On Vanishing. Lynn Casteel Harper
he and my grandmother had never so much as stayed overnight at our house when I was growing up, balking at the idea of “imposing” on my parents for even one night, let alone for an indefinite period. In the wake of my grandmother’s unexpected death, coordinating Jack’s care fell to my mom, who had some help from her sister who lived in Florida. Like most family caregivers, they did the best they could amid few viable alternatives.
I felt the weight of Jack’s distance each time I took the spur off I-70 at Kingdom City and headed due north, past farm fields and blank plains sky, to an unfamiliar exit. I sang James Taylor’s “Mexico”; the song’s carefree scenario and wistful longing for the country of Mexico’s sweet sun and bright moon soothed the sting I felt for my token visits to this remote place, to a man I had trouble locating. However, even Taylor’s Mexico contains a reality check—a paradise lost—sad letters from home, financial ruin, hard times. Not even Mexico’s hot sun and bright nights could protect against life’s inevitable blows. And Jack’s Mexico—the one in Missouri—was not a vacation destination, a make-everything-all-right utopia. Mexico, for him, spelled separation.
“Oh, Mexico!” I sang in full voice, windows down, my face toward the horizon’s vanishing point. “I guess I’ll have to go now!”
•
Jack’s story, while personal for me, is not particularly unique: an old person, frail of mind or body or both, lives out his final years in a nursing institution, under the watch of paid staff, segregated from the wider community. Given that nearly a million and a half people in the United States live in nursing homes, institutionalization of elders is not a private, isolated phenomenon. There are nearly 16,000 nursing homes and another 30,000 assisted living facilities in America. Senior housing is big business. Long-term nursing care costs $6,844 per month, on average, for a semiprivate room. An average assisted living apartment costs $3,628 per month. Medicare covers neither. According to the CDC, 50.4 percent of residents in nursing homes have a diagnosis of Alzheimer’s or some other form of dementia. As the ratio of adults under sixty-five to adults over sixty-five continues to drop, staffing these facilities will become increasingly difficult. Mexico is not Jack’s problem or my family’s problem alone—it is a public problem.
As I reflected on my grandfather’s moves, as well as those endured by the residents I came to know in the Gardens, I began to question this arrangement—one that makes it so hard for so many old people to remain situated in their neighborhoods and communities, requiring them to exchange the rhythms of home for the regimentation of clinical care. At times, the ubiquity of elder care facilities can seem to me to be emblematic of malignant social psychology—a form of banishment and exclusion, physical or emotional.
“Banishment” in the context of care homes is often interpreted in narrow ways: disallowing a person to participate in a group activity, or placing a person in her room without access to others. At this micro level, I have no reason to believe Jack suffered banishment at the Veterans Home. However, from the vantage point of the larger movements of his life and the lives of others like him, I can’t help but see the marks of banishment. In Jack’s case, he was sent away from his home of fifty-seven years; he was sent away from the region he knew; he was excluded even from Columbia, the new epicenter of his daughter’s family. He ended up on a landlocked island—physically out of sight and psychologically out of mind. He became a foreigner in the middle of his own home state. It is unlikely he knew his coordinates or could have located Mexico on a map. But my sense is that he possessed some awareness of being cut loose, adrift in no-man’s-land—and his utterly subdued affect, I believe, may have had something to do with this awareness.
It is not that all nursing institutions are abysmal or that nothing of value can or does go on within them. They are often the only alternative elders have to languishing—physically, emotionally, spiritually—in their own homes or in the homes of overextended relatives, without the help they need. Perhaps the only thing worse than having nursing homes is not having them. It is what they represent that troubles me: the movement of frail old people to the fringes, out of common life, and into “the kingdom of the sick”—to borrow Sontag’s illustrative phrase. They represent the readily available, readily agreed-upon societal solution to elder care, which involves relocation—more accurately, dislocation. That these institutions provide communities of care otherwise denied to elders, I can’t help but feel, indicates a larger societal failure to welcome, integrate, and support them in neighborhoods and the greater community.
Like the insane asylums of the nineteenth century, might the presence of separate homes for elders in the United States reflect the prejudices of a dominant culture—a culture that finds institutionalization a viable remedy to the problems represented by certain populations?
The geriatrician Bill Thomas, a self-proclaimed nursing home “abolitionist,” contends that traditional nursing homes represent the “declinist” view of aging—that is, the notion widely held in our society that older people are broken human beings who are less than they used to be. Rather than whole persons who continue to develop through their lifespan, old people are assumed to be in universal decline. This decline, so the declinist logic goes, rightly constitutes the elder’s primary identity as “patient” and determines her living environment as increasingly estranged from normal life and ruled by medical structures. Rejecting a declinist orientation, Thomas maintains that while growing old entails elements of decline, “the larger truth is that aging is a complex, multifaceted, and poorly understood component of normal human development.”
While the facility where I served as a chaplain was well run, the staff most often warm and caring, with an atmosphere of community spirit often emerging among the residents, it was ultimately still a clinical regime. I observed the residents anxiously line up (or, lined up) for their medication before each meal; residents were interrupted no matter their present activity to be given their pills; residents had little privacy, ever under the watchful eye of the clinical imperative to prevent falls. There were nurses’ stations, medication carts, long corridors, noisy common areas, and few small cozy spaces. Residents’ rooms had ceramic industrial-grade floors and harsh overhead lighting. Floor staff wore scrubs. There were dining hours and showering schedules. A four-digit code punched into a metal keypad unlocked the doors of the dementia unit.
The events that precipitate this mass displacement of elders from their homes are not highly visible communal catastrophes. No disaster—no war, flooding, famine—initiates the everyday expulsion of elders in modern America. The processes are slower, more covert, and less openly violent than other forms of banishment, and perhaps that accounts for why we have been slow to name the injustice. Old persons in the United States are not deported at the hands of conquering nation-states, but rather they are moved, more often than not, by loving caregivers. They are not going to places called Fort Lincoln Internment Camp or Willard Asylum for the Chronic Insane, but rather they move to places with names like Sunnyside Gardens or Seaside Manor.
Конец ознакомительного фрагмента.
Текст предоставлен ООО «ЛитРес».
Прочитайте эту книгу целиком, купив полную легальную версию на ЛитРес.
Безопасно оплатить книгу можно банковской картой Visa, MasterCard, Maestro, со счета мобильного телефона, с платежного терминала, в салоне МТС или Связной, через PayPal, WebMoney, Яндекс.Деньги,