# The plight of the elderly in First world countries



## Nate Higgers (Jan 7, 2022)

I’m working on a project at a senior care facility for work. Part of what I’m doing requires me to be in the residents rooms and doing work while they’re in the corridors or in their own rooms bedridden or staring out the window in a wheelchair. 

I’ve been thinking about the whole situation with people living longer than they did 20-30 years ago, and I wonder if some of the elderly individuals in situations like these are _existing _or if theyre _living. _I’m not trying to advocate for euthanasia or assisted suicide, let me be clear. I’m simply wondering if there needs to be some kind of ethical discussion about the quality of life some senior citizens are able to get once they’re at a certain age (also taking into account their medical/psychological condition). 

At the risk of sounding like a full tinfoil hatted conspiracy theorist I am aware that there’s a large chunk of business and revenue that comes from the commoditization of elder care (basically everything except the beds and the meds in a hospital or a care facility is made by McKesson, a publicly traded corporation), and there’s a whole cottage house industry that popped up around charging medicare/insurance companies/TriCare for all the services and personnel that make up elder care. 

*tl;dr: is there something we can do for the elderly that are in these situations to help them get a better quality of life? Is it ethical to even consider that some of these individuals are being kept alive simply because its profitable from an actuarial POV?*


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## m1ddl3m4rch (Jan 7, 2022)

Who cares about senile diaper shitters. They're for the jab mandate so that makes them the enemy of our rights. Thankfully they'll be dead soon.


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## Nate Higgers (Jan 7, 2022)

m1ddl3m4rch said:


> Who cares about senile diaper shitters. They're for the jab mandate so that makes them the enemy of our rights. Thankfully they'll be dead soon.


The geezers I’m talking about are like the ones in this care home who are like 80-90 years old and they can’t even bathe themselves or exist without full time care. I’m sure you’re talking about the 50-60 year old “well back in MY day what *I* did was” cohort. 

I’m talking about the wheelchair geezers who have no more political opinions, or thoughts that are more detailed than “what the fuck is this filipino nurse trying to say I just want to watch John Wayne”


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## m1ddl3m4rch (Jan 7, 2022)

Nate Higgers said:


> The geezers I’m talking about are like the ones in this care home who are like 80-90 years old and they can’t even bathe themselves or exist without full time care. I’m sure you’re talking about the 50-60 year old “well back in MY day what *I* did was” cohort.
> 
> I’m talking about the wheelchair geezers who have no more political opinions, or thoughts that are more detailed than “what the fuck is this filipino nurse trying to say I just want to watch John Wayne”


And I'm saying covid has made me completely ambivalent toward the elderly and their supposed plight. They've lived longer than most in history. Whether their lives were good or bad, fun or sorrowful, easy or hard, they've had enough life for one lifetime. Time to draw the curtain on these person-shaped burdens.


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## Nate Higgers (Jan 7, 2022)

m1ddl3m4rch said:


> And I'm saying covid has made me completely ambivalent toward the elderly and their supposed plight. They've lived longer than most in history. Whether their lives were good or bad, fun or sorrowful, easy or hard, they've had enough life for one lifetime. Time to draw the curtain on these person-shaped burdens.


I can’t say I haven’t had the same thought as you and I see it echoed in the How Did Boomers Become This Way thread on this same board. That’s also why I included that sort of afterthought towards the end of the OP about the huge cash cow that is elder care. 

I’m just trying to pick some farmers brains on the situation


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## Chocolate Wombat (Jan 7, 2022)

> *tl;dr: is there something we can do for the elderly that are in these situations to help them get a better quality of life? Is it ethical to even consider that some of these individuals are being kept alive simply because its profitable from an actuarial POV?*


I think something that might make things easier for them is some sort of hybrid care where they are visited at home by trained staff to help the family care for them. But with the people at the ages and in the states you're talking about it's really just palliative care and waiting for them to die.

It also makes me question the value of extending life so long when the last decade or so the person is practically a vegetable. I'm not sure I want to make it to 90 if I'm barely sentient at 80.


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## MysticLord (Jan 7, 2022)

Who cares?

There's nothing you can do about it, the people who can do something about it make too much money from it to stop it, and everyone else has more than enough problems of their own.


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## Nate Higgers (Jan 7, 2022)

Chocolate Wombat said:


> It also makes me question the value of extending life so long when the last decade or so the person is practically a vegetable. I'm not sure I want to make it to 90 if I'm barely sentient at 80.


That’s basically what I’m saying while simultaneously dancing around the issue of euthanasia. I’m working with a coworker who is like 61-62 years old who “most likely has throat cancer” and we’ve been having conversations about this all week regarding him thinking “I don’t know if I even want to live that long if I gotta live like them…I’d rather not do the chemo and just let the cancer take me”


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## Dyn (Jan 7, 2022)

m1ddl3m4rch said:


> I found a thread that wasn't about vaccines or niggers, so of course I took exception to that


lol shut up


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## Prophetic Spirit (Jan 7, 2022)

first world countries? there's some 3rd world countries with the same problem
not every country from that world is a failure nation, you know? others are struggling with similar problems, just with less money.


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## Chocolate Wombat (Jan 7, 2022)

Nate Higgers said:


> That’s basically what I’m saying while simultaneously dancing around the issue of euthanasia. I’m working with a coworker who is like 61-62 years old who “most likely has throat cancer” and we’ve been having conversations about this all week regarding him thinking “I don’t know if I even want to live that long if I gotta live like them…I’d rather not do the chemo and just let the cancer take me”


I don't think there's a good answer to the question as it's different for every person. I'm personally of the opinion that as long as I'm coherent I'm going to keep on trying to stay alive. I can totally relate to someone who is in their 60s, sees how miserable people going through chemo are and nopes the fuck out of that. It's a shitty choice to have to make.


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## wtfNeedSignUp (Jan 7, 2022)

There is a point when elderly are being kept alive rather than living, but I'll be damned to let either the government or the populace to even start deciding when that point it.


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## Dyn (Jan 7, 2022)

Prophetic Spirit said:


> first world countries? there's some 3rd world countries with the same problem
> not every country from that world is a failure nation, you know? others are struggling with similar problems, just with less money.


Developing countries don't have that problem because they're not plastic corporate dystopias ruled by HR karens and mayonnaise ghouls, so the people there still have decent values and actually respect and take care of their elderly relatives.


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## Testacles Maximus (Jan 7, 2022)

I feel bad they won’t live to see aliens or future-cars.


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## Uberpenguin (Jan 7, 2022)

Uh...no, I don't think there is any way to, at least barring anything cataclysmic shaking up the world.

As time goes by and everything becomes outdated faster and faster, the accumulated wisdom the elderly possess becomes less and less valuable in a material sense. Once upon a time they held knowledge about the world that really gave them value, nowadays with how readily available information is and how fast the world changes they simply become obsolete. People also move around a lot more and there's no local community support web to make caring for the elderly at home feasible, so they have to get shipped off to homes where people need to specifically go out of their way to see them or involve them in things.

But with technology comes transhumanist perspectives and distance from nature, which involves major unease with organic concepts like death.

In other words people wouldn't even consider letting the olds die, but they also want to spend as little time, effort, and resources on them living as humanly possible because dealing with them is inconvenient and they provide no easily quantifiable benefit within the system, and charity does not work as a long term motivator. Welcome to the world we live in.


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## El Gato Grande (Jan 8, 2022)

I think they should have a choice if they are possible of making it.

Otherwise I believe they should be kept alive as long as possible because while life is often terrible (especially for the elderly) you only live once.


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## TurdFondler (Jan 9, 2022)

It's almost impossible to work a 40 hour work week and then also tend to someone with complex needs like dementia. 

I fully believe elderly care facilities exist mainly to make sure there's no wealth to transfer between generations of the working class.


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## B2_Spirit (Jan 9, 2022)

I've got relatives that insist on taking care of their 80 and 90s something in-laws and parents. They're wealthy enough to do it though, they don't need to be at work. I admire the sentiment/dedication because to me that's how it used to work and how it should be - I've seen what happens to the elderly in some of these care homes and fuck that. Then the boomers came along, treated their kids badly and wonder why they get shoved in a home at the first opportunity. I blame the general direction of the system away from inter-generational living and wealth and toward turning us all into worker bugs.

Taking care of dementia riddled relatives in no joke, to be clear. And there's nothing fun at the end of it. Most people in the past considered it a moral duty, and most of that generation considered it a moral duty to their kids on the other end. These days, who fucking knows. Everything is fucked. I know the day my brain stops working adequately and I'm just gonna go take a nap between some freight train cars because I don't have anyone who'd help and I wouldn't want to live unable to bathe, or remember my own name. But I'd want to go out on my own terms in my own way (out in Nature, for sure), not in some institution or in one of those cringe gassing pods in Switzerland.

I just feel bad for society in general. We've progressed in absolutely the wrong way.


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## 💗Freddie Freaker💗 (Jan 9, 2022)

Westerners should make multigenerational families a thing again.


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## Malodorous Merkin (Jan 9, 2022)

Old people are gross and scary.


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## Totallyunknown (Jan 9, 2022)

Western society does not care for it's elderly past about the age of 65. There are a few lucky ones that can maintain a close familial bond until about 75-80 when the majority of their life will become health problems. If you're American, you'll possibly have premiums or medication that isn't covered and if you're Canadian you'll face long wait times and mediocre health care. 

No one enjoys anyone who constantly complains about ailments. Maybe it's a health & society issue - people live longer by way of advancements in medicine but their lifestyle choices make them still too unhealthy to actively participate after years of abusing the body. You get old, your joints get a bit sore, you stop being as active, your diet catches up and now your 75lbs overweight and diabetic or have blood pressure problems or you worked in some shit factory with pollution that causes COPD later on now you're in a scooter on oxygen. 

Theres a good reason to fear getting old.


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## Aunt Carol (Jan 9, 2022)

I think our unconscious assumption, our mental model, is a step behind reality.

When people talk about honored elders historically having so much to teach the tribe; isn't it a shame we just throw them all in a SNF these days, they're not talking about the same population it used to be.   In older times, if you were 80, you were a hale and hearty 80 and/or you had a deep family network of care--otherwise you weren't 80 at all.  

The medical industry's default is to do everything, people don't have advance directives set up, people's children haven't thought about it either and request to do everything.  When adult children finally sit down to think about the incompetent elderly's goals of care, it's _after_ "everything" has been done and there's either some stability achieved or it's obviously the end.

It's easier psychologically (and legally) to never place that feeding tube than it is to take it out again.  There are a lot of people half-living with a MOLST/POLST that says "no antibiotics," and all they're doing is waiting for pneumonia like we did a century ago.

Taking care of a demented relative (or one who needs total care) in the home is a lot like taking care of kids in the home: hard to do if you need dual incomes to stay afloat, and that's not counting the psychological toll of it.  A demented adult is like a kid who can reach the top of the cabinets, and who has muscle memory of how to turn on the burners or start a car.  And, like the opposite of a kid, becomes less and less themself over long years.  

Meanwhile, you're still taking care of the actual kids.  It works if you're helping Grandma put on her compression hose and driving her to appointments, but she can still read to the kids and cook and oversee them playing, if not catch up to them running.  If it's just two flavors of dependent care, the home is going to break down.

I don't think there's one sweeping solution.  

Mandatory national service in the US is unfeasible but it'd solve it; make one of the civilian options for service an aide in a nursing home, and now you've got an age group who either spent a teenage year seeing the modern end-of-life, or their best friend did.

Encouraging advance directives would help: adult children suddenly have to decide for a parent who up to a week ago was their own advocate, and the answer is "oh shit I dunno do everything give me time to think."  Having that conversation with Mom years ago, with boxes initialed document that reassures you it isn't your fault if you follow her explicit wishes--not everyone is going to make the "best" decision, but this way it's _their_ decision.  

Nursing homes don't have to be awful, but the for-profit model makes it hard not to.  Mandatory staffing ratios are state-driven and can't be argued with; otherwise, it's always cheaper to bully a staff of codependents into overextending themselves and then blaming them for the pressure injuries.


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## topsikrets (Jan 9, 2022)

All I know is that if my family didn't wanna put up with me i'd take euthanasia over a care home any day of the fucking week.


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## DiscoRodeo (Jan 10, 2022)

💗Freddie Freaker💗 said:


> Westerners should make multigenerational families a thing again.


This is the big thing to be honest.

In all fairness, not everyone can necessarily afford a multigenerational family, and I do think that part of the reason why they died out was because people moved away from their home town and across the United States for economic opportunities (versus a family living in the same town or general region for generations enabling this),

but I really do with that multigenerational homes became the norm again.

On the issue of old age diseases, thats another dilemma. I agree with the general trend here that if you have zero quality of life in your 80s and 90s, then something has gone wrong. I don't know if suicide is the answer, or if improving medical technology is something that we should hope for, but if you make it to that age the choice to continue on or not should really be up to you.

Personally, Id be more of a fan of living well throughout your life, giving what you can to your family, doing adventurous things and just having a rich and diverse life which probably wouldn't afford you old age. Its less,_ live fast and die young_, and more _live well, avoid old age_. I think of many of my literary heroes, and a plethora of them did make it to old age, but almost none of them made it to the really geriatric years and I do think that taking the path less trodden down contributed to that. Could be autism but if you do fear true old age, don't kill your liver or live too roughly, but don't obsess over the inverse either (which I do tend to see people doing, quantity of years lived over quality). Live well, and hopefully you'll also depart well when its your time.


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## Sailor Kim Jong Moon (Jan 10, 2022)

Malodorous Merkin said:


> Old people are gross and scary.


I think that’s the problem. I was thinking about this and when you’re old and have dementia, you’re almost like a child. Which is sad because they have no parents to take care of them.

Truly, old people have a branding problem. 

I suggest we rebrand elderly dementia patients as really ugly orphans.


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## Almalexia (Jan 10, 2022)

Can only speak for burgerland, but private equity is currently deeply involved in commoditizing elder care and is becoming more so by the day. They routinely buy up providers, insurance companies, hospitals, pretty much anything and everything involved in the process. It's as soulless as you would expect - PE guys calling up providers demanding they make more cuts to the dementia-ridden residents so the PE guys can get their big bonuses, multiple houses, fancy cars, ski vacations, etc.

Medicaid pays for more elder care than any other funding source. And Medicaid is currently destroying state budgets by having ever-more ballooning costs that are taking away from everything else that states are trying to pay for - schools, transportation, etc. There is currently tons of Fed-printed funny money temporarily propping shit up (due to "COVID") that is pushing off the immediate crisis a bit longer. But the problem is that no one wants to work for bottom of the barrel Medicaid wages (usually min wage or a few dollars less than Walmart per hour) dealing with unpleasant old people and their bodily fluids as unlicensed personnel, or making even a bit more as CNAs. Nursing homes are closing not due to lack of demand but because they cannot get anyone to staff them. There is a straight up collapse happening right now. 

Here's another thing old people don't understand. Medicare (which usually pays providers decently, and which most old Americans qualify for) does not cover extended long term care in a nursing home or the community. It will pay for some temporary stays but if you need full time care on an unknown timeline, Medicare does not cover that. You will have to burn through your personal assets and then become poor enough to qualify for Medicaid, which pays the people who take care of you like complete shit. It is easier/harder to qualify for Medicaid based on what state you live in because they all have different rules with varying levels of generosity. (Or you can be "smart" and hire a lawyer to put your assets in a trust so you look penniless, or even do what the elderly Chinese do and never have a bank account in the first place. Cash under the mattress, baby - you qualify for everything.)

Anyway, boomers (inexplicably, but totally On Brand for this generation) do not plan for this or even bother learning about it until they need round the clock care, at which point it's too late. They think they've got Medicare (which they believe they've "earned" because they paid a paltry amount of FICA taxes that will not even cover their own Medicare expenses) and that will cover them. Well, the bill is coming. The boomer generation fucked over not only their kids, but their grandkids and great-grandkids _so hard_ economically that Gen X and especially millennials are too poor and debt-ridden to care for their aging parents even if they wanted to. Which they don't. And at this point absolutely no one else wants to, either.

It's not completely boomers' fault. Thanks to medical advances, people are living much longer than they should be, in terms of what both capitalism and our entitlement programs can accommodate. Then you add in shockingly poor nutrition/sedentary lifestyles that cause tons of health problems among the elderly, yet can be kept in limbo indefinitely by pharmaceutical drugs. It's a recipe for poor quality of life that continues on and on. I expect assisted suicide will become legal in almost all states within the next decade because there is literally nothing else to be done with this population.


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## SCSI (Jan 11, 2022)

Almalexia said:


> (Or you can be "smart" and hire a lawyer to put your assets in a trust so you look penniless, or even do what the elderly Chinese do and never have a bank account in the first place. Cash under the mattress, baby - you qualify for everything.)
> <snip>



Nope.  Uncle Sam will pierce trusts checking for this exact scheme.  By the time they're done with your anus, you'll be needing a better rectal reconstructive surgeon than Wedge.

*EDIT -- *When I wrote this, my mind jumped to the version of the scenario where it's a smug boomer who didn't plan ahead thinking he's outwitting the system by stuffing all his assets in a random trust right before he needs care. That wasn't the scenario @Almalexia had in mind at all.  My bad.


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## Kujo Jotaro (Jan 11, 2022)

Typically if keeping someone alive would appear cruel its the family member's or power of attorney that are to blame not the facilities. All life preserving measures from CPR to medications are decisions made by families or the resident themselves if they are still able to make their own choices.


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## Manul Otocolobus (Jan 11, 2022)

> (basically everything except the beds and the meds in a hospital or a care facility is made by McKesson, a publicly traded corporation)


The joke is on you, OP. McKesson is deeply involved in the meds game.


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## Feline Supremacist (Jan 11, 2022)

SCSI said:


> Nope.  Uncle Sam will pierce trusts checking for this exact scheme.  By the time they're done with your anus, you'll be needing a better rectal reconstructive surgeon than Wedge.


It's called estate planning and I used to do those at work. It's done several years before nursing home care is required. At the time transfers could no occur less than three years before. The problem is a lot of older folks have strained or non existent relationships with their kids so trying to convince dad/mom to turn ownership of the family home and assets to them can be difficult, if not impossible.


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## Almalexia (Jan 11, 2022)

SCSI said:


> Nope.  Uncle Sam will pierce trusts checking for this exact scheme.  By the time they're done with your anus, you'll be needing a better rectal reconstructive surgeon than Wedge.


Yep, it's got to be the right kind of trust or the scenario you described will absolutely happen. Medicaid Asset Protection Trusts are a thing. Several years are required before eligibility kicks in and you must disclose the trust's existence to the state while they check your financial eligibility. But they are 100% legal and will keep the state from taking your house after you die.


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## SCSI (Jan 11, 2022)

Feline Supremacist said:


> It's called estate planning and I used to do those at work. It's done several years before nursing home care is required. At the time transfers could no occur less than three years before. The problem is a lot of older folks have strained or non existent relationships with their kids so trying to convince dad/mom to turn ownership of the family home and assets to them can be difficult, if not impossible.



I was too flippant in my original reply and it didn't come out right at all, I should've taken a few minutes to rephrase and expand on what I was trying to say.  Your info matches up with my lingering memories from Trusts & Estates from <depressing number> years ago, I can only imagine how hairy trying to walk strained families through that process is, especially when a member may be starting to show signs of dementia and the accompanying belligerence, major points to anyone who does that work. That fucked-up relationship dynamic you mention is going to end up costing the Boomers (and their heirs) a fortune when they refuse to cooperate with their kids to properly protect their assets before its too late.  Seems like it could have some morbidly-interesting implications for the real estate market when you consider how skewed home ownership is towards that generation.  Can you imagine firms like Blackrock ultimately ending up with even a quarter of that generation's property as they start shuffling off the mortal coil in earnest?



Almalexia said:


> Yep, it's got to be the right kind of trust or the scenario you described will absolutely happen. Medicaid Asset Protection Trusts are a thing. Several years are required before eligibility kicks in and you must disclose the trust's existence to the state while they check your financial eligibility. But they are 100% legal and will keep the state from taking your house after you die.



I misread your original comment about trusts in a too-casual tone and fired from the hip there, sorry about that, totally didn't mean that to come off as kinda dickish as it looked on a reread.  I blame PTSD from too many past conversations with people getting "BRILLIANT IDEA!(TM)" brainwaves that will kamikaze them straight into a legal woodchipper if they get busted.  (Ever have a borderline-SovCit boomer call you with their """plan""" to skate around part of a contract they signed?  )

That multiyear advanced requirement is a killer with how widespread the Boomer "Peter Pan" attitude is you mentioned.  And so many of their kids and grandkids are their own version of conflict-avoidant towards death, for lack of a better way of describing it, that I'd expect it's going to be harder for them to find the will to try to push through that aversion and the resistence they get to try to wrangle their "I don't need help, I'll be young foreverrrr" elders into sitting down and actually setting up those trusts in time.  It only gets worse when you add the early stages of dementia into the mix, too.

The budget problems you mention from this... I'm thinking about them in the context of states like IL that are already hopelessly in the red.  Is there any even remotely-sane way out?


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## Feline Supremacist (Jan 11, 2022)

SCSI said:


> I was too flippant in my original reply and it didn't come out right at all, I should've taken a few minutes to rephrase and expand on what I was trying to say.  Your info matches up with my lingering memories from Trusts & Estates from <depressing number> years ago, I can only imagine how hairy trying to walk strained families through that process is, especially when a member may be starting to show signs of dementia and the accompanying belligerence, major points to anyone who does that work. That fucked-up relationship dynamic you mention is going to end up costing the Boomers (and their heirs) a fortune when they refuse to cooperate with their kids to properly protect their assets before its too late.  Seems like it could have some morbidly-interesting implications for the real estate market when you consider how skewed home ownership is towards that generation.  Can you imagine firms like Blackrock ultimately ending up with even a quarter of that generation's property as they start shuffling off the mortal coil in earnest?


That's it exactly. You have no idea how many screamed at their kids "You just want my money!" At some point they just check out and then the parents end up in a terrible public nursing home complaining their kids never visit them. Some manage to get a POA but many more just throw up their hands and say "I tried but I have my own family to worry about".


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## NoodleFucker3000 (Jan 11, 2022)

Ngl, I've seen both sides of this from my own grandparents. 

One lived to be in his 80s, but spent a decade before that in a nursing home because he broke a hip, refused treatment and ended up crippled and addicted to opiates bc he refused physical therapy to correct it and it healed all wrong. He had no awareness of anything towards the end, and simply lived off pain killers and apple sauce. 


My grandma is 95, only in the past 6 months has she finally given in to using a cane to walk. She cooks her own meals. She has no interest in being in a home and says that if they want to put her anywhere, they'll have to kill her first. 

What I'm saying is- aging is fuckin weird. Some people can't make to 75 without becoming a lifeless zombie. Some people live longer. Sometimes people get fucked by genetics and other people don't. At the end of the day there's no one size fits all solution for the elderly. Some of them are lucid until their last days, and deserve dignity and respect the same as anyone younger. Some elderly people are essentially infants and euthanasia would be kinder than letting them rot in a for profit "nursing" home.

Also elder abuse should be seen as harmful as child abuse, yet there is very little concern for the safety of the elderly, even if they are dying, nobody deserves assault and indignity.


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## SCSI (Jan 12, 2022)

Feline Supremacist said:


> That's it exactly. You have no idea how many screamed at their kids "You just want my money!" At some point they just check out and then the parents end up in a terrible public nursing home complaining their kids never visit them. Some manage to get a POA but many more just throw up their hands and say "I tried but I have my own family to worry about".



I believe it.  Some people are just fully-functional assholes to begin with and make their own hells, but the others... dementia kills the person before it kills the body. So many people who stay involved caring for someone with that end up scarring themselves and their own families for years afterwards. Then you get the fighting relatives, and they raise hell about every goddamn thing, from care to financial planning to actual probate afterward... Elder/probate stuff reveals who people truly are deep down inside, and a lot of them are monsters.

Related, something along the lines of your "I have my own family to worry about" comment always comes to my mind when I see suggestions that we solve the elder care problem by going back to multigenerational households.  I've seen that work wonderfully when the elders are mentally sound and the family relations are all healthy, but the severe dementia cases?  So many people underestimate how violent or otherwise abusive those can get, and it can go on for 10-20 years.



Spoiler: PL



Thank God my dad was able to get POA over my grandfather and get the estate in order before the paranoia set in too badly -- and bless the T&E attorney who had his back through all that, guy was a hero turning decades of Silent generation paper hoarding into a safe, solid trust while picking his way through the emotional minefield. He refused a nursing home until he was reaching hospice-stage health condition, and had gotten to the point where he refused to visit family outside his home because he was convinced they were going to try to place him in one against his will. (And if you guessed the relationship between him and his kids was strained, you nailed it.) Keeping him in care even after that point was almost as hard as getting him in in the first place due to how belligerent he'd become.  Don't know exactly where I'm going with this other than to say I have no idea how the hell the USA (or anywhere) is going to deal with situations like this happening more frequently and for longer than the existing system ever imagined could happen as the Boomers hit 80+.





NoodleFucker3000 said:


> Also elder abuse should be seen as harmful as child abuse, yet there is very little concern for the safety of the elderly, even if they are dying, nobody deserves assault and indignity.



The disparity in response to the two is interesting, if disturbing.  I wonder if it's due to a combination of the modern West's reluctance to confront death and an attempt to deny on a cultural level that mistreatment on this scale is happening?  A little like how domestic abuse and child abuse used to be open secrets society often averted its eyes from.  Though I'd also guess the economic problems involved with the elder care situation are a factor -- the amount of money and manpower probably needed to truly fix things is borderline impossible, but that doesn't make the moral desire to solve the problem go away.  Just spawns guilt and shame for being unable to succeed.  Except for the blood-sucking parasites preying on the whole situation, I suppose.


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## murph (Jan 12, 2022)

Nursing homes exist to drain the last pennies out of the elderly. If they can keep the piss smell to a minimum they are rated as excellent.

Get a gun and be prepared to use it.


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## Feline Supremacist (Jan 12, 2022)

SCSI said:


> I believe it.  Some people are just fully-functional assholes to begin with and make their own hells, but the others... dementia kills the person before it kills the body. So many people who stay involved caring for someone with that end up scarring themselves and their own families for years afterwards. Then you get the fighting relatives, and they raise hell about every goddamn thing, from care to financial planning to actual probate afterward... Elder/probate stuff reveals who people truly are deep down inside, and a lot of them are monsters.
> 
> Related, something along the lines of your "I have my own family to worry about" comment always comes to my mind when I see suggestions that we solve the elder care problem by going back to multigenerational households.  I've seen that work wonderfully when the elders are mentally sound and the family relations are all healthy, but the severe dementia cases?  So many people underestimate how violent or otherwise abusive those can get, and it can go on for 10-20 years.
> 
> ...



No, I feel you. I live in NYC for a reason, as far away from California as I can be while still in the USA.


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## The Wicked Mitch (Jan 12, 2022)

"*tl;dr: is there something we can do for the elderly that are in these situations to help them get a better quality of life? Is it ethical to even consider that some of these individuals are being kept alive simply because its profitable from an actuarial POV?"*

Build a timemachine and have them raise their children instead of dumping them in front of the TV or at some form of outsourced parenting. If you think it's bad now, wait until Gen X turns geriatric.


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## Almalexia (Jan 12, 2022)

I don't see any magic solution to this problem, but states paying family members to take care of their relatives is strongly on the rise right now as an alternative to nursing homes. People get outraged about this because "they're family, they should be doing it for free." But that doesn't acknowledge the realities mentioned in this thread. If you have an aging parent with dementia who lingers for 10, 20 years who starts needing round-the-clock supervision, there is no way anyone can realistically leave the workforce for that period of time. Paying family caregivers makes a lot of sense when the caregiving demands are way beyond normal family stuff like driving grandma to the store or doctor's appointment and cleaning her house once a week. 

Wages for this are low, on the scale of $11-15/hour with no benefits. But paying an adult daughter for some of the time she takes care of her aging mom can make these arrangements a lot more sustainable. There is a larger shortage of caregivers than ever and if the aging parent only has one "professional" caregiver who can only work X hours, paying the adult daughter can make it more likely the daughter can fill the gaps in care rather than having to seek nursing home placement. Aging at home is preferred by old people and usually better for them, and it's much cheaper for the state than paying $80, $90k/year for a nursing home bed.

On the rare occasion I see daytime tv, I'm seeing regular ads for "bring your own caregiver!" from home care agencies in between the Medicare supplemental insurance and reverse mortgage commercials. A lot of "professional" personal care attendants/CNAs quit during covid and haven't returned, so states are really leaning on the families right now.

And yes, state budgets are screwed by all this but they're not quite feeling it yet. Right now the feds are paying for a  much larger than usual share of states' Medicaid bills. Medicaid costs are split between the feds and each state, and the exact breakdown of what % is fed and what % is state depends on how rich the state is. But with COVID the feds dramatically upped their % to remove burden from states. So long as the fed printer continues to brr, the dead man will keep walking for the time being.


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## fuknhek (Jan 13, 2022)

A Life Worth Ending


Spoiler: Full text magazine article



by Michael Wolff

On the way to visit my mother one recent rainy afternoon, I stopped in, after quite some constant prodding, to see my insurance salesman. He was pressing his efforts to sell me a long-term-care policy with a pitch about how much I’d save if I bought it now, before the rates were set to precipitously rise. For $5,000 per year, I’d receive, when I needed it, a daily sum to cover my future nursing costs. With an annual inflation adjustment of 5 percent, I could get in my dotage (or the people caring for me would get) as much as $900 a day. My mother carries such a policy, and it pays, in 2012 dollars, $180 a day—a fair idea of where heath-care costs are going.

I am, as my insurance man pointed out, a “sweet spot” candidate. Not only do I have the cash (though not enough to self-finance my decline) but a realistic view: Like so many people in our fifties—in my experience almost everybody—I have a parent in an advanced stage of terminal breakdown.

It’s what my peers talk about: our parents’ horror show. From the outside—at the office, restaurants, cocktail parties—we all seem perfectly secure and substantial. But in a room somewhere, hidden from view, we occupy this other, unimaginable life.

I didn’t need to be schooled in the realities of long-term care: The costs for my mother, who is 86 and who, for the past eighteen months, has not been able to walk, talk, or to address her most minimal needs and, to boot, is absent a short-term memory, come in at about $17,000 a month. And while her LTC insurance hardly covers all of that, I’m certainly grateful she had the foresight to carry such a policy. (Although John Hancock, the carrier, has never paid on time, and all payments involve hours of being on hold with its invariably unhelpful help-line operators—and please fax them, don’t e-mail.) My three children deserve as much.

And yet, on the verge of writing the check (that is, the first LTC check), I backed up.

We make certain assumptions about the necessity of care. It’s an individual and, depending on where you stand in the great health-care debate, a national responsibility. It is what’s demanded of us, this extraordinary effort. For my mother, my siblings and I do what we are supposed to do. My children, I don’t doubt, will do the same.

And yet, I will tell you, what I feel most intensely when I sit by my mother’s bed is a crushing sense of guilt for keeping her alive. Who can accept such suffering—who can so conscientiously facilitate it?

“Why do we want to cure cancer? Why do we want everybody to stop smoking? For this?” wailed a friend of mine with two long-ailing and yet tenacious in-laws.

In 1990, there were slightly more than 3 million Americans over the age of 85. Now there are almost 6 million. By 2050 there will be 19 million—approaching 5 percent of the population. There are various ways to look at this. If you are responsible for governmental budgets, it’s a knotty policy issue. If you are in marketing, it suggests new opportunities (and not just Depends). If you are my age, it seems amazingly optimistic. Age is one of the great modern adventures, a technological marvel—we’re given several more youthful-ish decades if we take care of ourselves. Almost nobody, at least openly, sees this for its ultimate, dismaying, unintended consequence: By promoting longevity and technologically inhibiting death, we have created a new biological status held by an ever-growing part of the nation, a no-exit state that persists longer and longer, one that is nearly as remote from life as death, but which, unlike death, requires vast service, indentured servitude really, and resources.

This is not anomalous; this is the norm.

The traditional exits, of a sudden heart attack, of dying in one’s sleep, of unreasonably dropping dead in the street, of even a terminal illness, are now exotic ways of going. The longer you live the longer it will take to die. The better you have lived the worse you may die. The healthier you are—through careful diet, diligent exercise, and attentive medical scrutiny—the harder it is to die. Part of the advance in life expectancy is that we have technologically inhibited the ultimate event. We have fought natural causes to almost a draw. If you eliminate smokers, drinkers, other substance abusers, the obese, and the fatally ill, you are left with a rapidly growing demographic segment peculiarly resistant to death’s appointment—though far, far, far from healthy.

Sometimes we comb my mother’s hair in silly dos, or photograph her in funny hats—a gallows but helpful humor: Contrary to the comedian’s maxim, comedy is easy, dying hard. Better plan on two years minimum, my insurance agent says, of this stub period of life—and possibly much more.


Mike Wallace, that indefatigable network newsman, died last month in a burst of stories about his accomplishments and character. I focused, though, on a lesser element in the _Times_’ obituary, that traditional wave-away line: “He had been ill for several years.”

“What does that mean?” I tweeted the young reporter whose byline was on the obit. Someone else responded that it meant Wallace was old. Duh! But then I was pointed to a Washington _Post_ story mentioning dementia. The _Times_ shortly provided an update: Wallace had had bypass surgery four years ago and had been at a facility in Connecticut ever since.

This is not just a drawn-out, stoic, and heroic long good-bye. This is human carnage. Seventy percent of those older than 80 have a chronic disability, according to one study; 53 percent in this group have at least one severe disability; and 36 percent have moderate to severe cognitive impairments; you definitely don’t want to know what’s considered to be a moderate impairment.

From a young and healthy perspective, we tend to look at dementia as merely Alzheimer’s—a cancerlike bullet, an unfortunate genetic fate, which, with luck, we’ll avoid. In fact, Alzheimer’s is just one form—not, as it happens, my mother’s—of the ever-more-encompassing conditions of cognitive collapse that are the partners and the price of longevity.

There are now more than 5 million demented Americans. By 2050, upward of 15 million of us will have lost our minds.

Speaking of price: This year, the costs of dementia care will be $200 billion. By 2050, $1 trillion.

Make no mistake, the purpose of long-term-care insurance is to help finance some of the greatest misery and suffering human beings have yet devised.

I hesitate to give my mother a personality here. It is the argument I have with myself everyday—she is not who she was; do not force her to endure because of what she once was. Do not sentimentalize. And yet … that’s the bind: She remains my mother.

She graduated from high school in 1942 and went to work for the Paterson _Evening News,_ a daily newspaper in New Jersey. In a newsroom with many of its men off to war, Marguerite Vander Werf—nicknamed “Van” in the newsroom and forevermore—shortly became the paper’s military reporter. Her job was to keep track of the local casualties. At 18, a lanky 95 pounds in bobby socks, my mother would often show up at a soldier’s parent’s front door before the War Department’s telegraph and have to tell these souls their son was dead. Many decades later, she would still go pensive at this memory. She married my father, Lew Wolff, an adman, and left the paper after eleven years to have me—then my sister, Nancy, and brother, David. She did freelance journalism and part-time PR work (publicity, it was called then). She was a restless and compelling personality who became a civic power in our town, elected to the board of education and taking charge of the public library, organizing and raising the money for its new building and expansion. She was the Pied Piper, the charismatic mom, a talker of great wit and passion—holding the attention of children and dinner-party drunks alike.

My father, whose ad agency had wide swings of fortune, died, suddenly, in that old-fashioned way, of a heart attack at 63, during one of the downswings. My mother was 58—the age I am now—and left with small resources. She applied her charm and guile to a breathtaking reinvention and personal economic revival, becoming a marketing executive at first one and then another pharmaceutical company. At 72, headed to retirement but still restless, she capped off her career as the marketing head of an online-game company.

For 25 years, she lived in an apartment building in Ridgewood, New Jersey, in a sitcom mode of sociability and gossip. Once a week, every week, she drove into Manhattan to cook dinner for my family and help my three children with their homework—I am not sure how I would have managed my life and raised children without her.

This is the woman, or what is left of this woman, who now resides in a studio apartment in one of those new boxy buildings that dot the Upper West Side—a kind of pre-coffin, if you will. It is even, thanks to my sister’s diligence, my mother’s LTC insurance and savings, and the contributions of my two siblings and me, what we might think of as an ideal place to be in her condition. It is a spacious room with a large picture window that, from the ninth floor and my mother’s bed, has an uninterrupted view across town. The light pours in. The weather performs. The seasons change. A painting from 1960 by March Avery, from the collection she and my father assembled—an Adirondack chair facing a blue sea—hangs in front of her. Below the painting is the flat-screen TV where she watches cooking shows with a strange intensity. She is attended 24/7 by two daily shifts of devoted caregivers.

It is peaceful and serene.

Except for my mother’s disquiet. She stares in mute reprimand. Her bewilderment and resignation somehow don’t mitigate her anger. She often tries to talk—desperate guttural pleas. She strains for cognition and, shockingly, sometimes bursts forward, reaching it—“Nice suit,” she said to me, out of the blue, a few months ago—before falling back.

That is the thing that you begin to terrifyingly appreciate: Dementia is not absence; it is not a nonstate; it actually could be a condition of more rather than less feeling, one that, with its lack of clarity and logic, must be a kind of constant nightmare.

“Old age,” says one of Philip Roth’s protagonists, “isn’t a battle, it’s a massacre.” I’d add, it’s a holocaust. Circumstances have conspired to rob the human person—a mass of humanity—of all hope and dignity and comfort.

When my mother’s diaper is changed she makes noises of harrowing despair—for a time, before she lost all language, you could if you concentrated make out what she was saying, repeated over and over and over again: “It’s a violation. It’s a violation. It’s a violation.”

The numbing thing is that you see this all coming—you see it, but purposely and stubbornly don’t see it.

As it started with my mother, it was already advanced for a college friend and close colleague. As an only child, he had less room to hide. I looked on with mild concern at his helplessness. I kept thinking my situation could never get as bad as his—he spoke actually, not comically, of murder. But we all catch up with each other. All train wrecks occur on a time line.

For my mother, it began with her feet. Her complaint, which no doctor could put a useful name to or offer much respite from, was that she felt the skin on her feet was too tight. One evening, almost three years ago, getting into the shower, she caught her lagging foot on the rail of the shower door and went down into the tub. She lay there, shivering in the tepid water until morning, when her neighbor became alarmed. There is a precept here, which no doctor quite spells out: Once it has begun, it has begun; decline follows decline; incident precedes incident. Here’s the medical language: “A decrement in capacity occurs.”

But we’ll cope, of course. My mother’s shower was equipped with special chairs (the furniture of aging is its own horrid story), grab-bars and easy-reach phones installed and I-can’t-get-up beepers subscribed to. She actually learned how to fall (not falling not being an option). At the least sign of a tumble, she would sink almost elegantly to the ground, and then, not being able to get up, she’d beep the police, the affable police, who would come and hoist her to her feet, whereupon she’d fix them coffee and all would be sort of well.

And then a holiday—those unfailing barometers of family health. Thanksgiving 2009 was already a weird one. My wife and I had split earlier in the year. The woman I was seeing—and had moved in with—was coming. My children were boycotting. It was my mother who was trying to be the strong and constant pillar. She insisted she could do the job. Her neighbor—a man who had been squiring her around for many years—would load the turkey, too heavy for my mother to lift, into the oven. My sister and I would arrive before the handful of other guests to do the finishes. All was in order when we got there—the potatoes boiled and ready to be mashed in one pot, the carrots roasted, the onion custard baked—all in order except that my mother had done these preparations a week before. Every pot yielded an alarming odor. What was worse was her lack of comprehension—and lack of alarm.

Plans, obviously, had to begin in earnest. Her three children—my sister and I in New York, my brother, a software consultant, in Maui—conferred. An independent life goes into receivership—and you think, _How did we miss all the failing indicators?_ My mother, like a rogue accountant, had been hiding much of the evidence: She could no longer tell time, nor count, nor keep track of dates.

Anyway, this is what assisted living is for, no?

We would move her to Manhattan, and, we managed to convince her and ourselves, she’d begin a great new adventure.

She was game—and relieved. The place, the Atria on West 86th Street, was just a few blocks from where my sister, an artist, lives and works. A national chain of residences for the elderly, the Atria is more a real-estate business than a health-care enterprise, providing, at hefty cost—the apartments are in the $8,000-a-month range—quite a pleasant one-bedroom apartment in a prewar building, full of amenities (terraces and hairdressers) and gradations of assistance. But it is important to understand—and there is no reason why one would—that assistance in an assisted-living facility, even as you increase it and pay more for it, is really not much more than kind words and attendance, opened doors, a bit of laundry, and your medications delivered to you. If there is a need for real assistance of almost any kind that involves any sort of calibration of concern, of dealing with the real complications and existential issues of aging people, then 911 is invariably called. This is quite a brilliant business model: All responsibility and liability is posthaste shifted to public emergency services and the health-care system.

The rate of hospitalization for all other age groups is declining or holding steady, but for people over 65 it’s skyrocketed. The elderly use 50 percent of all hospital days, according to one study. Emergency rooms, the last stop for gangbangers and the rootless, at least in the television version, are really the land of the elderly, and their first step into the hospital system—where, as Medscape matter-of-factly explains, the “inability to recognize normal aging changes … raises the chances of iatrogenic illness.” Iatrogenic illnesses being the ones caused by hospitals or doctors.

My mother went to the Atria’s after-dinner movie—_The African Queen,_ as I recall—one evening in May and then told someone she was short of breath. My sister got to the emergency room first—St. Luke’s Roosevelt—and called me to say I ought to come.

Everybody would manage his or her parent’s decline differently. Nobody is proud of himself. We all mess it up. This is partly because there is no good outcome. And it is partly because modern medicine is a random process without a real point of view and without anyone ultimately being in charge. The buck is relentlessly passed. Down this rabbit hole, we all become ineffective and pitiful.

My mother’s cardiologist, Dr. Barbara Lipton, a peppy younger woman who, annoyingly, called my mom “Mom,” had been for many years monitoring her for a condition called aortic stenosis—a narrowing of the aortic valve. The advice was do nothing until something had to be done. If it ever had to be done.

This was good advice insofar as she had lived with this condition uneventfully for fifteen years. But now that she was showing symptoms that might suddenly kill her, why not operate and reach for another few good years? What’s to lose? That was the sudden reasoning and scenario.

My siblings and I must take the blame here. It did not once occur to us to say: “You want to do major heart surgery on an 84-year-old woman showing progressive signs of dementia? What are you, nuts?”

This is not quite true: My brother expressed doubts, but since he was off in Maui, and therefore unable to appreciate the reality of, well, the reality of being near, we discounted his view. And my mother protested. Her wishes have always been properly expressed, volubly and in writing: She urgently did not want to end up where she ultimately has ended up. She had enough sense left to resist—sitting in the hospital writing panicky, beseeching, Herzog-like notes, to anyone who might listen—but of course who listens to a woman who scribbles such notes?

The truth is you’re so relieved that someone else has a plan, and that the professionals with the plan seem matter-of-fact and unconcerned, that you disregard even obvious fallacies of logic: that the choice is between life as it was before the operation and death, instead of between life after the operation and death.

Here’s what the surgeon said, defending himself, in perfect Catch-22-ese, against the recriminations that followed the stark and dramatic postoperative decline in my mother’s “quality-of-life baseline”: “I visited your mom before the procedure and fully informed her of the risks of such a surgery to someone showing signs of dementia.”

You fully informed my demented mom?

The operation absolutely repaired my mother’s heart—“She can live for years,” according to the surgeon (who we were never to see again)—but left us longing for her level of muddle before the valve job. Where before she had been gently sinking, now we were in free fall.

She was reduced to a terrified creature—losing language skills by the minute. “She certainly appears agitated,” the psychiatrist sent to administer anti-psychotic drugs told me, “and so do you.”

Six weeks and something like $250,000 in hospital bills later (paid by Medicare—or, that is, by you), she was returned, a shadow being, to 86th Street and her assisted-living apartment.

Unmoored in time, she began to wander the halls and was returned on regular occasions to the emergency room: Each return, each ambulance, each set of restraints, each catheter, dealt her another psychic blow.

And then we were evicted. I had been pleasantly surprised when my mother moved in that only a month-to-month lease was required. Now I learned why. Dying is a series of stops, of way stations, of signposts. Home. Assisted living. Nursing care. Hospice. You are always moving on.

But before we were evicted, there was another Thanksgiving—this one at my house, my mother collected and transported, my children reassembled—and then the next day, the “event.” The big one.

We had reached, I gratefully believed, her end.

EMS arrived, and once more, we were back in the St. Luke’s emergency cubicles. My mother’s “presentation” could not have seemed bleaker. The young resident was clearly appalled that we might have strayed outside the time frame for administering the drug that could slow the effects of what surely seemed to be a stroke. Of course, they were yet game to try. But we held our ground: We elected to do nothing here (prompting much renewed scrutiny of the health-care proxy). And please note the DNR. Hours passed. I left and came back. My sister left and came back. One of my mother’s aides left and came back.

And then those words, which turn out, in some instances, not to be a relief at all: “She seems to be out of the woods.”

What? How?

She had not had a stroke. She’d had a massive seizure. The differences between which being not exactly clear. And, if she had more seizures, which she likely would, this would kill her, an explanation and urgency that somehow resulted—“Did you agree to this?” I said to my sister. “I don’t think I did, did you?” “I don’t think so”—in my mother getting vast amounts of anti-seizure drugs, as well as being moved, once again, into more or less long-term hospital residence.

Coherence was completely gone. All that was left was a jumble of words and incredible anger.

Oh, yes, and here was the thing: The anti-seizure drugs were preventing further devastating and probably lethal seizures but, in themselves, were frying her brain even more.

And too, within a few weeks of lying in bed and resisting this final cataclysm, what abilities she had to walk, what slow and shambling remnant of walking, were gone.

This is where we were: immobile and incoherent. And filled with rage.

And so the first effort to directly talk about the elephant.

It happened in an interior room at the hospital, too small for much, and filled with cast-off furniture, into which fit her doctor, her neurologist, her social worker, and my sister and me. It seemed like the adult thing for us to do, to face up to where we were, and to not make these people have to tiptoe around the obvious.

I thanked everybody for what they had done, and then said reasonably: “How do we get from here … to there?”

An awkward number of beats.

NEUROLOGIST (shifting in his chair): “I think we want to define _here_ and _there_”—and tossing to the doctor.

DOCTOR: “Your mom is quite agitated. So we don’t really know what her less-agitated state will be.”

MY SISTER: “What are the chances that she will come back to anything like where she was before the seizure?”

SOCIAL WORKER: “We always have to deal with a variety of possible outcomes.”

ME: “Maybe you could outline the steps you think we might take.”

DOCTOR: “Wait and see.”

NEUROLOGIST: “Monitor.”

DOCTOR: “Change the drugs we’re using.”

MY SISTER: “Can we at least try to get a physical therapist, someone who can work her legs, at least. I mean … if she does improve, she’s left without being able to walk.”

NEUROLOGIST: “They’ll have to see if she’s a candidate.”

ME: “So … okay … where can you reasonably see this ending up?”

NEUROLOGIST: “We can help you look at the options.”

ME: “The options?”

SOCIAL WORKER (to my sister): “Where she might live. We can go over several possibilities.”

ME: “Live?”

It was my Maui brother who, with marked impatience, suggested that I obviously had no idea how the real world works. Such a conversation, treading on legal fine lines and professional practices, must be conducted in a strict code—keep saying, he advised, “quality of life.”

A week later, same uncomfortable room:

ME: “Obviously we are concerned on a quality-of-life basis.”

my sister: “She is completely transformed. Nothing is as it was. She’s suffering so much.”

DOCTOR: “The baseline has clearly dropped.”

NEUROLOGIST: “The risk is that the levels of medication that the agitation might respond to could depress her breathing.”

ME: “Again, this is a quality-of-life issue, right?”

DOCTOR: “Of course.”

ME: “The agitation seems extreme enough to warrant I would think going some distance, considering the quality-of-life issues. Even if that—”

NEUROLOGIST: “I’m not sure I’d be comfortable …”

ME (with a sudden brainstorm): “Or what happens if you just discontinue the drugs? Just cut them out.”

NEUROLOGIST: “Cold turkey could precipitate a massive seizure.”

ME: “And death?”

NEUROLOGIST: “And death. Possibly. Yes.”

ME: “Is this an option?”

NEUROLOGIST: “You have to make that decision. We can’t force her to take medication.”

ME: “Hum.”

Discontinuing the medication felt like both a solemn and giddy occasion. A week passed, and then the doctors began to report in a chipper way that she was doing well, all things considered. She had withstood the shock to the system. She was stable.

And then the social worker came around to say we were coming threateningly close to the maximum number of hospital days for which Medicare would pay. (We’d heaped another few hundred thousand in cost on the American taxpayer.)

“Now,” said my sister taking the straight-man role, “what do we do?”

My mother—infuriating us with her primal stubbornness—was transferred to the locked-floor dementia ward at the Atria facility in Riverdale, where the only caveat to patient behavior seemed to be a strict rule against hitting. Nine days later, after my mother socked a locked-floor aide, we were back in our room at St. Luke’s, where—because of her brief discharge, she could begin her Medicaid hospital-stay allotment from day one—she was happily received (for another couple of hundred grand).

What do you do with your mom when she can’t do anything—anything at all—for herself? This is not, first and foremost, about how you address her needs but about where you put her. No, it is first about who or what facility will take her.

No, it is first about what member of the family will actually sort through the incredibly byzantine and deadening options—or lack of options.

It is at this point that I became unreasonably mad at my Maui brother. In a way I understood the basis of his excuse: It was not a coincidence that he was living in Maui—his twenty years in paradise were in part an exercise of the modern right to distance himself from his family, a point which he was militantly maintaining now. He lived in Maui precisely to be far from all this. It was notable that among the people with whom I shared my tales-of-mother crisis, many, with far-flung ailing parents, identified themselves as the Maui brother. Of all things to escape, this might be the big one. And, too, in my Maui brother’s defense, all responsibility is relative: If he was doing less than I was doing, I was doing by a significant leap less than my sister was doing.

It is among the most reductive facts in this story: Women take care of the old. They can’t shake it because they are left with it. In the end, it is a game of musical chairs. The girl is the one almost invariably caught out.

My sister assembled the list of potential nursing homes, special elder-need facilities, and palliative-care centers in commutable distance. I grudgingly went along to the best after she’d eliminated the worst. Medicare grades each of these institutions on a five-star scale. Four stars were already charnel houses. One star therefore unimaginable. Just about the only five-star facilities in Manhattan are for HIV-positive patients.

Finely tuned into my mother’s profound fear of virtually all strange presences, touches, and noises, and yet her need for constant attention and reassurance, my sister found fault with every place. This might have finally annoyed me, except for the fact that each of these places wanted you to pay prodigiously for its depressing indifference, and, what’s more, many either excluded my mother’s condition or had waiting lists that would, it seemed reasonable to assume, outlast my mother.

Hospice was the best alternative. But while my mother was surely dying—with her doctors gladly willing to certify her in this regard—hospice, we so learned, was not for the certainly dying but the promptly dying.

Curiously, and unhelpfully, it was at this time that one of the neurologists making occasional visits took it upon himself to reevaluate my mother, declaring that her diagnosis was wrong. She did not have Alzheimer’s, as everyone seemed to assume. She had dementia, surely, but it was not going, and would not follow, the pattern of Alzheimer’s. She would not disappear; she would maintain some awareness and consciousness of her surroundings, he said, as though this were good news.

It was Marion, my mother’s aide, a woman of remarkable humor and constancy, who had shown up one day, sent by a random agency—and who has now been with my mother every day for almost eighteen months, not a day missed—who suggested just “bringing her home.” The best Manhattan approximation of “home” when there is no family homestead seemed to be the studio apartment where she is now, a short walk from my sister’s house.

My brother could only see this as a quagmire of cost and responsibility. My sister assured him, as the doctors were assuring us, that six months was a realistic outside framework. My brother did his own Google search. “Yes, yes, they’re right, six months at this stage is what you can expect. But you know what they die from? They die from neglect! _Neglect_! There’s no neglect here! It’s unnatural!”

I signed the lease.

“Who can believe it’s been a year?” said Marion when I signed the lease for another year a few weeks ago.

My sister comes over every morning. She brings the groceries, plans the menu, and has a daily routine for stretching my mother’s limbs (this in addition to the administration and paying of caregivers, and the collecting of monies from the always recalcitrant John Hancock). I’m here a few times a week (for exactly 30 minutes—no more, no less). Her grandchildren, with an unalloyed combination of devotion and horror, come on a diligent basis. And we have our family events: holiday meals eaten around her bed. Her 84-year-old brother and his wife visit regularly, and so does her 89-year-old cousin and her daughter. She even has one friend left who still calls her every day (all the other friends fell away a long time ago), conducting an extremely one-sided conversation over the speaker phone.

An occasional letter arrives from retired friends in sunny climes who have somehow missed or have been unwilling to register my mother’s condition. They take up in mid-conversation, proposing lunch the next time they are in the area, and recounting details of lives still going on. They continue to regard my mother as a woman who chats, cooks, reads, gossips, and commands attention. Always, suddenly, shatteringly, reading these letters, I see her this way too.

The absurdity of where we are, here on death row, measured not just in our heartache but nationally in hundreds of billions of dollars, can only be missed by the people who have no experience with the true nature and far-flung extremes of quality of life.

A few weeks ago, my sister and I called a meeting with my mother’s doctor. As others had fallen to the wayside, the head of gerontology at St. Luke’s, Dr. Brenda Matti-Orozco, a patient, long-suffering woman had stepped up to this job.

The doctor eased into our meeting with tales of health-care-administration woes, of cuts in Medicaid, of fewer beds in fewer facilities around town—did we know, she asked, that Cabrini had closed? Some people, she said, just upped and left their old relatives in the hospital. So much for the small talk.

“It’s been a year,” I began, groping for what needed to be said: Let’s do this, close it down, end it, wanting to murder the euphemisms as much as my mom. “We’ve seen a series of incremental but marked declines.”

My sister chimed in with some vivid details.

The doctor seemed at first alarmed that we might be trying to foist my mother back on her and the hospital and relieved when we said, frankly, we planned never to return to a hospital. We just wanted to help her go where she’s going. (Was that too much? Was that too specific?)

She does seem, the doctor allowed, to have entered another stage. (These half-life stages of death, such that you never reach it.)

“Perhaps more palliative care. This can ease her suffering, but the side effect can be to depress her functions. But maybe it is time to err on the side of ease.”

Another advance of sorts in our grim descent: Over uncertain weeks or months, her functions will depress even further in this ultimate, excruciating winding down.

“Your mom, like a lot of people, is what we call a dwindler,” said the doctor.

I do not know how death panels ever got such a bad name. Perhaps they should have been called deliverance panels. What I would not do for a fair-minded body to whom I might plead for my mother’s end.

The alternative is nuts: to look forward to paying trillions and to bankrupting the nation as well as our souls as we endure the suffering of our parents and our inability to help them get where they’re going. The single greatest pressure on health care is the disproportionate resources devoted to the elderly, to not just the old, but to the_ old_ old, and yet no one says what all old children of old parents know: This is not just wrongheaded but steals the life from everyone involved.

And it seems all the more savage because there is such a simple fix: Give us the right to make provisions for when we want to go. Give families the ability to make a fair case of enough being enough, of the end’s, de facto, having come.

Not long after visiting my insurance man those few weeks ago, I sent an “eyes wide open” e-mail to my children, all in their twenties, saying this was a decision, to buy long-term-care insurance or not, they should be in on: When push came to shove, my care would be their logistical and financial problem; they needed to think about what they wanted me to do and, too, what I wanted them to do. But none of them responded—I suppose it was that kind of e-mail.

Anyway, after due consideration, I decided on my own that I plainly would never want what LTC insurance buys, and, too, that this would be a bad deal. My bet is that, even in America, even as screwed up as our health care is, we baby-boomers watching our parents’ long and agonizing deaths won’t do this to ourselves. We will surely, we must surely, find a better, cheaper, quicker, kinder way out.

Meanwhile, since, like my mother, I can’t count on someone putting a pillow over my head, I’ll be trying to work out the timing and details of a do-it-yourself exit strategy. As should we all.



TLDR: NYMag article where the writer basically says 'My mom was one of the most resourceful, intelligent, charismatic people I knew, but after a series of medical interventions, she now needs around the clock care and the only things left in her mind are anger and fear because she doesn't understand anything that's going on around her. We take care of her because we love her and it's the right thing to do and we are wealthy enough to do it, but her existence is torture and it would be better if she was dead. So instead of planning for long-term care insurance, I'm going to plan some kind of exit.'  

No details given by the writer about what that exit will be. But whatever the answer is, I'm interested too. Can people fly to countries that perform assisted suicide just for that purpose? Can you arrange for that ahead of time or do you absolutely have to do that when you're lucid? Legalizing assisted suicide in North America sounds gruesome, but I'd sign up for that. If this became legal, could you sign up for it ahead of time? Because by the time you need it, you're probably too far gone to understand anything that's going on.


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## Aunt Carol (Jan 13, 2022)

fuknhek said:


> A Life Worth Ending
> 
> TLDR: NYMag article where the writer basically says 'My mom was one of the most resourceful, intelligent, charismatic people I knew, but after a series of medical interventions, she now needs around the clock care and the only things left in her mind are anger and fear because she doesn't understand anything that's going on around her. We take care of her because we love her and it's the right thing to do and we are wealthy enough to do it, but her existence is torture and it would be better if she was dead. So instead of planning for long-term care insurance, I'm going to plan some kind of exit.'


Thoughtful and accurate.  The problem seems to be that every family has to discover it for themselves.  Happened with one of my grandparents; my parent is the Maui brother _and_ the only medical professional in that family.

Roz Chast wrote/drew a book about her own parents' aging, Can't We Talk about Something More Pleasant? which helped grandma-pill my holdout aunt.  Even though pictures always help, it's a bit New Yorker-flavored.



Upthread I speculated that more young people having a stint working in nursing homes would help get an understanding of the current American way of death into the public consciousness.  

I wonder if a few popular movies on the subject would help, or a background plot arc in a prime time soap.  Seems like the few dementia and decline movies tend to focus on the patient, their spouse, and lots of flashbacks.  Adult children having to revisit old family dynamics and make goals-of-care decisions would be a great excuse for an ensemble cast to chew the scenery.



fuknhek said:


> No details given by the writer about what that exit will be. But whatever the answer is, I'm interested too. Can people fly to countries that perform assisted suicide just for that purpose? Can you arrange for that ahead of time or do you absolutely have to do that when you're lucid? Legalizing assisted suicide in North America sounds gruesome, but I'd sign up for that. If this became legal, could you sign up for it ahead of time? Because by the time you need it, you're probably too far gone to understand anything that's going on.


This has come up a few times in the munchie thread, so I'll quote myself:


Aunt Carol said:


> That's _exactly_ the current problem:
> 
> If you have a diagnosis of early dementia, you're not eligible for medical aid in dying because it's early dementia and not end-stage.
> If you wait until you have have late dementia, you're no longer compos mentis, and thus cannot receive medical aid in dying.
> ...


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## JosephStalin (Jan 14, 2022)

Some observations from one in his seventh decade of life...

Ya, want to see something horrible, check out any over-55 mobile home park.  Place tends to be as quiet as a cemetery.  All those people living in their boxes, waiting for death.  Not for me.

Something sad - go to a nursing home.  Once again, another warehouse for those waiting to die.  Not unless I'm a fucking vegetable.  Keep in mind many want to stay alive as long as possible, no matter what their condition, because as long as they are alive they keep drawing pensions/Social Security/VA disability benefits - money for their wife/family. * These people keep putting their family first. *

In our state (Insanity, also known as CA) they did the smart thing of paying family members to care for the elderly.  FAR cheaper than any nursing home.  Pay's just over $15/hour, get a little sick leave.  If you join the union you can get certain benefits through them.  You need not be someone's relative to care for someone under this system, either.

Have been pretty fucking lucky.  Been able to beat the life-threatening and life-damaging conditions on the operating table.  Have avoided becoming an invalid/vegetable/etc. so far.   No idea what the future brings, though.    I stay optimistic.


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## fuknhek (Jan 14, 2022)

Exit International: This is the organization that designed the 3d printed suicide pods. I've heard of them but I haven't read through all of their material. I think if the author of that NYmag article were planning some kind of 'exit', this is the org he might consult. And I don't know why but the fact that they include an article about the thoughts of a rabbi arguing (basically) for the sanctity of life, that makes the organization seem less ghoulish and gung-ho about death than someone might think. 

No idea if they have any kind of lobbying arm to change the legal bind you pointed out, @Aunt Carol. 

This is getting a little off topic, since this doesn't address the needs of existing elderly people and the people who care for them. It might help me when I get to the point where I'm facing the early stages of dementia, or I get the news of impending serious illness that I'm certain won't have a good outcome. But who wants to bring this to someone else as an option? Like, hey Nan you're really sick and you probably won't get better, have you considered painless assisted suicide?

@Aunt Carol That comic you linked to seems amazing. Everyone should have this kind of conversation with their older relatives while they're still lucid enough to make decisions for themselves.


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## T0oCoolFool (Jan 14, 2022)

This thread is depressing. I was hoping I could read something positive or at least hopeful.  The way modern society views old people and how they handle elder care is goddamn depressing.

I don't want my mom to go to a nursing home, but that's what I fear will happen. And this thread makes me worry even more.


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## fuknhek (Jan 14, 2022)

T0oCoolFool said:


> This thread is depressing. I was hoping I could read something positive or at least hopeful.  The way modern society views old people and how they handle elder care is goddamn depressing.
> 
> I don't want my mom to go to a nursing home, but that's what I fear will happen. And this thread makes me worry even more.


Aging and death are depressing, I get you. It's bad enough to think about yourself getting old and dying, it's even worse to have to think about someone you love getting old and dying. 

I guess the ideal end is to live a long, healthy and cogent life, full of happiness and vigor, until you suddenly die in your sleep or drop dead of an aneurism or something. Not many people end that way. There is usually a slow decline where you need a lot of care. 

Why do you hate about the thought of your mom in a nursing home? Is it just because you think they're awful? What do you think would be better?


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## Iron Jaguar (Jan 14, 2022)

They're living too long and sucking up resources. Especially the Boomers.


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## T0oCoolFool (Jan 14, 2022)

fuknhek said:


> Aging and death are depressing, I get you. It's bad enough to think about yourself getting old and dying, it's even worse to have to think about someone you love getting old and dying.
> 
> I guess the ideal end is to live a long, healthy and cogent life, full of happiness and vigor, until you suddenly die in your sleep or drop dead of an aneurism or something. Not many people end that way. There is usually a slow decline where you need a lot of care.
> 
> Why do you hate about the thought of your mom in a nursing home? Is it just because you think they're awful? What do you think would be better?


I loathe nursing homes. I absolutely despise them. Even the "good" ones are terrible. Elder abuse and neglect is high, and lots of nursing home staff couldn't give less of a damn. Even if you find a "good" nursing home with staff that do their absolute best, it's still terrible because there's never enough staff, and they're burned out and overworked, so your loved ones may end up suffering or dying simply because the nurse on call is running on nothing but fumes due to pulling double shifts.

Nursing homes are depressing as hell. Even if you don't have to worry about neglect, they're simply soulless and boring. And filled with nothing but sad grandmas and grandpas wishing their family would visit. Some family do visit every day, but it's rare, and even then, it's not the same as living in your own home and dealing with your friends and family.

I don't ever want to go to a nursing home. My dad said he will kill himself before going to one willingly. My mom said the same thing. I don't blame them, nursing homes are scary.


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## Mr. Skeltal (Jan 14, 2022)

T0oCoolFool said:


> This thread is depressing. I was hoping I could read something positive or at least hopeful.  The way modern society views old people and how they handle elder care is goddamn depressing.
> 
> I don't want my mom to go to a nursing home, but that's what I fear will happen. And this thread makes me worry even more.


I'll care for my parents but I refuse to let my children go through what my mother and grandmother went through with my great-grandmother. Dementia is a genuine killer and a horrible condition to "live" with.

I'd rather have a tragic "ice fishing" accident than live with dementia.



T0oCoolFool said:


> I loathe nursing homes. I absolutely despise them. Even the "good" ones are terrible. Elder abuse and neglect is high, and lots of nursing home staff couldn't give less of a damn. Even if you find a "good" nursing home with staff that do their absolute best, it's still terrible because there's never enough staff, and they're burned out and overworked, so your loved ones may end up suffering or dying simply because the nurse on call is running on nothing but fumes due to pulling double shifts.
> 
> Nursing homes are depressing as hell. Even if you don't have to worry about neglect, they're simply soulless and boring. And filled with nothing but sad grandmas and grandpas wishing their family would visit. Some family do visit every day, but it's rare, and even then, it's not the same as living in your own home and dealing with your friends and family.
> 
> I don't ever want to go to a nursing home. My dad said he will kill himself before going to one willingly. My mom said the same thing. I don't blame them, nursing homes are scary.


Nursing homes are greenrooms for death. I hated having to visit them and would rather die violently like my late brother-in-law than linger on like my poor great-grandmother. Past a certain age I'll probably just write myself a DNR that neither my wife nor children can fuck with.


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## T0oCoolFool (Jan 14, 2022)

Mr. Skeltal said:


> I'll care for my parents but I refuse to let my children go through what my mother and grandmother went through with my great-grandmother. Dementia is a genuine killer and a horrible condition to "live" with.
> 
> I'd rather have a tragic "ice fishing" accident than live with dementia.
> 
> ...


I also hated visiting them. One time this old lady in a wheelchair legit grabbed my arm as I walked by and said "Please let me leave here, please" and just kept begging me and anyone else that walked by to let her go back home. It was heart breaking and it haunts me every time I think about it. Thinking of how one day you're a young and vibrant human, next thing you know, you're stuck in a damn nursing home.

I'm with you. I'd rather die a horrible death than slowly rot in a nursing home.


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## Aunt Carol (Jan 15, 2022)

fuknhek said:


> Exit International: This is the organization that designed the 3d printed suicide pods. I've heard of them but I haven't read through all of their material. I think if the author of that NYmag article were planning some kind of 'exit', this is the org he might consult. And I don't know why but the fact that they include an article about the thoughts of a rabbi arguing (basically) for the sanctity of life, that makes the organization seem less ghoulish and gung-ho about death than someone might think.


I looked around their site.  It's interesting how carefully their articles and fora are reg-walled:

Entry to the forums is by approval only.​A one-month wait period may apply to new subscribers & Exit members.​If you are over 50 years and of sound mind then you are welcome to apply for membership of the Forums through our *Registration Page.*
For questions you may contact us.​Remember – you will first need to *subscribe to The Peaceful Pill eHandbook*.​Photo ID is required.​
Not bulletproof, but they sure don't want any teens and troons fucking up a sincere mutual-aid network.



fuknhek said:


> This is getting a little off topic, since this doesn't address the needs of existing elderly people and the people who care for them. It might help me when I get to the point where I'm facing the early stages of dementia, or I get the news of impending serious illness that I'm certain won't have a good outcome. But who wants to bring this to someone else as an option? Like, hey Nan you're really sick and you probably won't get better, have you considered painless assisted suicide?
> 
> @Aunt Carol That comic you linked to seems amazing. Everyone should have this kind of conversation with their older relatives while they're still lucid enough to make decisions for themselves.


Another interesting rabbit hole is VSED, voluntarily stopping eating and drinking.  Maybe it's a kind of suicide-light, or maybe it's a conscious version of when a very demented person just becomes uninterested in eating and slowly drifts away.  Young munchies have started invoking the name, but it seems like it's something people 80+ are just naturally better at.

You're right that active euthanasia is a hard thing to pitch another person, and that's probably part of why legal change is difficult.  Imagine being the caregiver for a severely demented relative and publicly advocating for euthanizing your Pop-pop; the backlash would blow past the Schiavo scale.

The way things are now, and are likely to be for a while, the dialogue is more about goals of care in the context of an existing illness.  In long term care there are people with "no antibiotics" on their care plan, waiting for pneumonia or a pressure injury.  In acute care hospitals, the timeline for death and for decisions is shorter, which has good and bad aspects.  There are still people who were out gardening in the morning, had a stroke at lunch, never regain consciousness and are gone by the next week.  However, if the next of kin chokes in the clutch, once that percutaneous feeding tube is in, it's legally and ethically hard to stop the train.

When an older person can speak for themself, they usually talk about what they saw happen to their parents (and sometimes their partner or siblings) and tend not to choose aggressive care when it's projected to be futile.  (Semi-related link: How Doctors Die )

When an older person is already not mentally intact--or worse, when this is a sudden change from complete independence--that's when it gets difficult.   Sometimes they're not demented but they have that cognitive impairment where it's easy for the kids to tell them what to do, and the kids didn't watch Dad die because Mom was there to hide the hard parts, but now it's Mom's turn.  Sometimes the patient and their close relatives have come to the same sad decision--and then an absent sibling flies in from out of town, activates all the old family guilt buttons, makes sure Mom is going to have a long and painful death, and flies back to California again.

You can never say it out loud, but it's a lot like when you have to make the euthanasia decision for a pet.  How much pain can you justify for a feeling being who can't understand the future?

A few years ago, my cat was diagnosed with an advanced lymphoma.  We later joked that if I'd decided to go with kitty chemo and massive abdominal surgery for the poor cat, that'd mean my mother taking my name off her advance directive.


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## Secret Messages (Jan 17, 2022)

If I’m in shape enough to leave the care home I’m getting out. If I’m incapable of climbing out the window just put a bullet in my head so I don’t waste away my children’s inheritance paying top dollar to exist glassy-eyed, eating slop and getting my diaper changed. I have a family history of dementia and if I’m diagnosed, after my affairs are sorted the non-emergency line will find me OD’d on painkillers in my bathtub with a Do Not Resuscitate.


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## Manul Otocolobus (Jan 17, 2022)

That writer made the same mistake my father's side of the family did with my grandmother, which was the same damn mistake that my mother's side of the family repeated for my grandfather.

On my father's side, my grandmother was 91 years old. She had suddenly developed a heart valve issue that would surely, eventually, kill her. Unless... they did surgery. My father, as well as my aunts and uncles all said "Ok, so do it!" and I was alone in saying "This is a terrible idea. Let her die. She deserves to have a nice, quick end after 90+ years. I love grandma as much as everyone else, but she deserves dignity. Don't do anything. At her age there is a fairly high chance that she will see a substantial neurological deterioration following a caridac procedure involving prolonged anesthesia" For as much notice as my father, as well as my aunts and uncles gave me, I might as well have let out a fart. She had the procedure, and the outcome was as I predicted, a persistent dementoid state. My father would be standing there and she would ask when he was going to visit, and address my father as his father, who had been dead for more than 30 years. She would have hysterical screaming episodes in the middle of the night. This went on for two years until she finally died of a heart attack. It was a very, very long two years for me, my father, and the rest of the family.

On my mother's side, my grandfather was 82 years old. It started with him developing a major deterioration in his sight. Then an increasing constellation of minor symptoms. Until suddenly one day he didn't know where he was (he was at home, the same place he'd lived for more than 20 years), who anyone was (including my grandmother), and what was going on. Once we got to the hospital it was clear he's had some kind of stroke. The various specialists advocated for various intervention, as well as a transfer to a nursing home. Once again I advocated for doing absolutely nothing, taking him home, and letting him die. He had said, on multiple occasions that if anything happened to him to take him home and let him die, and if we didn't, he would find a way to come back and "haunt your miserable asses for all time". Of course, once again, being the grandchild, my opinion was invalid. Fortunately, my mother held the same opinion I did. Unfortunately that was at odds with what my grandmother and my uncles wanted. So, they patched him up as best they could, which meant he was in a persistent state of sorta being there but not really, and living in a nursing home. 9 months go by and he had a heart attack in the middle of the night. Rinse and repeat of the last visit to the hospital, with yet another piece of his mind slipping away. Once again, I advocate for letting the poor man die with dignity, and once again, I might as well have been picking my nose for as much attention as it got. Yet another stroke 6 months later. Rinse and repeat once again at the hospital. Exact same scenario, exact same outcome. A little less than two and a half years later he has a massive stroke that there is no recovery from and dies. Again, a very, very long two years for all involved.

The only benefit of going through this is that my mother said I am to take her out at all costs if there is absolutely any chance of her experiencing a similar outcome. I am quite relieved by this. I have made sure my siblings and my good friends know the same is true for me. My father, as a catholic, wants the full court press. I told my brother than he can handle that since I'm responsible for Mom.


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## Aunt Carol (Jan 17, 2022)

Manul Otocolobus said:


> Of course, once again, being the grandchild, my opinion was invalid.


I'm so sorry to hear this story keep playing out, and there you were as Cassandra.


Manul Otocolobus said:


> The only benefit of going through this is that my mother said I am to take her out at all costs if there is absolutely any chance of her experiencing a similar outcome. I am quite relieved by this. I have made sure my siblings and my good friends know the same is true for me.


Question about the family members who voted _for_ the medical torture: have they learned anything?  Have they said anything about their end-of-life plans?  Cognitive dissonance would probably prevent anything now, but in a few years or with a diagnosis, I'd hope they would say "jeez, I saw what happened with Dad/Mom, here's what I want."

It seems to keep playing out, family by family, the first one in a generation to have a lingering death is the painful example for everyone in some kind of radius of distance, genetic relation and age.


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## Manul Otocolobus (Jan 17, 2022)

Aunt Carol said:


> I'm so sorry to hear this story keep playing out, and there you were as Cassandra.


Thank you.



Aunt Carol said:


> Question about the family members who voted _for_ the medical torture: have they learned anything?  Have they said anything about their end-of-life plans?  Cognitive dissonance would probably prevent anything now, but in a few years or with a diagnosis, I'd hope they would say "jeez, I saw what happened with Dad/Mom, here's what I want."
> 
> It seems to keep playing out, family by family, the first one in a generation to have a lingering death is the painful example for everyone in some kind of radius of distance, genetic relation and age.



Yes, my one uncle on my mother's side had a revelation a few years later that he did the wrong thing. He acknowledged that he let his own issues with my grandfather cloud his judgement, and wouldn't want the same for himself. He actually apologized to my mother and me, which was cathartic.


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## Bunny Tracks (Jan 18, 2022)

One of my best friends has worked in a nursing home for several years, and the thing that stuck out to me from his stories is that it's rarely the residents that are the biggest problem. 

It's actually the staff.

From what I've gathered, the staff at his place seems to be little more than a clique of Nurse Ratchets, and broken-down jocks with little to no prospects. 

Petty arguments break out all the time, and things get stolen constantly. Residents get dumped into activities they don't want to do, or just left in their rooms because the staff doesn't want to deal with them. Hell, sometimes they just get left in hallways.

 If you're like my friend, and actually try to do fix this, you get written up because the person that did this is friends with upper management and because a lot of the residents don't actually remember what happened. 

No one checks the cameras either, because only management can do that, so usually it's their word against theirs with a third-party who can't even remember what really happened.


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## Aunt Carol (Jan 18, 2022)

Bunny Tracks said:


> Residents get dumped into activities they don't want to do, or just left in their rooms because the staff doesn't want to deal with them.


Depending on the facility, the Activities department doesn't help the matter.

They get judged on butts in seats, or attendance at activities, so I knew them as being ruthless at recruiting people to come play bingo, or to sit and molder in the same room as bingo and have it count as a social activity.  Residents with no volition were like free points to them.   I had an Activities Directer come and sneer at us and ask if there was a _reason_ Mrs. Smith _can't_ come to the movie.  Well, because she was changed, full-lifted into the wheelchair, fed lunch and then you had a minion sneak in and wheel her her to music already.  You have a quota, but tell that to the skin on her butt that's still up in the chair.

The same SNF decided to start a token economy to get residents to activities.  There was a one-woman beauty shop at the facility who came in a few days a week, and it was a big flex for the residents to have the money to go there.  Private pay residents, no problem; other residents just got their hair washed with their regular bath from the aides.  So there would be lucid residents shuffling off to every activity they could, to earn tokens toward a free beauty shop visit.  

I remember one old lady confessing to me that she absolutely hated bingo, but you got two tokens plus you could win more with a bingo, and she was trying to save up for a perm.


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## Bonesjones (Jan 18, 2022)

Feline Supremacist said:


> No, I feel you. I live in NYC for a reason, as far away from California as I can be while still in the USA.


Lol if you actually believe that


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## Mayhem (Jan 20, 2022)

I can powerlevel a lot here, as I have been a caregiver for more than a decade — secondary for a while, and primary for the last two years.

My health is totally shot. I’m on anxiety meds, thyroid meds, and I’ve got weight that I cannot lose, no matter how little I eat. I went into menopause ten years early, so I will likely never have a child of my own. I don’t sleep well. My back and body ache every day. I cry at work and in my car regularly. Every intimate relationship I’ve been in for the past ten years has failed.

The person I care for, my mother, had a massive heart attack a decade ago due to smoking, raging diabetes, and extremely high blood pressure. She was lucky to have survived. I am grateful she did, but ten years later, I honestly would be relieved if she died in her sleep or overdosed on pills. Her mind is still fine, but she is miserable and really doesn’t want to live anymore. However, she’s not in hospice care, doesn’t have an expiration date. She could be dead by the end of this year, or still kicking in five years. I have no idea and neither do her doctors.

The stress on caregivers is immense, and caregivers are majority female. A third of us Americans here on KF are currently caring for an elderly relative or a sick spouse or child. There comes a point with many of us where we just cannot take care of our elderly any more: they become incontinent, angry, depressed, abusive. Dementia takes its toll. Most caregivers don’t want to put their family in a care home, but they live so fucking long and there is very little help for us. We have to work and care for our own families, too, or else we’ll end up alone, with no one to love us or care for us, and even less lucky than the people we cared for.

As someone stated earlier, Medicare will pay for part of the care, when it is mandated on doctors’ orders. Getting those orders is an adventure in and of itself. When our elderly need more care than a simple hour or so per day, that is when the money dries up. Very few have the money for extended long-term care in a facility, and the nice facilities can be five figures a month. There are also laws in many states that allow strangers to seize the assets of the elderly ”for care,” which means that the court-appointed stranger can sell everything the person owns and throw them into a cheap nursing facility, then pocket the rest of the money, even if they have a will and named their heirs. It’s state-sanctioned thievery.

Honestly, my mother did a month in a care facility and was…happy. She did better there than at home because she had people to talk to and things to do, like physical therapy. But she doesn’t want to go back. She’s determined to die at home, and in the meantime, is making me fucking miserable and destroying our relationship. Having to clean up your parent’s shit, wipe their ass, bathe them, feed them, and put up with their psychological and physical abuse will make you hate them.

I would never intentionally harm my mother. But I can’t say that I’ll be all that sad when she’s gone. And I think most caregivers would say the same. Her doctor’s office is full of elderly people, in wheelchairs and in walkers, on oxygen, being accompanied by their exhausted children, who are also old before their time. People can live a very long time now with serious illness, but I don’t think it’s a good thing.


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## Jarch6 (Jan 21, 2022)

I would never stick my parents or grandparents in some home, and I would sooner go into the countryside and die before being interred in one. However, if your parents were the sort who actually kicked you out of the house at eighteen to fend for yourself because they bought into some "pull yourself up by your bootstraps!" meme, I can understand why you'd do the same to them at the end of their life. Furthermore, what an ignoble end. Rather than dying surrounded by family or friends, as an elder would in the past, so many of these people are subjected to a prolonged hospice drugged to the gills watching TV. Avoid such a fate, do not saddle yourself with metabolic dysregulation and feebleness from a poor diet and inactive lifestyle - cling onto vitality.


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## Aunt Carol (Jan 21, 2022)

JosephStalin said:


> Ya, want to see something horrible, check out any over-55 mobile home park.  Place tends to be as quiet as a cemetery.  All those people living in their boxes, waiting for death.  Not for me.


This is probably telling on myself and the community where I choose to live, but there are a ton of people we see inpatient who live at an over-55 mobile park and still do _hella_ meth.  The information age has helped people stay involved in all the family and semi-family feuds even when they're inpatient; their cell phones jingle and ding all through the night as the squabbles continue on group texts and Facebook, grandmas deferred to as the speed-fueled matriarchs they are.

I'm not endorsing the lifestyle choices, especially in the setting of cardiomyopathy, but maybe you're only looking at _nice_ over-55 MH parks.


Bunny Tracks said:


> One of my best friends has worked in a nursing home for several years, and the thing that stuck out to me from his stories is that it's rarely the residents that are the biggest problem.
> 
> It's actually the staff.
> 
> From what I've gathered, the staff at his place seems to be little more than a clique of Nurse Ratchets, and broken-down jocks with little to no prospects.


Shit wages+shit working conditions retain shit people; the people with morals and a hope to do better eventually leave.  Not to exonerate terrible staff, but the administration of a nursing home has a lot to do with it.  If they decide it's just fine to have one CNA for thirty residents, then the kind of person who will stay is either very, very devoted, or someone who looks at the half-assed job it's possible to do, says "meh," and eats some pudding from the nutrition fridge.

There is a really weird regulatory grey area and it varies by state, but AFAIK most places do not have a legal staffing ratio for long-term care, so Management can handwave something about acuity and leave two aides and a nurse for a hundred or so people.  Someone has an accident using the full lift?  Well, it's staff's fault for not having two caregivers when using the lift per policy, never mind if that'd even be possible given what they have to work with.

Similar weirdness: an adult foster home or similar can hire you as a "caregiver" off the street, and you're OK to give meds including subcutaneous insulin.  (Some places have a brief orientation and employ people as a "med-passer," actual title.)  Take a month-long CNA class and get licensed, and you can't legally apply medicated ointment.  

RNs at a SNF are often graduates of a substance-use program; if you were diverting IV opiates and want to stay clean/are required to tell the Board that you want to stay clean, working somewhere there aren't any IV opiates is more sustainable than having a second witness with you in an acute care setting.


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## Jarolleon (Jan 21, 2022)

“I feel thin, sort of stretched, like butter scraped over too much bread.”-Bilbo Baggins

More seriously I think the core problem is that we've figured out how to partially offset the effects of ageing on the limbs, eyes, &c. but we haven't worked out how to do the same for the mind. So people live longer but are mentally capable for very few of those extra years. Also someone else brought up how olds are no longer repositories of wisdom because the world changes so fast and those few timeless things can be learned from books &c. . IMO this is only half of it, the other half is that you had to have some admirable qualities or amazing luck to live to a ripe old age before modern medicine, so if you saw someone who was that old they probably did have something to teach you.


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## Slap47 (Jan 21, 2022)

JosephStalin said:


> Some observations from one in his seventh decade of life...
> 
> Ya, want to see something horrible, check out any over-55 mobile home park.  Place tends to be as quiet as a cemetery.  All those people living in their boxes, waiting for death.  Not for me.
> 
> ...





Jarch6 said:


> I would never stick my parents or grandparents in some home, and I would sooner go into the countryside and die before being interred in one. However, if your parents were the sort who actually kicked you out of the house at eighteen to fend for yourself because they bought into some "pull yourself up by your bootstraps!" meme, I can understand why you'd do the same to them at the end of their life. Furthermore, what an ignoble end. Rather than dying surrounded by family or friends, as an elder would in the past, so many of these people are subjected to a prolonged hospice drugged to the gills watching TV. Avoid such a fate, do not saddle yourself with metabolic dysregulation and feebleness from a poor diet and inactive lifestyle - cling onto vitality.





Totallyunknown said:


> Western society does not care for it's elderly past about the age of 65. There are a few lucky ones that can maintain a close familial bond until about 75-80 when the majority of their life will become health problems. If you're American, you'll possibly have premiums or medication that isn't covered and if you're Canadian you'll face long wait times and mediocre health care.
> 
> No one enjoys anyone who constantly complains about ailments. Maybe it's a health & society issue - people live longer by way of advancements in medicine but their lifestyle choices make them still too unhealthy to actively participate after years of abusing the body. You get old, your joints get a bit sore, you stop being as active, your diet catches up and now your 75lbs overweight and diabetic or have blood pressure problems or you worked in some shit factory with pollution that causes COPD later on now you're in a scooter on oxygen.
> 
> Theres a good reason to fear getting old.



Rightwing Boomers sorta fucked themselves by making inter-generational households one of those most sinful things ever. They fucked over their own parents ala Grandpa Simpson and are now getting fucked over themselves. Now we have normalized cutting off family members and they're first in line whenever they have a problem.

Its one of the most horrible regressiosns in North-American (Canada-USA) society that we have ever seen. Grandparents and parents became burdens instead of integral members of the family. Boomers kicked their kids out at 18, refused to be baby sitters for the grandkids to go party, and then got thrown in a home. You see this story everywhere.

I think the trend is reversing, but only because immigrants have "you will care for me and I will see my grandkids" so ingrained into their cultures and because lower wages for young people is having them actually live with their parents. Of course, the white Boomer generation hates this and you see an insane amount of resentment building up. Alot of those young people are going to betray  and abandon their parents anyway because of how badly they're being treated.


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## Jarolleon (Jan 21, 2022)

Slap47 said:


> Rightwing Boomers sorta fucked themselves by making inter-generational households one of those most sinful things ever. They fucked over their own parents ala Grandpa Simpson and are now getting fucked over themselves. Now we have normalized cutting off family members and they're first in line whenever they have a problem.
> 
> Its one of the most horrible regressiosns in North-American (Canada-USA) society that we have ever seen. Grandparents and parents became burdens instead of integral members of the family. Boomers kicked their kids out at 18, refused to be baby sitters for the grandkids to go party, and then got thrown in a home. You see this story everywhere.
> 
> I think the trend is reversing, but only because immigrants have "you will care for me and I will see my grandkids" so ingrained into their cultures and because lower wages for young people is having them actually live with their parents. Of course, the white Boomer generation hates this and you see an insane amount of resentment building up. Alot of those young people are going to betray  and abandon their parents anyway because of how badly they're being treated.


It might be a Northern European tradition. The young men used to be sent out to make something of themselves, often by joining warbands, any man who stayed home in his prime years was seen as a loser. The Norse called them "coalbiters" for example. This became less militaristic as societies became organised enough that going Viking was no longer feasible, for example the Germans have a tradition of wandering years where newly trained tradesmen, "Journeymen",  would wander the country taking odd jobs and getting free lodging with their guilds. The English used to send their kids to be raised by other families around the age of 10, a custom brought to New England. There is some benefit to this, if you get _too _multigenerational you become a clan society like the Islamic world, where there's no incentive to invent anything ,nobody trusts anyone unless they have some kind of family tie (e.g. Arab militaries are total garbage because they're using doctrines crafted for nations with actual cohesion beyond the clan level) , and rates of cousin marriage are stupidly high. Of course nepotism exists in the West too but it's to a small enough extent that people actually get mad about it when it's discovered.

 I think the RW boomers only fucked up because they expected American social cohesion to stay just as high as it was in their own youth, how could they have seen it coming that the entire culture & economy would be taken over by a clique of madmen who wanted to punish White America for existing? In their time it was reasonable to expect someone to make their own way, and that this would build character.  When you could get a decent job without going through jaded HR departments that subject your words and qualifications to the same scrutiny they'd give to some desperate H1-B Pajeet lying his ass off to get the job, and that's if it wasn't tossed out by a robot for not using the exact keywords & format they were looking for.

It's a very postmodern form of revenge, rather than flat out stealing money from Whites or going reverse-Hitler, you simply change society so that their own folkways are competitively disadvantaged. You nerf their way of doing things & skillsets from S tier to C tier. So it becomes their turn to choose between total irrelevance and adopting the ways of a foreign culture who they used to look down upon.


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## Aunt Carol (Jan 21, 2022)

Jarolleon said:


> IMO this is only half of it, the other half is that you had to have some admirable qualities or amazing luck to live to a ripe old age before modern medicine, so if you saw someone who was that old they probably did have something to teach you.


This is, in my opinion, the main issue.  We now have the ability to keep everyone living past their age of independence (or moderate interdependence), but we don't have the staff to fill the resulting need for dependent care.



Slap47 said:


> I think the trend is reversing, but only because immigrants have "you will care for me and I will see my grandkids" so ingrained into their cultures and because lower wages for young people is having them actually live with their parents. Of course, the white Boomer generation hates this and you see an insane amount of resentment building up. Alot of those young people are going to betray  and abandon their parents anyway because of how badly they're being treated.


Living together, with grandparents who can help raise the grandkids while the parents work: objective benefit for economic reasons, let alone a healthy society.  If the grandparents aren't capable, you end up with parents in the middle spending their working money for childcare _and_ adult respite care during the day.  Absolute best case scenario is the parents have a ton of kids, and the eldest daughter whom they've already parentified to care for the younger kids gets to change Grandpa's briefs as well.

(Not needing dual incomes to sustain a family is a matter beyond the scope of this specific thread.)


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