When the care of my parents fell to me six years ago, I knew I would need help if they were to stay in their own home. I beat the bushes for reliable helpers who could provide personal care for my mother, do light housework, and sometimes cook my parents a hot meal at noon. After learning that home health care is not covered by Medicare, I looked at my parents’ combined retirement income and saw that it could easily cover four hours of daily care.
Many members of my church, I discovered, were also caring for elderly parents. I asked them for referrals to possible helpers. Those leads proved few and unfruitful. The women already had more clients than they could handle.
Next I checked into home health care agencies. Their services were limited to bathing, feeding, and setting up medications. They didn’t do windows-or even clean bathrooms or cook meals. Also, they were shorthanded and could not guarantee what time of day or even what days their workers would be available. A regular routine was essential for my mother who, along with Parkinson’s disease, suffered from stroke-related dementia.
At last I found a new agency in town that provided “senior services,” including housework and cooking. Their hourly rate was reasonable. But we never knew who would show up. Some days it was Gloria, some days Sharice, and some days a person we’d never see again. The constant change of faces in her house didn’t help my mother’s growing paranoia.
Then we struck gold. Ella was willing and could cook. She was gentle with my mother, who quickly came to trust her. She listened attentively to my mother’s ramblings as she bathed and dressed her. But, like many of the women who do this work, Ella was no spring chicken herself. After Christmas, she was diagnosed with cancer. By Easter Ella was dead.
For some time my mother had been suffering small strokes. Then the big one hit. After three weeks in the hospital, she still needed round-the-clock nursing care. Thus began our introduction to Fair Acres, the best of three local nursing homes. At that point, I thought my mother could not survive a year in her condition. I was wrong. She lived at Fair Acres almost five years.
Christian media and education about family life have focused primarily on child-rearing. Little attention has been given to caring for aging parents. In that arena, Christians, like their unchurched neighbors, generally find themselves at a loss. Many Christians are wrestling with the question of how to incorporate the commandment to honor their fathers and mothers in their already crowded lives.
A quick survey of the history and current status of nursing homes may help us think more seriously and concretely about the continuing, pressing need to honor the elderly in one of the tried and truest ways.
How did this happen?
How elderly Americans have been cared for has changed markedly over the centuries. The colonialists duplicated the English Poor Laws system, which obliged church parishes to maintain the infirm and destitute within their precincts. Of course, most parents were cared for by their families. But, if you were old, poor, and childless during the early years of this country, chances are you went to a workhouse or poor farm.
Residents were often kept under lock and key and had to wear uniforms in the hope that public humiliation would keep down their numbers. These establishments were a catchall not only for the elderly, but also for the “deaf, dumb, blind, idiots, aged and sick, poor children, unfortunate women, insane.”
Owing to the country’s new Constitution, however, the responsibility of funding public poorhouses passed from church to state. Some states solved the problem simply by boarding their elderly in private homes in order to save the expense of building and maintaining a facility. Tennessee auctioned off its paupers to farmers looking for cheap labor. New Jersey law forbade the emancipation of slaves over the age of 40 for fear the state would have to support them in their declining years.
Caring for old people—which many of Christianity Today‘s readers are or will soon be doing-will be one of the major challenges to the nation in the next decade. We now live longer, albeit with many diseases and disabilities we never survived to experience before. Babies born in 2000 can now expect to live to the age of 73-23 more years than the 1910 crop of babies.
No one at home anymore
A 2002 study by the research agency Zogby International measured the differences in expectations between parents 65 and older still living in their homes and their adult children. About half of the children believed their parents would want to live with them as they aged. But two-thirds of the parents did not want to live with their children.
Almost all the children expected to personally care for their parents’ daily needs at some point. But how realistic is this? Relatively few adult children, Christian or otherwise, now live near their parents. Also, in most middle-aged marriages, both people work outside the home. Their children may be in daycare or school during the day, but no one is home to look after an aging, infirm parent.
In “The Death of the Hired Man,” Robert Frost defines home as “the place where, when you have to go there, they have to take you in.” But no longer. In fact, if you went there, chances are you’d find nobody home.
Most of my mother’s fellow nursing home residents would call themselves Christian, as would a majority of their children. Some local churches hold regular services or Bible studies at Fair Acres. But few churches in this country actually own or operate nursing homes. Those few generally cater to retired clergy, and their cost puts them beyond the reach of many members.
For 91 percent of American retirees, their Social Security check is their major source of income, hardly enough to cover nursing home costs. Indeed, if you’re over 75 and live alone, chances are better than 50-50 that you live on less than $10,000 a year. Therefore, it should come as no surprise that 68 percent of all nursing home beds are paid for by Medicaid, with Medicare picking up another 8 percent.
When the Zogby poll asked about the cost of long-term care, only a third of the parents thought they would need their children’s financial help. More of the children-44 percent-expected to shoulder some of those expenses.
But another look at the numbers opens a new problem more urgent than who pays the nursing home bill. I was shocked to learn that 46 percent of nursing home residents have no living children, and more than half have no close living relative.
Once a citizen of the nursing home nation, you no longer operate on a money economy. At Fair Acres the rich are those who can get to the dining room under their own steam, use the toilet by themselves, and can still speak and be understood. My mother arrived there with little of that capital.
Nevertheless, her fellow residents envied her wealth of daily family visits. My father never flagged in his faithfulness. During the five years my mother lived at Fair Acres, he missed spending mornings with her only about a dozen times, most during illnesses of his own. I relieved him in the afternoon. My mother’s cousin also visited her twice a week, and a busy sister-in-law often came on Thursdays.
To visit widows and orphans
Only a handful of residents enjoy such consistent companionship. Many have survived all their friends and family. If they have children, they likely live at some distance. The sad fact is that two-thirds of all nursing home residents have no regular visitors at all.
Most people visit nursing homes reluctantly. The whiffs of urine that inevitably pervade such facilities, the monotonous cries for help, the faces frozen with despair or dementia can unsettle one’s own psyche. We can’t help wondering, Will that be me? Will I end up in a place like this? As the gap between your age and that of the average nursing home resident narrows, the question becomes persistent.
Christians with aging parents might ponder Jesus’ provision for his mother, made in his own last extremity. “‘Behold, thy mother!'” he tells his beloved disciple. “And from that hour that disciple took her into his own home.” Money isn’t mentioned, only the relationship.
Prudent financial planning is necessary, but money will not keep the body from wearing out. Nor can dollars defend against isolation and loneliness. Fair Acres’ residents value above all companionship-someone to listen to their stories and tell them what’s happening in the outside world. When you can’t talk, you still want someone to hold your hand, watch the sun set or the rain fall, share a cookie, hum a tune, remember your birthday, hand you a Kleenex for your tears.
Relationships, even more than pension funds, require care and cultivation. Jesus taught that our heart and our treasure are found in the same location. Add value to your relationships every year, like an IRA contribution. Reach out to other people. Express gratitude to friends and family. And, even if it’s hard, visit someone in a nursing home.
Virginia Stem Owens is a writer living in Huntsville, Texas. Her most recent book, which she wrote with her husband David, is Living Next Door to the Death House (Eerdmans, 2003).
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Related Elsewhere:
Virginia Stem Owens also wrote about her mother in the nursing home. Thanksgiving at Fair Acres | A meal with my mother and other nursing-home residents opened a small crack in their stony detachment, and gave a brief glimpse of the kingdom of heaven. (Nov. 17, 2000)
Other Christianity Today articles on caring for the elderly include:
The Heroism of Caregivers | PBS’s sober documentary examines how families cope when loved ones can no longer care for themselves. (Oct. 10, 2002)
CT Classic: Muriel’s Blessing | Despite the toll of his wife’s Alzheimer’s, a husband marvels at the mystery of love. (Feb. 09, 2004)
CT Classic: Living by Vows | As his wife suffered with Alzheimer’s, Robertson McQuilkin said, “If I took care of her for 40 years, I would never be out of her debt.” (Feb. 09, 2004)
Final Chapter | Robertson McQuilkin reflects on his wife’s long battle with Alzheimer’s. (Feb. 09, 2004)
Other Christianity Today stories from Owens include:
Good Friday | Part two of “The Great Reversal,” a CT Classic article. (April 20, 2000)
Walking Where Lewis Walked | My reluctant entry into the world of pilgrimage. (Feb. 10, 2000)
The Fatted Faithful | Why the church may be harmful to your waistline. (Jan. 11, 1999)
Karla Faye’s Final Stop | How my hometown deals with being the execution capital of the world. (CT, July 13, 1998)
Other Books & Culture stories from Owens include:
Death and Texas | How a self-styled “Community Conversation” turned into an anti-conversation carried on by an anti-community. (B&C, Nov/Dec. 2000)
What Shall We Do with Mother? | Poll your friends over fifty. Most of them are already wrestling with this question. (B&C, Jul/Aug 1999)
Grave Matters | I shouldn’t have let my parents talk to those funeral salesmen unchaperoned. (B&C, Mar/Apr 1999)
