Friday, May 22, 2009

"Nasty, Brutish, and Long" Ira Rosofsky on Eldercare

Ira Rosofsky is a psychologist working the nursing home scene. He's sixty-two and the author of a book next on my to-do list.
I just listened to a podcast interview with him and can tell from what he says that he knows what he's talking about. I can relate because of personal experience with my mother during the last three to five years, and because my post retirement vocation for seven years is in the world of old people.

Nasty, Brutish and Long
is not heavy duty reading. I have not read it yet but I sense it will be a quick read you can pass on to someone else when you're done. I got a heads-up from Christina Castro who has a marketing desk at Penguin Books. They got my email somewhere and I'm one of their targeted bloggers. As long as they don't start spamming me with all kinds of junk I'm keeping the mailbox available.

In nursing homes across the country, members of the Greatest Generation are living out their last days. No matter how exciting or mundane their lives, they’re now occupying a hospital-style room—a public space where you can’t lock your door and strangers come and go. Life is a succession of pokes and prods, medications, TV, bingo, and, possibly, talking to Ira Rosofsky.

Nasty, Brutish, and Long is a candid, humane, and improbably humorous look at the world of eldercare. With a compassionate eye but mordant wit, Rosofsky, a psychologist charged with gauging the mental health of his elders, reveals a culture based not in the empathy of caretaking, but rather in the coolly detached bureaucracy of Medicare and Medicaid.

A portrayal of what is increasingly becoming the last slice of life for many, Nasty, Brutish, and Long is also a baby boomer’s poignant meditation on mortality, a reflection on his caregiving for his parents’ final days, and an examination of the choices that we, as a society, have made about healthcare for the elderly who are no longer of sound mind and body.

Before I forget, we need to explain the title for readers who may not remember their history or political science classes. Thomas Hobbs was a Seventeenth Century philosopher and thinker who was an early architect of what has called the social contract principle of civilized people. This description from Wikipedia summarizes it thus:

Hobbes postulates what life would be like without government, a condition which he calls the state of nature. In that state, each person would have a right, or license, to everything in the world. This inevitably leads to conflict, a "war of all against all," and thus lives that are "solitary, poor, nasty, brutish, and short."

To escape this state of war, men in the state of nature accede to a social contract and establish a civil society. According to Hobbes, society is a population beneath a sovereign authority, to whom all individuals in that society cede their natural rights for the sake of protection. Any abuses of power by this authority are to be accepted as the price of peace. [We could talk all day about how that same discussion took place this week between no less a couple than our current president and former vice-president, but that is for a different time and place...]

Here is a snip from the little blog the Penguin people furnished the author.
Pay attention to the questions he poses and consider how the answers might be part of the solution to the bloated costs of what passes for health care in America. This is a very timely book for anyone of any age thinking about that discussion.

In 1651, during a brutal civil war and just after Parliament cut off the head of King Charles I, the English philosopher Thomas Hobbes called life, "solitary, poore, nasty, brutish, and short." Life expectancy was 40.

Fast forward three and a half centuries, and thanks to medical science, life expectancy is 80. Life is longer. Yet is it any less nasty and brutish?

My book, Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare considers that question, and wonders whether the dinner-party host who declined to put cut flowers in water was right when he said, "It only prolongs their agony."

Are the institutions in which we place the frail, elderly anything more than water for cut flowers-only prolonging the agony.

I am a psychologist who spends his days talking to mostly sad, often confused, yet occasionally happy old people in a variety of eldercare facilities across the State of Connecticut.

Alzheimer's, loneliness, chronic disease are my daily fare.

My book presents the stories of the ancient people I meet and casts a cold eye on the culture that sustains them in their final days, weeks, and years.

Their narratives have a compelling intrinsic interest-a personalized oral history of the twentieth century. In the lives of many nursing home residents, I may be the only person who actually sits down, establishes eye contact, and listens.

But no matter how exciting or mundane the narrative arc of their lives, these nursing-home residents have one and all wound up in a corner of a hospital-style room living in a public space where you can't lock your door and strangers walk by and see you lying helplessly in bed. You might be lying next to someone who spends his waking days screaming, "Help! Please help!" Or you might be the one screaming.

Hannah Arendt looked upon the ordinariness of Adolf Eichmann and saw the banality of evil. I look upon the ordinariness of elder care and speak of the banality of banality.

I work both sides of the street. Along with the nursing home residents is the narrative of my and my wife's caregiving to our own aging parents-the personal meeting the professional, the health-care provider as health-care consumer.

In my book, I also move from the anecdotal to the general, and consider these questions.

==> Do our elderly need to be insitutionalized in places that look and feel like junior hospitals-hospital-lite?

==> Why does the government spend $70,000 to keep a patient in a nursing home while declining to spend only $30,000 for an often more appropriate, more home-like assisted living center?

==> Why do we spend billions on demonstrably ineffective anti-dementia drugs when we could be spending it on basic research and higher levels of staffing?

==> Why do the most highly trained staff in nursing homes-as well as most other human-service institutions-spend the least amount of time with residents?

==> Why do the staff in a nursing home view the closed door in a resident's room with the same suspicious eye as a parent viewing the closed-door of a teenager's bedroom?

==> Why can't you use the word "sex" in a nursing home without "offense" as a modifier?

==> Why is it immeasurably harder to get a simple glass of wine than a powerful major tranquilizer or a lethal cigarette?

Nasty, Brutish, and Long is also my baby-boomer rumination-at 62, I'm old enough to cash in my 401K yet too young for Medicare-about intimations of mortality. In the eyes of the people I see is the not-too-distant future of us all, or at least all of us who would like to grow old.

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