Thursday, August 15, 2002

“No young man,” wrote the poet William Hazlitt, “believes he shall ever die.” How the older man confronts his mortality inspires the rest of us. So it was with grace and dignity that Charlton Heston told the public that he might have Alzheimer’s disease. “I must reconcile courage and surrender in equal measure,” he said. “Please feel no sympathy for me.”
Friends, fans and even political enemies were impressed with his eloquence and presence, his acknowledging that this may be the toughest role he’ll ever play. (Only Slate magazine, Microsoft’s on-line journal, snickered, observing that he might have to give up his Second Amendment rights under California law prohibiting someone with a mental disorder from owning a gun.)
His announcement coincided with the news that the condition of Ronald Reagan, who suffers from Alzheimer’s, has radically deteriorated in recent months. It was especially poignant that Nancy Reagan, in expressing sympathy for Charlton Heston, placed the coming Heston family’s ordeal in personal terms: “Our family knows all too well the cruelty of this disease, and we pray that God will give the Heston family, especially [Mr. Hestons wife] Lydia, … the strength to face each day that lies ahead.”
All this was reminiscent of the famous speech by Lou Gehrig, the great New York Yankee whose terrible debilitating disease was named after him, when he told baseball fans, at a tearful goodbye ceremony at Yankee Stadium, that he regarded himself to be “the luckiest man on the face of this earth.” He paused to pay homage to those closest to him, especially his wife, “a tower of strength” showing more courage than he ever dreamed existed.
The supporting casts in these families are required to make the last years as comfortable as possible. How many among us could count on such support? In today’s world of split families, children who work in faraway places and a formal system that favors bad institutional care over home care, who has a Nancy or a Lydia?
Wages are low for those we hire to do such jobs. The unemployed who complain that such work is demeaning are not emotionally equipped to tend the dying with sensitivity and attentiveness. Boomers who once debated the merits of day care for their children now debate the prospect of eldercare for themselves.
Medicaid, the means-tested program that pays most of the bills for the aging poor, encourages institutional care. If a senior is not impoverished, Medicaid provides incentives toward that goal. Under the present system the only reimbursable option is a nursing home. When I paid several visits to one local nursing “facility” (it could in no way be called a home), which I was told was top of the line by Medicaid standards, old people were sitting alone, hunched over in wheelchairs, scattered in hallways, while attendants gossiped with each other.
Scandalous stories about bad nursing homes abound, but “fixing” the nursing care problem is only one direction society should take. Why not create an array of choices for families without insisting that they become poor to avail themselves of care?
“The current long term care system makes skilled nursing facilities as the primary and, for many families, the only viable option,” writes James L. Wilkes II, in “Family Policy,” a publication of the Family Research Council. He suggests that an array of reimbursable care, which includes a “respite program” for visiting relief workers to provide short-term breaks for tired families who care for the elderly. Day-care centers with activities for the seniors could also augment care. Many immigrant women arrive in this country with traditional “family values,” eager to care for older people, but find it difficult to obtain green cards.
It’s hard to oversee homecare, but we could do better in having professional monitors make surprise visits. Small group homes when properly run can be preferable to the larger impersonal institutions. Vouchers could also work to encourage private entrepreneurs in the community to provide informal kinds of care that would be less expensive than nursing home care and encourage a greater choice of options to suit the particular needs of an aging citizen. Certain states are experimenting with Medicaid waiver programs that offer an array of alternatives and indicate that lower costs may add up to a higher quality of life for the aging.
As the baby-boomer generation pass through different stages of life they have increased the demand for maternity beds, schools, jobs and housing. As they age and even they will they will tax an inadequate system for sustaining care. The elderly worry about health and money and which will fail them first. We as a society must make it possible for them, like Charlton Heston, to reconcile courage and surrender.

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