I took part in a “think-tank” at the Center on Age and Community, a structured brainstorm involving artists and people who work with elders and their families in long-term care facilities, advocacy organizations and other roles and settings. Our brief was to look at “transforming activities in long-term care,” “activities” being all the things that people in such circumstances are offered to do: from sorting poker chips to telling stories to making art.
That started out sounding like a fairly narrow charge, but like almost any question you stare at long enough, it expanded to fill all the available conceptual space. It become evident that addressing the conditions that induce caregivers—whether at home or in facilities—to end up parking elders like abandoned cars, interventions are needed at every level: relieving the burden on families who must care for aging relatives with diminished capacity, bringing about “culture change” in services for older adults, from indifference and warehousing to “choice, dignity, respect, self-determination and purposeful living.” The chain of need extends all the way up to a transformation in our collective awareness, reframing aging as a universal human process rather than a medical problem.
Even in the think-tank’s specialized company, there was no consensus on what that human process entails. Some people thought there was too much denial of age, too many gray-heads swallowing Viagra when the calendar indicated it was time to eat lunch at the senior center instead. I’m inclined to the opposite view, that our definition of “old” has been superseded by changes in life span and lifeways, as I wrote last year.
But do we really need a consensus? I’d be satisfied with honoring all people’s right to decide for themselves what it means to act one’s age. But even to achieve that commonsense aim entails a huge paradigm shift, away from the privatization of suffering that typifies our public policy and toward humane acceptance of collective responsibility.
I like to use C. Wright Mills’ formulation to characterize where we’ve gone wrong: treating public issues as private troubles. You can’t pay the mortgage, you’re worried about losing your house? So what if the reasons have much to do with bad economic policy, with an economic crisis that affects people whether they have been personally prudent or not? It’s your private trouble, not a public issue. Good luck!
You say your father needs help even taking care the basics—food, hygiene, safety? And it’s all you can do to work full-time and look after your kids, but you do your best, hoping you won’t die of sleep deprivation? That’s your private trouble, even though many people you know will face similar circumstances, and whether or not they make it through without cracking will depend on their having been lucky enough to draw the right family fortunes or the right employer in the lottery of life. Good luck!
In the short term, of course, there are many things that individuals and organizations can do to ameliorate unnecessary suffering, even if they don’t address the root causes. People talked about revising personal priorities toward the humane, relational and spiritual: for instance, give your family cheese and crackers for dinner one night each week, devoting the time saved to telling stories or making music with grandma or grandpa. It was fun to watch the artists at the think-tank unspool a ribbon of good ideas about how to create moments of beauty and meaning even in restrictive environments, to see that sink in, to see that ah-ha moment when some of the dedicated, sensitive people involved in long-term care recognized that artists had to be integral to their work, not some sort of luxury option.
This was all extremely interesting and useful. But for me, the most enlightening takeaway from the think-tank came when people who work directly with elder care talked about obstacles and resistance to making even such immediate, doable changes. Too many people in charge of elder care are habituated to what they are already doing, they said, to what is familiar. They don’t want to accept the risk of changing. By the time this part of the conversation had arrived, we’d been talking long enough and in enough detail to make clear that the familiar way was often a path of failure: it demoralized care workers, neglected and increased the suffering of the people in their care, left a wake of exhausted, frustrated souls.
Flash! That’s when the realization dawned: they were describing people who are willing to go on failing in familiar ways—maybe forever—rather than take the risk of failing in new ways!
Scholars of cognition attribute this in part to the “status-quo bias,” our tendency to prefer whatever is familiar, the devil we know. But I keep finding myself appalled by how strong that bias seems to be, how much surplus suffering we are willing to bear before the incentive to change becomes compelling.
Is there a social sector in which this dynamic does not appear? Education, health, environment, economy, culture, transportation, employment and on and on? Is there one in which persistent failure and the fear of failing in new ways are not constant companions?
I’m having trouble wrapping my head around the full implications of this insight. You see, risk is defined as “the possibility that something unwelcome or unpleasant will happen.” When we repeatedly fail in familiar ways, risk becomes a daily guarantee: something unwelcome and unpleasant occurs over and over again, day after day. If logic had anything to do with it, risking any feasible new approach judged to have a 50-50 or better chance of succeeding would always be a sensible choice, since the alternative guarantees failure.
Right now, I’m putting my shoulder on the side of awareness, in part because I don’t know what else can help. I guess I’ll just point it out wherever I see it, in myself or in others: “Excuse me, but why not risk failing in a new way for a change?”
I have no idea if this will have any effect, but to quote Kurt Vonnegut, I am certain it will keep me “Busy, busy, busy” (which is what a Bokononist—Bokonism is the religion he invented in Cat’s Cradle—whispers when thinking about “how complicated and unpredictable the machinery of life really is”).
The first event of the think-tank was a wonderful concert by David Greenberger and Paul Cebar, spoken word based on interviews with memory-challenged elders set to jazzy, funky, bluesy music. I’ll close with the last lyrics of this great clip on YouTube:
My mother always said,
“You’re gonna get in trouble some day, you talk too much.”
I said, “No, Momma, that’s how you get to be smart!”
The full recording is due out in August. In the meantime, click here for some more samples.