Professor Vaughn D. Bornet reports from the front lines of geriatric care and casts a sardonic (history professorial) eye on institutional living. Bornet is a nonagenarian and this blogger — twenty years younger — doesn't see the cuckoo's nest in the immediate future. Of course, a stumble or a fall (and a fractured hip) can transform life in the blink of an eye. Nonetheless, no one gets out of here alive and the next-to-last stop may be the cuckoo's nest. If this is a (fair & balanced) generational nightmare, so be it.
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This Is What It's Like When You're Living In An Old Folks' Home (It Could Easily Be Worse)
By Vaughn Davis Bornet
Tag Cloud of the following piece of writing
Even though knowing I would eventually be aging, I paid little attention and made few preparations. “It’s just another annoyance,” said I. That was true as I hit 70. Still true at 80. I did notice 85 but did little. Oh, visits to a cardiologist reminded one that time was passing, and so were the trips to the hospital blood people to get my cholesterol numbers. That pacemaker couldn’t be ignored.
The decline and passing of one extremely close to me, a few years back, was a trumpet call that my own aging was something of a signal. Sure enough: with my dear wife declining in a nursing home I decided with ice on every path to my doors it was time to be “institutionalized.” It wasn’t long—a few short months—before I began to get educated on all kinds of subjects new to me.
Picking that new home went smoothly. One would think this would involve a major search, using gallons of gas and engaging in hiking of corridors. It won’t, probably, because each place visited has trained salespeople who are charming, know the sales buttons to push, explain away obstacles you think up, and maybe produce a busybody friend or acquaintance already there who will make the shopper abandon rationality too soon. Suddenly you have a new home involving three meals a day and don’t know if the chef can cook—or even if they have one who attended any culinary school to graduation.
The day to move arrives. One day it was off to bed in your own little room in that home with no mortgage, flowers planted next to the walkway—everything familiar! The next day brought a new world: a living room and bedroom; but maybe only a multipurpose room. A space called “kitchen” is jammed in a corner; nearby is a small bathroom with well used fixtures, the tiny microwave you just bought at a discount house, no disposal, bright ceiling lights, venetian blinds, and a bland carpet, maybe new. Strange warning devices permeate that ceiling. Corridor noise and TV sounds from others were taken care of pretty well, it turns out. You paid extra for a “view.” Spectacular? Maybe, maybe not. Whether that balcony will turn out to be worth the cost is indeterminate. (There’s that sun; traffic; garbage pickup at 4:00AM; bees; furnishing it; but: drinks on the deck!)
Looking about your first day, over there is your familiar dresser from “home.” Familiar bed too, but with queen sized mattress downsized. That lovely oil painting and some photographs of close relatives from yesteryear give the illusion of “home” because familiar books lie about. You decided to bring the aquarium and already you’re glad something alive is with you when the door shuts. Old Shep went to his new home. They said you could “have him,” but it was three hundred dollars in advance, there was his daily plumbing problem, and, worst of all, you knew his enthusiastic jumping would knock somebody down right off the bat. (You’ll get used to being without him. Display a large picture of that dog for yourself and empathetic visitors who “love dogs.”)
Soon enough it is going to be the dining room of your huge building that’s the focus a full three hours a day. No matter the promises made back when you traded wits with the manager. Meals are going to be a mixed bag from now on. Mealtime, let me authoritatively predict, is going to be a major time waster for you all the rest of your days. General rule: the nicer the help and the more choices and options, the slower the service and the longer the waits. Talked with someone whose mind is going, lately? Maybe an Alzheimer victim? Gear up your residue of patience, yes, and of sympathy. Memorized anybody else’s anecdotes when bored to your skull lately? Especially, get ready to converse at elevated volume, or a facsimile, to communicate at the table—and expect to be glared at from adjoining tables. It can’t be helped, unless you want to “sit there” passively as a permanent stranger. (I had no idea how many “deef” people we have around.)
Institutional meals come in two styles. One has meals at, say, 8:00, 12:00, and 5:00. Be there on the hour or be put at the end of the line. (And be told, “You were late!” by a teen age flunky.) Instead of that rigidity, maybe your elite institution will try valiantly to serve you at “your convenience.” Well. I predict you’re about to be fattened up. It may center your Life on those meals. With minimum exercise, you are about to eat constantly, with your new buddies—as you boycott your empty third floor digs and sit motionless three hours or more daily. Another possibility: You may start putting TV programs ahead of every other aspect of life. Beware.
Another innovation is about to show up: you or a relative or caregiver are going to load up your one kitchen cabinet with salt-immersed soups, with milk that will go bad, with crackers, sardines, bananas that get overripe, fruit that spoils. Eggs and bacon seemed like a good idea: the former proved less permanent than the latter. Blue cheese and crackers go well with bourbon, water, and ice cubes. (Now there’s a friend-maker for 4:15 PM daily. Keep a bottle of good Port around!) You’ll soon find that the medications new friends take preclude alcohol and you have to drink alone….
Now: with whom do I sit—and therefore talk—meal after meal? Hard to say. I know one thing: “Open seating” doesn’t really mean that. Count on this: very old ladies tend to clump together, three or four to a table, and they tend to own it even to the extent of three meals every day! “Somebody’s coming” will be a mantra snapped at you as you inquire about joining them. There develops a private club atmosphere, with sudden and mysterious silence breaking out as you prepare to sit. You will be awhile finding out the situation, but seats in institutional dining rooms soon get earmarked for “locals,” or people “from our church,” or “my caregiver.” (Try, hard, to deduct the many meals you miss from the ones your caretaker eats and that gets billed to you!)
Other reasons why seats are “mine” are length of time living there and nostalgic memories of ones who declined and died. Some who may cling together at a table are persons who are all hearing impaired, those who did—or didn’t—go to college, former librarians, or those who choose to be entirely silent. A table may be one where nobody says a word, not ever, unless something gets spilled. Yet many odd things unite people: I know one where three non-menu dishes of vanilla ice cream unite the ladies at two or more of their meals daily. One couple I know of takes fruit plates to the room nightly “for tomorrow.” One man says the seats are low, so he picks up his meal and eats alone in his room. So what? Electric wheelchairs can be a rite of passage or, more likely, a vehicle guaranteeing independence. Warnings for speeding in the case of one burly man got vehement before self-correction.
Constant presence of an attractive caregiver can have appeal for several persons other than the individual paid that hourly wage. These dedicated, normally middle aged women are an incalculable asset to the nation in this century, but they are little praised—or even noted. They arrive alone in their cars at 8:00AM or earlier; or they come at five; many arrive for the night shift at ten, long after dark, ready for whatever the long night will bring. Widows, the divorced, maybe the formerly imprisoned? Some are quietly physically handicapped, whatever. America’s elderly cannot do without caregivers, and it is way past time to acknowledge their central, even crucial, role in handling our “old age problem.”
Who, exactly, chooses those strange movies to be shown in that little theater/TV room? Must they always be 10 minutes late starting? Wheelchairs complicate the seating. Must a quarter of the audience leave noisily well before the end? Talking could be a problem but probably isn’t. Finishing desert and tidying up may prevent a quiet start. Must tall ones always sit in front? Step over that cane unless you are planning to join the sad broken hip fraternity/sorority. Let others argue over the volume. Do make sure the subtitles are always switched on.
Medications have to be handed out daily to those in assisted living. It needs to be done right: expertly! (Some, I think, make of pill time an interval for creating an area stir with various invented stipulations.) Morning pill takers include those just back from the nearby hospital, some with Parkinson’s, heart patients, those relying on “water pills” (postponing diabetes II?), and many who look OK but somehow aren’t. A quarter aspirin is a common reliance. The pill givers are invariably clever and tactful, patient, observant. Indeed, they are in a vital occupation little noted but essential in old age homes. Those “pill pushers,” really “pill distributers” going from table to table know that they simply dare not get it wrong! Some pills are vital and beloved relatives are depending on them!
Three times daily, the quality of meal service is much analyzed by the bored, who have little else to discuss. “How good are your meals?” Don’t ask. Most institutional food arrives from out of state (in our case) by huge truck. Our routine food preparation is, well, about what you would expect; maybe even less. Turnover in the entirely too low paying food service jobs is likely to be, well, constant. Under $10 an hour is no incentive. It’s hard work, too. Serving several dozen OLD people takes memory, patience, good hearing, empathy, and forbearance. People blame the nearest employee. Meal servers work Hard. A brief sojourn between breakfast and lunch, then lunch and dinner, gets the meal server off his/her feet, but only briefly. It’s my guess that youths with huge college loan debt are legion.
Back to those caregivers, who are blessedly present when you need them. They may sit through a full meal, not eating maybe, as they plan the meal they’ll be serving at home later on. Get the kids off to school before work begins! “Must hurry, ‘cause I’m off to dress a nice old fellow with a runny nose. He’s mumbling through the year, chin touching chest….” Be there, caregiver, when that frail lady falls out of bed and breaks that hip. Clean up those messes!
“Let me see: how many old folks have I ‘worked with’ so far?” Maybe you’re on the verge of a complete change of venue and routine, starting now. That is, your latest client died, and the new one just signed the lease yesterday to live out her new life. Some daughter or son is busily deciding many a detail, guessing a lot. Funny thing: the caregiver’s the expert but relatives make innumerable decisions in virtual ignorance. Nobody cares much what experienced persons think at a time when everybody’s emotionally drained or hyped. Fortunately, these close ones, will get sharper in judgment sooner or later. (Here’s a well meant suggestion: $15.00 a hour is not excessive for a good caregiver. Recall “portal to portal” as the old trade unions put it? Consider taking care of some of the gasoline bill that gets run up enroute to inconvenient old age structures housing your loved ones.
That the main elevator has a mind of its own no one doubts. It understands; there is no vacillation; but without being asked, it delivers, sometimes at least. It was not built to handle innumerable four-wheeled walkers; electric motorbikes street legal and not; and room cleaner’s janitorial wagons considerable in size. (Make management have it serviced regularly and post the certificate!)
Overall, it is a whole new world out there—that world of “aging” and institutionalization—with or without conventional medical care. When somebody goes into an institution or gets that first caregiver there is bound to be an array of outsiders who will definitely learn a whole lot they never dreamed of before. Bet on this: few relatives are ready intellectually or emotionally for that new world their parent is entering. Nobody, at first, knows anything about anything!
Owners of those huge buildings nationwide are learning how to get away with add on charging, for there is big money to be made. Brookdale, headquartered in Nashville is now by far the largest in the United States. It operates well over a thousand institutions located in nearly every state. Emeritus, yesterday’s giant, is no more as of August (and just in time, for it lost a variety of multimillion dollar lawsuits toward the end, with “punitive” damages awarded. It even took a two million dollar judgment won by California employees of 30 institutions after they claimed abuse.) Even so, it is very hard for any outsider to avoid looking at today’s institutions and then rendering impatient, even harsh, judgment on much of their daily performance, for educational coursework has not kept up with change.
For those now living an institutionalized life, with or without care, still continent or unavoidably anything but, vast numbers are daily users of four wheel strollers or motorized vehicles, small wheeled strollers, wheelchairs, or wobbly old legs and canes. Still: walking unassisted or aided, it’s a Life. No matter what, a growing handful of our old folks are going to live pleasantly enough from, say, 90 to noticeably over 100. I just learned of one scholar who lives in a ten story deluxe locale, hale and hearty—above the waist, anyway—at 107. (Once he edited an encyclopedia; now he does the institution newsletter.)
Rewarding life is not entirely minimized in those institutions. Management arranges side trips by bus for a happy half a day, or so. They’ll willingly take you to your pesky appointments or a Wall Mart type store. As residents give up driving they pocket the gas money and use it during anything resembling a crisis for a taxi or a small transport vehicle. Not entirely ambulatory seniors go in units of a dozen for lunch or “scenic drives,” or some suggested destination of choice.
Well-meaning visitors, some who are church oriented or ministers; musicians; lecturers; even some of various ages who want to lend a hand—such help-giving individuals become familiar parts of the old age landscape for the institutionalized. They make what might otherwise be a “sham life” into something less unendurable. Laughter is common enough. Our underpaid weekly “cocktail pianist” is close to Waldorf quality and uplifting for a luncheon hour. Somewhere in the background, sadly, my rent will be raised $100 a month, every year, as by edict from on high. Knowing that keeps me a tiny bit subdued.
This senior citizen is at this moment knocking out these thoughts on his familiar computer with its beautiful new monitor. My TV screen is state of the art, and I have a cellphone but haven’t mastered most features. I’ve successfully lived through 23 months of living in “an old age home,” more or less happy, pretty much solvent, a long active adult who sometimes finds himself bored out of his skin. I’m gradually approaching that century mark, and as they say in the theaters, “I’m waiting for the next Act,” even though I think the scene I’m engaged in is—for better or worse—enroute to the Finale. Ω
[Vaughn D. Bornet is an Emeritus Professor of History and Social Science, and Chairman of the Social Sciences Division at Southern Oregon -College- University. He written several books, including Welfare in America (1960), Herbert Hoover, President of the United States (co-authored with Edgar E. Robinson, 1975), The Presidency of Lyndon B. Johnson (1983), and An Independent Scholar in Twentieth Century America: The Autobiography of Vaughn Davis Bornet (1995). Bornet received a BA (history) from Emory University and a PhD (history) from Stanford University.]
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