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"Caring
for Individuals
as a Group:
A Theological Analysis of Care of the Elderly in Nursing Homes"
By Vicki Oman
Caring for the Elders in Our Society
Reflections: On caring for the “individuals” in nursing homes
Theological Analysis: A vision of caring through mutual knowing
What is “a valuable life”?: A theological poem
Caring for the Elders in our Society
Provision of care for the elderly as a group
is big business, but it has become a controversial issue. Who receives care, who pays for it, and how society will keep up
with the needs of the elderly are some of the issues which are being
intensely debated. In these debates over “the elderly”, it is crucial that
we remember the individuals within the group. There are some common experiences which all aging members of
society share, but the needs and circumstances of each elderly individual
are varied, and it is unrealistic to make decisions based on
generalizations.
Our society is aging, and doing so rapidly.
In the years between 1983 and 1993, the number of individuals in
the United States who were aged 85 and older increased by 34%.In 1992, 4.4% of individuals aged 65 and older were residents of
nursing homes. From the
period of 1980-1981 to the period 1990-1991, nursing home use increased
33%.The increasing life span
of individuals and the growing need to care for these individuals (in
1992, 71% of elderly had disabilities) have drawn attention to issues
surrounding medical decisions and long term care choices for the elderly. (Statistics from Administration on Aging)
As I have shown, the number of elderly members of our society continues to increase. As being elderly becomes less rare, it also becomes less respected; the revered role which elders used to play in our society no longer exists. The elderly could, at one time, feel secure that they would be cared for by their extended family, but family systems and the needs of the elderly have changed. Most extended families no longer live together, and most family members have lives which keep them away from home for more of the time. This, combined with the increasing medical complexity of long lives, has contributed to the increased need for long term care beds. Some contend that the causality lies in the opposite direction, that increased availability of formal services for the elderly has caused family members to take less responsibility. (Greene, 136-141) In my personal experience, families may relinquish some responsibility due to availability of home health services, but the decision to place a family member in long term care is not easy, it is usually the least tasteful and most dreaded option, and it is a decision which is typically delayed until it is absolutely necessary. For financial and emotional reasons, most individuals choose “the least” option for care (elderly housing, home health services, assisted living, retirement or rest homes) before choosing “the most” option (a skilled nursing facility, or nursing home).
Reflections: On caring for the “individuals” in nursing
homes
The costs of these varied healthcare options have framed the debate over setting limits on healthcare provision for the elderly. Some look ahead and believe that it has become necessary to set some sort of limits on the healthcare services (especially life-extending interventions) elderly individuals receive. All individuals aged 65 and up are eligible for Medicare, and 11% of individuals aged 65 and up were on Medicaid in 1992 (Administration on Aging). Most individuals who are admitted to long term care facilities as private pay patients will spend all of their money and ultimately be recipients of Medicaid for the rest of their lives. Medicare and Medicaid are public funds, and there is much concern over the future of paying for the care of a population which is still projected to grow; projections for the year 2040 are that 21% of the population will be elderly individuals representing 45% of health-care expenditures. (Callahan, 24) Callahan advocates setting limits on healthcare for the elderly for more than financial reasons. He considers the obligation which the elderly have to the young, the acceptance of decline and death, and the valuing of the old for their age, not for their vitality.
This view has fueled a debate which has,
predictably, covered many topics, including: costs and the use of
resources, the natural life span, euthanasia, the role of science, class
biases, the meaning of aging, who should be making the choices.
There is a call for the resolution of this debate to become public
policy. The primary objection to such policies is that the
experiences of the aged are so very varied and unpredictable, and are
influenced by such a variety of factors, that to set limits based on broad
standards is unrealistic and does not take into account individual
variations and needs. (Holstein,
37-43) It also makes dangerous assumptions about what defines a
valuable life.
What is “a valuable life”?: A theological poem
Caring for the elderly can be viewed as a human rights issue, a financial issue, a public policy issue, an ethics issue. Where does that leave the individuals requiring and receiving care? In many ways, the elders whose needs are debated become objects. In the above debates, elderly individuals are reduced to ethical concepts, economic costs, assessments of societal value. In the nursing home setting, where attention to individual needs and rights have revolutionized the care these facilities offer, (please refer to “Reflections” link) it is still very easy to objectify individuals and reduce them to the sum total of what is documented in their charts. Where are the individuals’ experiences, feelings, and needs taken into consideration? If God is the ultimate caregiver, where is God in this system of “caring”?
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