This summer I am taking a ‘practice class’ for my junior year as a social work major. I am working at an elder services agency, and have been assigned a client of my own.
I met him the previous week, taking advantage of the meals-on-wheels delivery to introduce myself. He invited me into his house, which needs work he can no longer do himself. We sat at the dining room table to talk, and his cat wandered over to inspect me. Finding my presence acceptable, the cat proceeded to rub his cheeks against my hands and arms. I spoke with the gentleman for about half an hour; just enough to explain who I am and why I came. ‘Building rapport’. “I am a student, Mr….I’m here to just talk with you for a while as part of my program.” We agreed that I would come by the next week and talk some more. He wrote the date, time, and my name down, and was genuinely excited to have someone new to talk to. He does not receive many visitors.
He waved me out the front door, and I walked to my car giddy with the positive result of the meeting; my first solo with a client.
The next week, I knocked on his door. After several moments he answered, and looked blankly at me, unsure of who I was or why I was there. He had no memory of the previous visit. I did not mention that we had a meeting scheduled, but instead introduced myself as if I had never been there before. It does no good to point out a failure of memory; it would only confuse and possibly anger him. Hurt his dignity.
The gentleman has ‘Dementia of the Alzheimer’s Type’, and I understood that there was every possibility this could happen. He has good and bad days, but appears to have started the quickening decline. Once a very vital and energetic man, he is now facing continuous and accelerating loss of independence. His mind will not allow him; can no longer allow him, to process the grief appropriately. He may become angry at times and lash out at his family or health workers in frustration because all he will remember is what he used to do, and no longer can. To him, locked in increasingly older memories and unable to be in the present, he will expect that what is a memory of vitality to be the actual truth, and will not understand why his body will not respond.
We all have difficulty at times facing transitions in our lives. Some are more difficult than others; some are more organic than others. There are transitions we choose; job changes, places we live or go to school. Then there are those that simply happen; the changes of aging, of being human. It may sound trite, and it seemed to me as I wrote this last paragraph that it is an obvious point.
But it really isn’t.
We take these changes for granted; they happen to others. It is only when we face them ourselves that we understand: what you have now will end, and then what will you do?
What will your old age look like? Most people do not understand the process, either the aging itself or the financial questions involved. When we are young we see the process of aging from the outside; people slow down, they go into nursing homes or hospice, and pass away. It is an emotional time for most family members, none more so than the care partner*. Then we forget about it. Put it out of our minds.
As a Buddhist, I have meditated on the idea of impermanence many times. As someone with Bipolar, I have lived with the idea of my own mortality daily, as if it were my shadow always following me (as Loudon Wainwright sings; “life’s a job you’re fired from, unless of course you quit…”). Working with elders, I am confronted with a new level of impermanence every day. Meeting my client for the second time and having him not remember me at all was shocking, despite my expectation that it could happen. It is one thing to know something intellectually, another to experience it.
So I ask again: what will your old age look like? Many of us expect our children to care for us. Take us in and house us as we did for them. For many of us this will not be the case. Not because our children are ungrateful or bad, but simply because life won’t allow them to. They may have small children and no room, or work full time, or move far away, or any of the numberless other reasons beyond their control.
This is not a commercial for 401k savings plans, or a rant about Social Security benefits. You can research those things on your own time (or maybe I’ll end up writing about it someday anyway; I am a policy wonk, after all).
The financial calculation is this: there is a sharp line drawn between who is eligible for subsidized benefits, and who has to pay for them out of pocket. That line is not as high as you might think, and it continually gets lower. For most of us who imagine ourselves in the middle class; we live on a bubble. We have too much money to receive assistance, and too little money to pay for it ourselves.
“What will your old age look like?” is also, then, a political question+. What do we owe each other? For those of my friends who believe in limited government; what picture do you have of the end of your life? It is important to keep in mind that changes to government programs and spending cuts, however well intentioned, have impacts beyond the stated goal. This is not to say they are wrong out of hand. It is a serious question of belief and vision. There is also an imperative in America that we leave something behind for our kids. The reality is that more often than not that something gets spent. It has to. A nursing home can cost up to six figures a year. A good nursing home even more. Staying in your house saves money in the short term, but you will still likely pay for everything until the money is gone. Then you can get help.
It is not a comforting scenario, and I apologize for its bleakness. What R and I have realized in talking this out is simple: when we can, we will. That means rather than waiting for the inevitable decline that age brings, we will live in this moment. Save what we can, and enjoy it as we can. It makes little sense to save it for a tomorrow that will not come, or save it for a time it becomes a liability. We have this moment to live.
(The music for this post is a traditional song performed by Uncle Earl called ‘There Is a Time’. It has been on my mind for quite some time, especially when I sit zazen and contemplate impermanence.)
*I use ‘care partner’ instead of ‘care giver’ to denote that the care involved is a two-way street. The client, patient, loved-one is not a passive receptacle of charity, but a reciprocating human being.
+I tried to avoid political discussion in this thread. I even made a promise to my Face Book friends that I wouldn’t make this a political discussion. After trying several times to end this, I found that it could not be avoided.