You Don’t Need A Magician To Make People Invisible
By Wendy Ford
Please bear with me a moment. I have to get something off my chest and just vent. Where in the heck do some people get off and come from that they treat their elders with such disdain and lack of respect and dignity! How can they stand by and do nothing when an elder is in distress? How can they patronize with such disrespect and disdain? How can they just flippantly dismiss the value or even the very existence of another human being? What triggered this? A telephone conversation with a client’s family member, that’s what. But more on this in a bit. An explanation is in order first.
The perspective from which this piece is written is one that has been developed over a long period of time and from personal observations and experiences. It is a perspective spoken from with a certain amount of expertise. My area of interest and practice is the elderly, in particular the frail elderly. Those women and men who are living in assisted living facilities and nursing homes and some who are able to be in their own homes, for now. Having worked in the health care profession for over thirty years (yes, over thirty years which makes me not too far from being considered an elder myself in the eyes of many) affords a broad and deep base from which to speak. The easy thing to write about would be all the thousands of wonderful, loving families and individuals encountered over the years who have given of their time, their hearts, their money, their energy, their homes, for some their careers, their health and, ultimately more than a few have been seen to have even given their own lives in the care of an elderly parent or family member. To all of those selfless and generous individuals goes my deepest gratitude, respect and admiration. Without them the professional towel might have been tossed in a long time ago. They keep up my spirits and fill my heart. They are my foundation. They make it worth slogging and wading through all the ever-changing Medicare rules, regulations, documentation and payment guidelines. They more than make up for the ones who cause so much frustration and heartache; for those families and individuals who treat their elders so shamefully, with disregard for them as people or even worse (in my opinion) refuse to acknowledge their very existence.
It isn’t necessary to go into the details of the specific telephone conversation that triggered the opening questions. You’ll pick up the gist of it. A phrase I find being muttered more often than should be necessary is, “Shoot the family and keep the patient.” This is often preceded by a telephone conversation or encounter with the family or “responsible party” of a potential client. Hackles raise and teeth clench when receiving a response that goes something like this: “Oh, mother (aunt, uncle grandfather, whatever) is 90 years old and forgetful, has arthritis and a bad heart. She won’t ever walk very far again. What makes you think you can do anything? What’s the purpose? (Left unspoken is, “Why bother and waste your time?”)” Oh, I don’t know, I thought preparing her for the next walk-a-thon might be a great idea and a grand goal! How about relieving her pain by working her arthritic joints and strengthening her legs so she can get up out of a chair with her walker on the first try? How about enabling her to get to the bathroom with minimal assistance so she doesn’t have to always go in the diaper she’s in? How about making her less dependent (note I did word independent was not used) on the help of the caregivers so she has some sense of self-worth and dignity? How about seeing the smile on her face when I walk in and the hug she gives me? And did you know she thinks you’re the best daughter in the whole world and can’t stop talking about how proud she is of you? How she lights up talking about her grandchildren even though she’s never even met most of them? She even understands you have your own life so you really can’t get in much (even though you live 5 miles away and only come once a month and then it’s just to bring supplies and sign paperwork because the facility requires it in order for her to keep living there?).” THAT’s the response that must be swallowed to keep from spilling out at times.
Oh, don’t be mistaken. It is NOT being said that the elderly being viewed by the youth as “has-beens” or “old hat” is anything new. There’s always been the generation gap. And each new generation is, in the eyes of their elders, well on the way of going to hell in a hand basket because their language is so sinful and their music is that of the very devil and they have no respect for the previous generations. But over the last thirty years I do notice that the value of our elders seems to be being diminished in the eyes of many (including government programs and resources). What’s worth exploring is WHY this is occurring with seemingly increasing intensity and volume at the very time that the elderly population is the fastest growing segment of our population.
It must be confessed, there are clear memories of eyes being mentally rolled as a teenager (never have even dreamed of really doing it) at some unsolicited bit of sage advice thrust upon me by well-meaning parents or teachers or grandparents. So too, exist vivid recollections of having that same advice bite me in the butt or ring in my ears at a later time (perhaps years later) as the truth of what they were saying or warning against came to light. This usually took place as I was trying to pull myself out of some hole I had dug and fallen into or the wall that my face was flush up against because advice had not been taken or predictions or warnings heeded. It was only at those critical times that understanding dawned: the advice had come from knowledge gained through experiences. That only my best interest was at heart and they had been trying to prevent me from having to learn or go through the same experience(s), or whatever it was, and learn the hard way. It was only then that the true value of what had been freely given became apparent.
There also exists the clear memory when, as a new graduate, the ink on my Physical Therapy license was not yet dry. A therapist who had been around for ten years was, in my fresh young eyes, over the hill. How could anyone who had been in the field that long possibly be up to date on the most current research and techniques? A therapist who had been in practice for twenty years? A relic. How could someone that old even hope to be up to date and useful and knowledgeable in a field where research and data was shedding new light almost daily and that was changing faster than the books and articles could be printed? So, armed with the latest information and techniques (learned on fellow therapy students, in a class laboratory setting with all the latest equipment, having had three whole months of clinical internship in which to put my skills into practice) I walked into my first real job as a full time staff therapist. I was ready. I was prepared. I was a therapist. Yep. I was ready. Bring it on. Yep. I was ready. Yeah, right.
Fortunately for me, that mentality lasted less than a week. A therapist who would come to be a sort of mentor patiently provided guidance through the first experiences of handling an independent patient load without the back up of a clinical instructor. She provided introduction to the complex and real workings of the medical field. A friendly and sympathetic ear was available to listen, a kindly voice ready with advice when asked, and a soft but strong shoulder was there to catch the tears as the struggling ensued to get the ideals of the world of academia to mesh with the complex and often harsh realities of the real world. It was sort of like taking the training wheels off the new two-wheel bike and riding down the sidewalk with all of the bumps and cracks and tree roots and people coming from the other direction and the neighbor’s dog chasing at your heels and hitting a sudden downhill slope and having your foot slide right off one of the pedals as you hurtle headlong into who knows what instead of on the nice smooth asphalt of the wide and empty driveway. The basics are the same but it’s the fine details no one ever told you about that will trip you up! Her insight and experience were invaluable. The value of the knowledge and experiences of one who had gone before came to be appreciated and cherished.
That’s an interesting phrase: “the value of the knowledge and experiences of one who had gone before.” That is what is being perceived as being lost regarding our elderly by many in our current society; the value of the elderly. Why is that so? Why is the value being diminished or lost? What could be the consequences?
In times past in our society, and indeed still today in many cultures, the elderly were revered, honored and cherished. The elders used to be sought out for their advice and wisdom. Their stories were listened to and lessons learned from their experiences. Just where did our oral traditions come from? Where did our family histories come from? Where did our sense of family and connectedness come from? What held families together? The elders. If elders are not to be valued, who will pass down the family histories, stories, legends, and traditions? What will hold families together? What will connect us with our past? What will the effect of no past be on the future? They say history is written so that lessons can be learned by future generations. If there is no history written or valued then what becomes of the future? If history is to be constantly rewritten so that it is always currently politically correct what becomes of the truth of what really happened (no matter how shameful or embarrassing or how big the mistake)? If the lessons learned by our elders are to have no value and are to be ignored, what will happen to future generations?
Extended care facilities, nursing homes, assisted living facilities, group homes are springing up faster in our nation than ever before. Granted the elderly population is growing, but why the warehouse mentality?
Warehouse mentality? Yes. You are already familiar with it. Want the best price for a new DVD player? You can find a really good bargain if you go to a warehouse where they have bought in bulk and offer reduced the prices from the Mom and Pop appliance store that used to be around the corner when you were growing up. Want lower food prices? Go to the warehouse club and get lower prices than from the family market that your Mom used to take you to on Saturday mornings.
That same thinking is showing up in the way our society is treating its frail elderly. If you put all of the frail old ones in one place, in one building or group of buildings then it will be more convenient and more cost effective to care for them. The average person doesn’t have to think about them or deal with them on a daily basis. The average person really never has to be confronted by their needs and problems. The average person has no idea that there even is a portion of our society called the “Frail Elderly” because the frail elderly are being neatly tucked away out of the conscious awareness of most. Society has managed to make them invisible. And it didn’t take any magic to accomplish this extraordinary feat either!
Please be assured, this is NOT being critical of the increasing tendency for the retired to gather in their own communities with their own entertainment and recreational facilities. Nor is it being discounted that it is much more cost effective to give quality care to a group of individuals in one setting than to try to deliver quality care to individuals one by one who are spread out geographically throughout a community. No. What is of great concern is the growing invisibility of our frail elderly.
Part of the answer to the question of why this warehouse mentality has begun to flourish lies in the fact that most households in our society depend on all members working out side the home. The stay at home Moms and Dads are not as prevalent as in past generations. There is no one to stay with a failing elderly parent or family member twenty-four hours, seven days a week, three hundred sixty-five days a year for five, ten even fifteen years. Part of the answer also lies in the fact that people are living longer, well into their 80’s and 90’s. As they live longer their children are approaching their 60’s and 70’s! More and more or us approaching retirement will be spending those years caring for aging, ailing family members. And, as the economic demands continue to squeeze resources made available to the elderly, more and more of us will be actually having to work past and through our retirement years in order to make ends meet and survive. Then who stays home takes care of Mom or Dad?
OK. The warehousing mentality and concept can be explained. Sort of. But once an elderly person is institutionalized they become isolated from society. Neighbors no longer just stop by because they don’t drive anymore and can’t get across town to visit. If the elderly person has retired and moved from the Midwest or East to Florida or Arizona to enjoy their retirement, chances are there is no local family or that any family is scattered across the nation. Being isolated from society makes them more or less invisible. Invisibility leads to a loss of connectedness. If there is no grandchild sitting on the floor by your knee who is going to listen to your stories, or even care if you have any stories to share? What would make you even want to share your stories if there is no one asking, no one listening? Without a sense of belonging, without a sense of worth and value, without a feeling of connectedness why would an elder want to even continue to live? Depression is a major problem among the elderly and frail elderly, evidently with good reason.
From personal experience I can assure you the stories are many and of great value. They can make you laugh until the tears flow, they can tug at your heart until the tears flow. You can get some mighty fine recipes from how to handle pie dough when its humid to how best to stretch a pot of soup and tips about how to get spots out and get items clean without using a lot of chemicals. You can learn about how things used to be, how and what people cared about, what made them happy or sad, what challenges they had to overcome. A city girl might learn just how a grain silo works, that a cow needs to be pregnant before it gives milk, (Who knew? Aren’t dairy cows just that? Cows that are bred to give milk?) or that probably the hardest thing to be is a farmer who is at the mercy of the elements and still somehow makes a living. You can learn about life. You can learn about what it takes to make it through tough times. You can learn about heart, and grit and bravery and stubbornness. You can learn about what makes a person survive and thrive.
If people can’t listen, if people can’t take the time to ask, if people can’t or don’t care, what does that say about them? Maybe it’s because our society is so accustomed to everything moving fast with instant this, and that. Time schedules to keep, productivity numbers to be met. On a personal note, countless hours have been spent off time logs and payroll records (don’t interfere with the productivity of the day, please) because I refused to rush or brush off one of my clients who wanted to tell a story or share a new picture or just needed a friendly chat. It was just my personal gift to me to spend the extra time with them.
Maybe people have forgotten how, or just don’t want to be bothered, to take the extra time an elder often needs to process thoughts and ideas. Many people simply do not understand and are ignorant and unaware of the extra time elders may need for mental processing. For example, people often mistake the extra time or repetition of something an elder might need because of poor hearing to be the result of confusion and dementia. Time is simply not taken to listen to what the elder is saying or asking.
Maybe unconsciously people are afraid of their own mortality and death. For the frail elderly are certainly close to their time of transformation. Maybe people are afraid of getting old, afraid of their own aging process. For youth is not as eternal as hope. Maybe people are consciously or unconsciously afraid of the changes that old age can bring physically and mentally. It has been scientifically proven that even people afflicted with dementia can remain mentally active if stimulation is provided, but without continued stimulation even a normal brain’s mental functions will gradually deteriorate (regardless of the age of the physical vehicle). The physical changes are many as the physical vehicle deteriorates. Eyesight and hearing fail, arthritis can freeze and twist once supple joints, beautiful heads of hair turn white and become thin or nonexistent.
Thanks to Wall Street and marketing, our society has become obsessed with youth and youthful appearances. The natural changes that accompany aging are not welcomed and are no longer an acceptable option in the marketing-created, manufactured, disposable, microwave society of today. If it’s old, throw it out. If it’s broken or damaged, throw it out. Replace it with a new or younger one. Indeed many marriages have fallen victim to that concept! Has this trickled over into our concept about aging? Are our elders falling victim to this disposable society? It is chilling that this should even be a possibility, that this question should even need to be asked.
Magicians evidently are not the only ones capable of making things disappear. Our society seems well on the way to making entire portions of itself invisible. Many of us in the healthcare field have taken note of the changes our society has made and is making regarding its attitude toward its elderly and frail elderly populations. Maybe this piece will cause you to examine how you view our elderly. Perhaps this piece will inspire someone to volunteer in a facility just to talk and spend time with some of our elders. Maybe this will nudge someone to call or visit their own elder (I called my own Mom and Dad in the middle of writing this piece). Maybe this will provide a stimulus for thought as to just where our society is headed in regards to the treatment of and attitudes toward our elders. Is the current direction and trend to be continued? Or does it need to be halted and changed? If no one speaks for those without voices of their own, who will ever hear them? If no one directs attention to their existence will anyone ever see them? Just because the elderly and frail elderly are often silent and invisible, it does not mean they don’t exist. When you reach your time of advanced years, who will make you invisible? To put a twist on a phrase: For there, with the grace of God, go I.
May the Light of Truth shine to open your eyes, your ears, your mind, your heart.