'Taking care' in an aging society

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The Jewish New Year begins tonight, inevitably recalling melancholy memories of the past with hope for happy days to come and the exquisite possibility that we will be written down in the Book of Life for another year. Like the dissonant sound of the ram's horn, calling Jews to pray, the observance forces introspection. It's a bittersweet season for mourning those loved and lost and for reflecting on whether we have lived up to the ideals they bequeathed to us.

As a child, I hated it. The High Holy Days made my parents sad. They grieved for their own dead parents. I wanted something like our New Year's Eve celebration, when the noisemakers and paper hats and abundant bubbly made everybody giddy, laughing and singing and marking the midnight hour with hugs and kisses all around.

But now, with the understanding that is the consolation for the passing of the years, I have come to share the sentiments of my vanished parents. My mother and her mother, who lived into what is now labeled "old, old age," were fortunate to have been cared for by their children. I vividly remember the day a hospital bed was wheeled into our guest room for my grandmother, whose heart was too weak to any longer allow her to live independently. I was often awakened in the wee hours of the night by my grandmother calling out my mother's name, as though she were a child frightened by the dark. A generation later, my own mother moved into an apartment next door to us. The frailty that came with her ninth decade required "assisted living" -- with the assistance provided by family. Until her 91st year, when we arranged for 24-hour care in her apartment, my mother was free to visit under her own steam every day. "The best thing I ever did," she often told me, "was to move next door to you."

A report by the Presidents Council on Bioethics recalls these memories. "Taking Care: Ethical Caregiving In Our Aging Society," is about the personal and public challenges that sons and daughters face as the nation moves toward "a mass geriatric society." We debate the economics of Social Security, Medicare and Medicaid, but we're loath to confront our complex and sometimes paradoxical attitudes toward the oldest among us. The authors of this report want to change that.

Self-reliance, self-sufficiency, personal choice and autonomy compel us to write living wills, to take out long-term care insurance. "But in so doing, [this approach] deliberately ignores the truth of human interdependence and of our unavoidable need for human presence and care, especially when we can no longer take care of ourselves," writes Leon Kass, chairman of the Council on Bioethics, in this thought-provoking and anxiety-evoking document. "The moral emphasis on choosing in advance needs to be replaced with a moral emphasis on caring in the present. The moral emphasis on independence needs to be supplemented with a moral commitment to serve the lives of those we love regardless of their disabilities."

In a column not long ago about that television commercial depicting an elderly couple insisting that they don't want to be a burden on their children in their old age, I suggested that my children were exactly who I wanted to be a burden on not to oppress, but to reward, in the way that little children are a burden on their parents. The mail reflected agreement in direct proportion to the age of the reader.

We're younger longer, and older longer, than at any time in human history. We live in a youth-worshipping society, but the elderly wield political clout that could draw us into a psychological and economic war between the generations. As the elderly increase in numbers, younger workers decrease proportionately, due to lower birth rates. It's likely that a third of the population will live to be over 85; by the year 2050 the number of those over 85 is likely to be as many as 18 million. But after 85, only 1 person in 20 is fully mobile. An aging society affects every corner of our lives -- health care, housing, work, goods, political power, personal relationships and family connections.

The Baby Boomers are learning to their astonishment that as they age, moving closer to "senior status," their perspectives are changing. "Taking Care" is a government document but it avoids bureaucratic argle-bargle, calling for "deeper wisdom and resources of character" as a nation and as individuals: "We will need greater ethical reflection on what the young owe the old, what the old owe the young, and what we all owe one another." A new year, Jewish or otherwise, is a good time to reflect on that.