents into their homes, there is often no one there to care for them during daytime hours without going to the expense of hiring skilled nursing care.

The fact is that only a small percentage of nuclear families are interested in pursuing such arrangements.  The “sandwich generation” often finds itself squeezed between caring for children and aging parents simultaneously with fewer resources to rely on (smaller homes and smaller incomes).  With decreases in American family size, there are fewer siblings among whom to distribute the responsibilities of caring for aging parents.  Thus, a couple with minor children may easily find itself in the untenable position of making arrangements for the care of two sets of parents, four elders with vastly different needs.

The breakdown of the nuclear family has only exacerbated matters.  How is a single mother, already stretching her meager resources to care for minor children, supposed to come up with the time and money to care for elderly parents when they are no longer capable of living on their own?

And what becomes of childless singles and couples when they require assistance with basic self-care in their so-called golden years?  While relieved of the consequence of vengeful adult children “sticking them in a home” (whew!), at best they may have a partner taxing his or her personal reserves of energy to continue to care for the loved one at home for as long as possible.  Where the senior in need is single, widowed or divorced, the option of staying at home or with immediate family vanishes more quickly than a dream upon awakening.

The only practical answer for the heavy responsibility of caring for aging parents with increasing care needs is the extended family.  While this was once status quo, when industry and then the service economy eliminated the need for many hands to participate in subsistence agriculture, large and multigenerational families became unfashionable in favor of many decades of American nuclear family worship.  As the stay-at-home-mother vanished and then the nuclear family began to disappear altogether, fewer and fewer resources were available to draw upon for the care of children and elders.  More recently, it seems, families are rediscovering the value of sticking together to share economic and emotional burdens and resources across generations and even among “non-blood” families of affiliation.  The old adage that “many hands make light work” was never more true.

The concept of caring for each other rather than depending on government and other institutions to take on this role is roughly parallel to the cost savings that businesses seek to achieve by squeezing every drop out of existing resources rather than spending money.  Many government entities have started recognizing the benefits of maintaining elders at home by providing some level of compensation to family members taking on care duties.  Ultimately, however, it’s not about money.  Maintaining the resource-pooling advantages of extended family requires a decrease in selfishness and an increase in selflessness, a willingness to forego a certain amount of freedom in exchange for giving and receiving security and a commitment to building bridges rather than burning them.

Part of the difficulty in achieving widespread acceptance of this model is the paradigm shift required:  Trading conditional love (do what I want or I’ll throw you in a nasty nursing home) for agape, the unconditional love (“love your neighbor as yourself”) that most faiths equate with God’s love for His people.

Clearly, we have a long way to go.  I can only hope that my nieces and nephews will care for my wife and me when the time comes.

But, if I am to be totally honest with myself, I am forced to admit that this is not something I can unequivocally count on.


2 thoughts on “When I’m 84

  1. This is something I’ve thought about a lot. I’ve also watched some documentaries on aging and dying. There is a statistic that the only factor that gives a person a decent chance of not ending up in a nursing home, is having three or more daughters. So as you can imagine, most people will end up in an institutionalized setting if they are ever unable to live independently.

    Trying to revert to an extended family model is a tricky thing, especially for families where there is bad blood between parents and children for whatever reason. While I had a wonderful grandmother live with me growing up, other people in my household were not happy with the arrangement and there was constant tension and strife. And I had more than one relative who would have been a nightmare to live with. So in my view it remains an open problem with no clear solution.

  2. Your statement about needing at least three daughters is eye-opening. This is one of many good things about large and extended families. To me, it seems sad that parents spend so much of their lives giving everything for children, then end up alone in their old age. There was once a social compact in place, but alas, no more. That said, you are so right that it is next to impossible to live with some people. My mother and one of my sisters are prime examples.

    Also, I believe that “bad blood” between parents and children (and between anyone, for that matter) is a choice. The consequence of that choice is burnt bridges and a reduction in options. I see too much homelessness in this area that is, at least in part, a product of not being able to get along with family. This is cultural in nature. Japan, for example, nurtures a culture of consensus and compromise that extends all the way from the bedroom to the boardroom. Part of the reason that we have been unable to achieve this in the USA is that the much-celebrated “melting pot” makes us, as a society, fragmented and heterogeneous. We prize independence here (rather than dependence on family), but this is illusory; we end up dependent on the government instead. Even more so in socialist nations. Ultimately, we have to choose what is important to us and live with the consequences of those choices.

    Thanks so much for reading and commenting.

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