You can use fancy names – continuing care retirement community or adult congregate living facility – hire a landscape architect – use aroma therapy – even run full billboard ads showing octogenarians dancing the night away.
But as Anne Richards, former Governor of Texas, was fond of saying “You can put lipstick on a sow and call it Monique, but it’s still a pig.”
Institutional aging exists in America because we’re confused. We’re not quite sure how to balance our dramatic shifts in mortality and morbidity demographics, fractured nuclear family, failed long-term care system and the distaste for our frail, incontinent elders. Additionally, there are quality of life considerations that parallel our dwindling reserves of religious faith. (There is an eerie silence in our churches and temples, while casino blackjack tables operate 24/7)
Yet, you have to look closely to find the real “bad guys” in this story. The anti-heroes are not always obvious.
It’s easy to point a finger at a greedy aging facility owner who pays his CNAs $8/hr and shout “Ah-Ha”, while the real culprit – the social and cultural stereotyping of an aging population- remains hidden.
After the passage of Medicare and Medicaid in the 60s, we thought we’d found the answer for the terminal end of a rapidly aging population: the skilled nursing facility( i.e. ‘nursing homes’). Here’s the recipe – take one group of sick, depressed, demented, disabled, and near-the-end-of-their-life folks; put them all in a bag. Add enough psychotropics to keep the whole lot manageable and shake vigorously.
We thought this was a formula that would work. It didn’t. It doesn’t. And it wont. Its time to take a step back, rethink the challenges an aging population presents and redesign a new terminal aging model.