Saturday, February 4, 2012

Thoughts on assisted living, aging, Dad, and guilt.

by Dr. Jeffrey Lant
Author’s program note. Here is the most important four-letter word in the entire English language: home. It conjures up and is connected to every element of the well-lived life: spouse, family, peace, comfort, security. Nothing can match its importance, nothing can duplicate its significance. Nothing is more powerful than our memories of home and their enduring pull, always tugging at our heart strings. Home and its rhythms, its well remembered aspects, its secrets, its traditions, its confidences, its ways so well known and carefully maintained… these have a power over us that never fails, never pales, never wavers, never diminishes, and are always clear, fresh, joyful, unforgettable, bittersweet, haunting, the sweetest memories of our entire life.
This is an article on the moment that comes to each of us… when this home, our very special, irreplaceable place, must be given up because its proprietors can no longer maintain it, now needing particular care themselves. This is an article about a moment poignant, sad, dreadful, irrevocable. It is about the people who take this step first, our parents… then about their children, us, who will trod the difficult road, too, but not yet… and what they must do today, a day of emotional turmoil, distress, a day for which all preparation is inadequate.
For this article I have selected the song “My Old Kentucky Home” (1852) by America’s first great composer, Stephen Foster. It is one of the most wistful, longing songs of our country… and whenever one hears it one thinks, and tearful too, of one’s own home, now gone, far away, never to be replaced, always to be remembered, the more so as the destination you are now going to can never be a home like the one left behind. Go now to any search engine. Find and play it at once. It is the perfect accompaniment to this article.
The call.
The call we all fear, cannot bear thinking about, but must think about — comes the day our aging parents first consider assisted living, whether outwardly calm and willing, or fighting the hopeless battle to avoid this fate, roiled by turbulent emotions deep within, so clearly visible without.
Assisted living.
The words “assisted living” are two of the most frightening and disturbing in our language. It is easy to see why. Assisted living is mostly the province of the retired, the ill, the aging, geriatric survivors of better times. As such it is a venue to be put off and avoided whenever possible, for as long as possible; as much so as if each assisted living facility had posted at its front door this immemorial admonition from Dante’s “Inferno”: “Abandon all hope ye who enter here.”
Such institutions are perceived as the final way station before cosmic extinction; the place one enters unhappy, angry, misunderstood, and which one leaves dead; the place for the irremediably old, those who are past it, marginal, unconsidered, beyond the care and concern of anyone other than those paid to care and be concerned; lonely people of the Eleanor Rigby variety.
All of life…
Assisted living, with its implied inadequacies and dependence, is always and often indignantly compared to the joy of independent living, where you do what you want, when you want, with whom you want, in just the way you want; in other words the kind of living each of us desires, insists upon, and does everything possible to maintain. Assisted living, of course, is widely perceived as the antithesis of the desired independent living.
But this is wrong.
ALL living is assisted living. For unless you are rabidly antisocial and determined to remain that way, alone, isolated, happy and contented in your aloneness, you are assisted — every single day — by people whose aim is to make you reasonably happy, reasonably content, and reasonably comfortable. Thus, in truth, when one moves from living regarded as independent to living regarded as assisted, one is evolving from one kind of care to another kind of care; one is tweaking circumstances the better to ensure the maximum continuation of your desired life style. One is not undergoing metamorphosis, but comparative and necessary improvement.
Sadly, most people undergoing this process are unable to see this, or at least to state it to guilt-ridden relatives who are thus distressed by the painful thought that Aunt Martha is being cast off rather than moved to an appropriate level of care, concern, and consideration. Most assisted living facilities these days resemble college campuses or resorts; they know the grief, anger, recriminations and distress which new residents bring and work hard to create an atmosphere that is at once attractive, even beautiful; livable, practical, and serene, factors which soothe the guilt of those recommending assisted living to those near and dear but are often dismissed as inadequate or unimportant by those being recommended into the facility.
Receiving the intelligence.
Twice in my life, so far, have I been a participant to greater or lesser degree, in conversations surrounding the movement of one near and beloved to assisted living. The first such conversations involved my mother; the second set involved my father. These conversations could hardly have been less similar — or more instructive about the principals involved and affected.
My mother, student of Dylan Thomas that she was, did not, nor could not, go gentle into this good night. She raged, raged against what she was sure was the dying of the light. Despite weakening health and the myriad of problems stemming therefrom my mother fought hard, strenuously, vociferously, painfully against the notion of “incarceration” in an assisted living facility, thereby branded as penal institution, not comfortable necessity. Her transition from living deemed independent to living deemed assisted was therefore protracted, painful, packed with imprecations, denigrations, accusations, maledictions which made Emile Zola’s famous declaration “J’accuse” look sniveling.
My father handled the matter entirely different… and I suspect this was partly because he will have with him his wife Ellie; to be alone at life’s end is painful; to be partnered with a loved mate lessons the pain while increasing the means to combat and to live with it.
Sad, wistful, practical, accepting.
When my father called yesterday to inform me that he and Ellie had made arrangements to share their dwindling, most precious days together in assisted living, I felt a lump in my throat. He extolled the grounds, their private apartment, the food, the friendly residents… but whether he believed all this as stated or was just trying out what would become the stock reason or their move, I cannot say… for I was reflecting on a few words that he had said.
Entering the dining room where they would find their daily meals, he was surprised to find it peopled with the old, feeble, and infirm. Could this be he at 86, Ellie at 87? Or had some mistake occurred? She, knowing how difficult it had to be for him to transform his independent life to one “assisted”, took his hand and reassured him that no mistake was made; they were in the right place, which he would soon know, if he did not know already. And thus these proud, fiercely independent souls, more used to assisting others than being assisted, move into the next phase of their lives, together, facts faced, practical decisions made, gently, calmly, with love and care. And I admired my father so, not merely as son to father, but as man to man. For he faced the difficult, the fearful, the unpalatable, with grace, quietude, reserve, with good judgement, good humor, and a good wife, well stocked and ready for the journey ahead… which they will travel similarly and with kindness, above all with kindless and the help of those glad to assist them, and with kindness too.
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