Another COVID-Related Casualty

We’ll be tallying up and analyzing the consequences of COVID-19 for years to come. The pandemic has not only had a direct human toll, in terms of deaths, and hospitalizations, and illnesses, but also substantial indirect impacts — on businesses, on local economies, on social interaction, on children’s perceptions of the world, and countless other parts of our lives. This week Deer Isle felt one of those indirect impacts when the Island Nursing Home announced that it will be closing its doors in October after 40 years in business.

As has been the case with many of the human casualties, COVID was just one of the causes of the demise of the Island Nursing Home. As the article linked above indicates, the facility had been dealing for years with challenges in hiring qualified staff, attributable to a series of factors–a general shortage of qualified health care workers, its remote location on an island, “Maine winters,” and a lack of affordable housing in the area–and the COVID pandemic exacerbated the staffing shortage to the point that the facility can no longer provide care. And this isn’t the first time that the COVID virus has affected the facility, either; in 2020, there was an outbreak at the facility among both residents and staff.

The closure of the Island Nursing Home will have an impact on this community, by virtue of its position as a significant employer and because it will leave residents, and their families, with difficult decisions about where to go. Many of the residents are from this area, and the notion of moving away to unfamiliar surroundings is unsettling to them. And there will be challenges in finding places for the residents, because the staffing shortage experienced by the Island Nursing Home is also being felt by other facilities. That’s a real problem when a growing percentage of our population is aging and reaching the years when they are seriously looking at assisted living facilities.

Slowing The Aging Process

Mention “aging” to someone in their 50s — like me — and you’re likely to provoke a grim expression.  We feel the aging process in our muscles and bones, we get that ugly twinge after a sudden move, and we see it when we look in the mirror and notice the grey hairs, the wrinkles, and the pathetic turkey neck.

But what if aging could be slowed?  What if therapies and treatments could be developed that would decelerate the ravages of time, or stave it off altogether?

Scientists are looking into the possibility that gene therapy, hormone treatments, and other approaches might have that effect and have been using some of the new treatment concepts in experiments on animals.  Economists believe that treatments that successfully delay aging — and thereby allow people to be productive and healthy longer — could have enormous economic consequences.

Speaking as one of the aging generation, I’m all in favor of seeing whether reasonable treatments can be developed.  At the same time, however, I question whether heroic efforts should be devoted to deferring the effects of aging when there are many other public health issues that also need attention.  And a public health focus on aging makes sense only if the years that are added are healthy, sane, active, non-institutionalized years.  When you regularly visit a nursing home and see how many Americans are living their final years, you can legitimately question whether living longer is inevitably a great thing.

My Periodic Glimpse Of The Aging End Game

With Mom in an assisted living facility, my visits to see her have exposed me to the impact of old age in ways I’ve never seen before.  It’s been an eye-opener.

Typically my interaction with the residents happens in two scenarios — coming and going, and in the dining room.  When you enter the facility, you pass outdoor benches and rockers.  If the weather permits, there are usually some residents outside.  Most of them are smokers.  It was a bit jarring the first time I saw 85-year-old women dragging away on cigarettes, but the smokers probably figure what the hell — why not, at this point? Curiously, the smokers seem to be among the residents in the best overall shape.

Many of the other residents are congregated in the large common room near the entrance.  Some of them are in wheelchairs, and most of the rest use walkers.  Some are sleeping — usually deeply, often with heads back and mouths wide open — and others are just sitting.  Although there usually are many people in the room, there typically isn’t much conversation.  Even when I walk in on an event, like a bingo game run by a chipper assistant or an accordion performance, many of the residents are disengaged.

Some residents still get dressed up and take care with their appearance, and others have just let it go.  You’ll see women in make-up and jewelry and coordinated outfits and others who just wear loose shifts.  Some of the people clearly are with it, and others aren’t.  Recently, when Mom was still down in the dining room when I arrived, I sat at her table with a cheerful woman who, upon being introduced, immediately told me that she had no short term memory.  Within a minute, she repeated herself several times.  She clearly was aware of her condition, but there was nothing she could do about it.

Mom’s assisted living facility is a nice place, as such facilities go.  It’s kept very clean, the meals are well-prepared, and the staff members are friendly and attentive and work hard at what has to be a very tough job.  Most of the residents seem to have accepted their situations and are . . . waiting, and trying to make the best of things.  They can’t take care of themselves, their spouses are gone, and they really don’t have any good alternatives.

Even though I’ve been visiting the place for more than a year, I’m still sorting through my reactions to the very complicated issues raised by the end-game scenario.

Picking Out A Skilled Nursing Facility For A Loved One

You’re happy that your loved one has survived a serious health problem — then you realize with a jolt, perhaps with a nudge from a social worker, that you must figure out where that person will go when they are discharged tomorrow.  But . . . how do you decide where?  We haven’t been trained for these kinds of decisions.

Although hospital social workers won’t express an opinion, they’ll give you names and, if you live in Columbus or another metropolitan area, probably will tell you that you’re lucky because there are many options.  Sometimes, however, broad choice can be less a blessing than a curse.  How do you narrow the field down to the one place that is the best choice for your loved one?

There’s lots of information out there, but what does it mean?  There are ratings on-line, but how are they developed?  If you’re in your 50s, talk to your friends and you’ll learn that many of them have already gone through the process with their parents.  They may recommend a place or warn you away from a place that they describe, in awful terms, as a kind of institutional hell on earth.  You appreciate the warnings, but it also scares you to know that such places may exist and a bad decision may land your loved one there.  The significance of your decision seems increasingly overwhelming.

So you go visit places, because everyone says to do so — and you realize that the places look pretty much the same.  There’s a chipper female administrator who takes you on a tour.  The facilities are ranch-style, with no stairs, and are brightly lit and decorated.  You hear about the therapy equipment and nurse-and-therapist-to-patient ratios as the professional staff walk briskly past, look in at a resident’s room that looks just like the resident’s room you saw in the last facility you visited, and scan the therapy room with its machines and balls and mock stairsteps.  They all look pretty much the same, too.

You see the residents, of course.  After the initial shock of seeing crumpled figures in wheelchairs and beds — poor, hurting, older people unlike the healthy, vigorous folks you see every day — you realize that’s why the facility is there.  You can’t disqualify a place because you encounter a groaning older person gesturing at you with an outstretched, scrawny, grasping arm and a haunted look in their eyes, because virtually every place has them.  You just try not to imagine your loved one eating next to that poor soul, because you can’t.

You soon understand that the tours and the chipper administrators and recommendations and warnings from your friends can only get you so far.  How can you tell whether this place, or that place, has the kind of patient, upbeat therapists who can give a scared, exhausted person the incentive to get out of bed and try to walk again, or talk again, or use their injured arm?  How do you know how the food will taste if it must be prepared in low-sodium, pureed form because your loved one needs to relearn how to swallow — and is it even possible for bland pureed food to be appetizing?  How do you know whether the seemingly competent staff will really pay careful attention to your  loved one, rather than the angry man causing the commotion three doors down?

You really can’t know, of course.  It’s an impossible decision that you must make, but you do the best you can, trying to weigh the competing considerations and hoping that your instincts move you in the right direction.  Mostly, you hope.

Looking For A Quick, Clean Exit, Far Into The Future

How do you want your life to end?  An even more difficult question:  how do you want the lives of your loved ones to end?  An article in New York magazine, about a family’s struggle with their mother’s long, slow decline — and the related emotional and societal costs — raises those stark heartbreaking issues.

I think most people would like to go out like my grandfather did.  He lived to be 99, kept his mental and physical health until the end, then had a stroke while eating breakfast and died later that day.  No institutionalization.  No dementia.  No months or years of a twilight existence, apparently unaware of his surroundings, experiencing bedsores and diaper changes and incomprehension.

Of course, we don’t get to make stark choices between the ideal and the awful.  Instead, families deal with impossible judgment calls.  Should the frail 84-year-old woman with the bad hip endure the pain, or have an implant operation that could give her a pain-free existence — or produce a shock to the system that causes her to slide into an irreversible downward spiral?  If an elderly relative decides not to undertake life-extending treatment, should the grief-stricken children try to argue him out of his decision?  How should a family deal with an institutionalized Alzheimer’s victim in the bewildered, angry, unrecognizing end stages of mental decline and the guilt that comes from not wanting to see their relative in that terrible condition?

The author of the New York article yearns for a “death panel” — he calls it a “deliverance panel” — where family members could appeal for a relative’s death.  There’s a reason why the concept of such panels provoked such opposition during the recent debate on health care reform, however.  What modern Solomons would staff such panels?  The doctors who want to sharpen their skills at an aggressive life-extending procedure and get paid for their efforts?  The bureaucrat who sees his health care budget exploding and wants to rein in costs?  The hospital administrator who thinks the room the patient occupies could be better used by someone receiving more care and treatment?  The children who are heartsick about the potential loss, hoping for a miracle, guilt-ridden, exhausted, overwhelmed, and concerned about their inheritances, all at once?

There are no easy answers to these terrible issues.  I think the appropriate first step is for everyone to make their own decisions about their own care, when they are still healthy and capable of doing so, and memorialize those decisions in some kind of binding way so that their surviving relatives aren’t saddled with impossible choices.  Is the prospect of long-term institutional care and constant pain a source of unimaginable horror, or would you be willing to put up with it in order to meet your great-grandchildren?  Only the individual can know how much of a deviation from the ideal end-of-days scenario they are willing to endure.