{"id":29824,"date":"2026-01-29T12:48:57","date_gmt":"2026-01-29T19:48:57","guid":{"rendered":"https:\/\/maxcarmichael.com\/blog\/?p=29824"},"modified":"2026-01-31T17:05:31","modified_gmt":"2026-02-01T00:05:31","slug":"letters-to-my-mother-part-5-what-are-we-to-do","status":"publish","type":"post","link":"https:\/\/maxcarmichael.com\/blog\/?p=29824","title":{"rendered":"Letters to My Mother, Part 5: What Are We to Do?"},"content":{"rendered":"

\"\"<\/p>\n

Previous: I Tried to Help<\/a><\/p>\n

\n

Beliefs, Plans, and Denial<\/a><\/p>\n

Healthcare Realities<\/a><\/p>\n

Home Care Realities<\/a><\/p>\n

Care Home Realities<\/a><\/p>\n

Life and Death in Long-Term Care<\/a><\/p>\n

Closing the Cycle<\/a><\/p>\n

Human Nature<\/a><\/p>\n

What Are We to Do?<\/a><\/p>\n

\n

Beliefs, Plans, and Denial<\/h1>\n

Our Family<\/h2>\n

Papaw, my dad’s father
\nDied quickly, in hospital
\nOf heart failure<\/p>\n

Mamaw, his wife, widowed and living alone
\nBegan hallucinating<\/p>\n

Her son flew back and tricked her into a nursing home
\nSaid they were going to the doctor
\nAides grabbed her from the car
\nShe died miserable, among strangers<\/p>\n

My grandpa, your daddy
\nDied suddenly at home
\nOf a massive heart attack<\/p>\n

Your mother, my grandma
\nVoluntarily entered a nursing home
\nThrived there, singing, comforting
\nCheering the other residents<\/p>\n

My dad, your first husband
\nFound freelance home helpers by word of mouth
\nPaid them minimum wage
\nLived at home, managing his own affairs
\nUntil he died during a final trip to the ER<\/p>\n

You never made plans for the end of your life
\nRefused to talk about it
\nSaid you would never leave your home
\nWould rely on home help when the time came<\/p>\n

I believed you irresponsible, living in denial
\nUntil I realized that in the culture of our ancestors
\nTraditions in family and community
\nProvided for the end of life
\nIndividuals were not forced to figure it out for themselves<\/p>\n

My Friends<\/h2>\n

In our society, you were at one end of the spectrum
\nSome of my friends are at the other
\nAlways worried about the future
\nThey devote time and energy to planning for their end<\/p>\n

One friend worries about dementia
\nWorked to create legal provisions for assisted suicide
\nIf he begins to lose his mind<\/p>\n

But as we found
\nMental illness can defy science<\/p>\n

Losing your mind
\nYou could still think and remember
\nYou were afraid to die
\nAnd you fought for your life, even while unconscious<\/p>\n

What would the law say about that?
\nIs it really possible to plan for losing your mind?<\/p>\n

Other friends prepare for the end of life
\nBy buying long-term care insurance
\nImplicitly planning to spend their final days in facilities
\nLike the ones that failed us<\/p>\n

Some voluntarily move into “retirement communities”
\nWhen they get tired of maintaining their homes
\nLong before they actually need home care
\nThey like the idea of having care
\nAvailable onsite when they need it<\/p>\n

With visions of daily golf or bridge
\nThey don’t mind being sequestered among other old people
\nIsolated from community, families, and youth<\/p>\n

\"Golf-centric <\/a>
Golf-centric retirement community outside Phoenix <\/div> <\/div> <\/div> <\/div> <\/div>\n

Having spent two years
\nSeeking and working with the kind of care
\nMany people expect to be available
\nI believe we’re all in denial<\/p>\n

With healthcare and elder care commodities
\nIn our statist, capitalist, bureaucratic society
\nThe kind of care many expect simply doesn’t exist<\/p>\n

And often, we are forced into situations
\nWe never could have planned for
\nHospitalized with a sudden, unexpected crisis
\nSuddenly ending up in permanent long-term care<\/p>\n

My End<\/h2>\n

As someone whose quality of life
\nDepends on hiking and making music, art, and stories
\nI want my life to end
\nWhen I can no longer do those things<\/p>\n

I want my life to end
\nBefore I become dependent on the care of others<\/p>\n

The rural Irish lived in homes
\nThat included apartments for their elders
\nWhen the elders were too old to tend the farm
\nThey moved out of the main house
\nAnd became advisors to the young<\/p>\n

Traditional societies around the world
\nFacing limited resources
\nCondoned suicide by elders
\nWho could no longer care for themselves<\/p>\n

Stories of grandparents jumping or thrown off cliffs
\nAbandoned on ice floes
\nTrudging off alone in winter<\/p>\n

\"Son <\/a>
Son abandoning his mother on mountain in The Ballad of Narayama <\/div> <\/div> <\/div> <\/div> <\/div>\n

In our colonial culture
\nSuicide is such a deep and strong taboo
\nScience is discouraged from studying these practices
\nAnd with our deep puritanical bias
\nWe outlaw voluntary drug overdoses<\/p>\n

When friends ask
\nI tell them when the time comes
\nI’ll just walk out into the wilderness
\nBut what if it’s too late
\nAnd I can no longer get there on my own?<\/p>\n

Healthcare Realities<\/h1>\n

Doctors and Hospitals<\/h2>\n

Your primary care doctor retired
\nJust before your final crisis began
\nHer office made no attempt
\nTo find you a replacement<\/p>\n

Our loved ones’ decline often begins in a crisis
\nWhere they end up in the ER
\nThe emergency department of a hospital<\/p>\n

The goal of the ER is to rush a diagnosis,
\nTreatment, and discharge
\nFrequently, they’re wrong<\/p>\n

A loved one must be onsite
\nTo ensure you’re adequately examined
\nSafely discharged to a place with adequate care
\nReceiving timely follow-up with a physician<\/p>\n

If a patient is in danger of dying
\nStaff will ask
\nDo you want us to save you?<\/em><\/p>\n

This is called Full Code
\nInvolving CPR, intubation, defibrillation
\nBreaking ribs, puncturing lungs
\nRisking severe disabilities<\/p>\n

If the patient is hard of hearing or confused
\nBy strangers and an unfamiliar environment
\nThey will typically agree<\/p>\n

This decision is impossible for family to change
\nDoctors agree it’s wrong, but that’s the system<\/p>\n

If the patient is unable to make a decision
\nThe nurse on hand calls and wakes up next of kin
\nIn the middle of the night, demanding an immediate decision<\/p>\n

\"Indianapolis <\/a>
Indianapolis ER overcrowded during COVID pandemic <\/div> <\/div> <\/div> <\/div> <\/div>\n

When your condition is critical
\nBut you need more than a few hours
\nOf testing and treatment
\nThey admit you to Med Surg<\/p>\n

It’s a catch-all unit
\nWhere your case is supervised by a hospitalist
\nCoordinating a team of specialists<\/p>\n

But not all hospitals have all the relevant specialties
\nAnd in our colonial society’s reductive paradigm
\nSpecialists have no interest in
\nOr knowledge of other specialties<\/p>\n

They regularly claim authority
\nAnd make false conclusions, even let patients die
\nBased on ignorance
\nAnd a narrow perspective<\/p>\n

If the issue is behavioral or mental
\nA hospital psychiatric unit should be the last resort
\nThese units are designed like prisons
\nTo restrain and prevent violent behavior<\/p>\n

Because you had no PCP during your crisis
\nWhen you were discharged from hospital
\nThere was no follow-up
\nNo confirmation that diagnosis was correct
\nNo confirmation that treatment was successful<\/p>\n

Money and Care<\/h2>\n

Some people will assume that our problems
\nResulted from limited and substandard healthcare
\nIn our hometowns
\nThe capital of a notorious red state, and a remote rural town<\/p>\n

Many people assume the best healthcare can be found
\nIn affluent enclaves in New York, Boston, the Bay Area, Los Angeles
\nMinneapolis or Phoenix, with their Mayo Clinics<\/p>\n

But the real picture is much more complicated
\nYes, I had to fly to Seattle for specialized hip surgery
\nAnd to San Francisco for nonsurgical foot treatment
\nI could afford that, even in my low-income bracket
\nSo there was no need to live in those places<\/p>\n

Critical patients in small towns are always referred to cities
\nFor specialist treatment not available locally
\nBut you had an excellent heart surgeon in your Midwestern city
\nAnd our small-town psychiatrist was likewise exceptional<\/p>\n

Home Care Realities<\/h1>\n

With few exceptions, our homes and our parents’ homes
\nAre not designed to be accessible
\nAnd most could not be adapted for parents with mobility issues
\nParents who need outside caregivers
\nRequiring their own space and facilities in the home<\/p>\n

\"Steep <\/a>
Steep stairs to your loft bedroom became unsafe <\/div> <\/div> <\/div> <\/div> <\/div>\n

Our ancestors cared for their parents at home
\nThe architecture and skills handed down by tradition
\nI yearned to restore that tradition
\nBut dreaded the need when I saw it coming<\/p>\n

Our society fails to train us to be caregivers
\nLike everything else, caregiving is commodified
\nWith low pay, high burnout and turnover<\/p>\n

Home care agencies abound in every community
\nBut unless you can prove low income and assets
\nQualifying for Medicaid
\nPrivate pay is your only option
\n$30-40 per hour<\/p>\n

My dad found freelance home help by word of mouth
\nMost of them were adequate
\nFor you and your disabled son, I hired an agency
\nMost caregivers, supposedly trained
\nWere hopeless and had to be replaced<\/p>\n

Nearing the end, when you needed 24\/7 monitoring
\nAn agency promised that home care was an option
\nWe agreed on 8 hours per day
\nWith me taking care of you during the remaining 16 hours<\/p>\n

But at the last minute
\nDiscovered caregivers are unavailable overnight
\nOn weekends or holidays
\nSo when could I sleep, or take a break?
\nForget about overnight trips or vacations<\/p>\n

Care Home Realities<\/h1>\n

Types and Differences<\/h2>\n

Depending on our degree of independence and need for care
\nOur colonial, statist, capitalist, bureaucratic society
\nOffers a spectrum of facilities
\nAs service commodities we can purchase or qualify for
\nDepending on our financial status<\/p>\n

These facilities are most often designed
\nTo offer a continuum of care
\nIn which we can progress from more independence
\nTo more care, as we decline
\nAnd most are owned or franchised
\nBy national or regional corporations<\/p>\n

Those who actually prefer to age among their peers
\nSequestered from the rest of society
\nCan move to a facility with private homes, duplexes
\nOr apartments where “seniors” can live
\nAs independently as they please<\/p>\n

These are called retirement communities,
\nSenior living, independent living, etc.<\/p>\n

Both my parents experienced health crises
\nAfter which they were discharged to a short-term rehab facility
\nIntended to prepare them to return home<\/p>\n

Rehab is basically a skilled nursing facility
\nA short-term nursing home, part of the continuum of care
\nSo that when a patient fails rehab, they can move directly
\nInto long-term care<\/p>\n

And short-term rehab is covered by Medicare<\/p>\n

\"In <\/a>
In rehab after stroke <\/div> <\/div> <\/div> <\/div> <\/div>\n

Assisted living refers to an apartment complex
\nWhere residents can live independently
\nWith onsite access to as much care as they may need<\/p>\n

Assisted living facilities may stand alone
\nOr may be part of a continuum of care
\nFor qualified low-income residents,
\nRoom and board are covered by Medicaid<\/p>\n

In the facilities I reviewed
\nPrivate pay can range from $3,000 to $9,000 per month
\nLarge corporate facilities at the low end
\nSmall privately-owned facilities at the high end<\/p>\n

Memory care refers to long-term residential care
\nPrimarily for those diagnosed with dementia
\nBut as your case showed, they may accept
\nAnyone struggling with behavioral issues<\/p>\n

These are secure units
\nTypically requiring a keypad code for entry<\/p>\n

\"Memory <\/a>
Memory care home, December 2024 <\/div> <\/div> <\/div> <\/div> <\/div>\n

They may be designed more as homes
\nOr more as skilled nursing facilities
\nIn any case, memory care facilities may stand alone
\nOr may be a unit within a larger continuing care facility<\/p>\n

Again, Medicaid pays for room and board
\nAnd private pay ranges from $10,000 monthly<\/p>\n

Those who need help with medications
\nAnd activities of daily life (ADLs) in general
\nSuch as dressing, toileting, hygiene, and feeding
\nTypically end up in long-term care<\/p>\n

A skilled nursing facility
\nTraditionally known as a nursing home
\nWith rooms like in a hospital
\nShared or private<\/p>\n

For those unqualified for Medicaid
\nPrivate pay ranges from $10,000 per month<\/p>\n

The larger urban facilities we encountered
\nEncompassed all types in one building:
\nShort-term rehab, assisted living apartments,
\nMemory care and long-term skilled nursing units<\/p>\n

\"Lobby <\/a>
Lobby of continuing care facility: assisted living above, rehab right, nursing left <\/div> <\/div> <\/div> <\/div> <\/div>\n

Finding a Facility<\/h2>\n

Image Versus Reality<\/h3>\n

National magazines with retired subscribers
\nHave always been full of ads
\nFor supposedly elite elder care facilities
\nMostly in the East<\/p>\n

My Stanford alumni magazine has glossy full-page ads
\nFor “senior living communities” in affluent enclaves
\nLike Carmel Valley<\/p>\n

\"Senior <\/a>
Senior yoga in Carmel Valley <\/div> <\/div> <\/div> <\/div> <\/div>\n

But the places with big advertising budgets
\nAre the places that are not good enough
\nTo survive on word-of-mouth
\nThat’s the way advertising works<\/p>\n

And even if we got our parents into one of those places
\nWe wouldn’t be able to visit them regularly<\/p>\n

Some believe that more money
\nWill get you better care
\nThat’s how we’re indoctrinated
\nIn a capitalist economy<\/p>\n

But that’s not what I found
\nThe best places I found are the smallest and hardest to get into
\nThey may or may not be the most expensive<\/p>\n

But because they’re small
\nThe elite homes
\nSoon become confining, claustrophic<\/p>\n

I suspect the really rich
\nAre able to offer incentives and accommodations
\nFor paid, live-in caregivers at home<\/p>\n

I’ve driven past, and been referred to
\nHuge facilities with hundreds of apartments or rooms
\nLandscaped grounds, vegetable gardens
\nBistros, pools, theaters
\nI would never place a loved one there<\/p>\n

\""Resort-style <\/a>
“Resort-style senior living” in Indianapolis <\/div> <\/div> <\/div> <\/div> <\/div>\n

The best places I found in Indianapolis and Tucson
\nWere private homes staffed by the owners
\nAnd small, locally-owned facilities
\nDesigned around family-centric models
\nBut all those had waiting lists<\/p>\n

And because you weren’t able to plan ahead
\nOur needs were urgent
\nWe had to settle for places with immediate openings<\/p>\n

Our Experience<\/h3>\n

In your metro area of Indianapolis
\nWith a population of nearly a million
\nAn online search returns about 20 elder care homes<\/p>\n

The search for Carmel, the affluent northern suburb
\nReturns an additional 15
\nThere will be lower numbers for suburbs
\nTo east, west, and south<\/p>\n

Hence, for a big city
\nDozens of options within weekly driving distance
\nBut due to uneven property values
\nTypically located far from our homes and workplaces<\/p>\n

Most of these follow the “continuing care” model
\nWith units for rehab, assisted living, memory care
\nAnd long-term skilled nursing<\/p>\n

Like most \u2013 maybe all large cities
\nIndianapolis has placement agents for elder care
\nAn agency I worked with has “scouts” for each part of the city
\nBut they only provide placement at large corporate chains<\/p>\n

Tucson, with the same population as Indianapolis
\nHas an agent that will identify and show you
\nOptions to meet your specific needs
\nAt a broad range of facilities
\nFrom corporate chains to private homes<\/p>\n

\"Living <\/a>
Living room of private home converted to assisted living, Tucson <\/div> <\/div> <\/div> <\/div> <\/div>\n

Overwhelmed by choices
\nAnd the unreliability of online ratings
\nI followed personal recommendations
\nFrom people I trusted
\nBut was disappointed anyway<\/p>\n

Life and Death in Long-Term Care<\/h1>\n

Management<\/h2>\n

All the management I dealt with
\nAt every facility
\nShowed two faces
\nFriendly and caring at first<\/p>\n

Then, if family takes a close interest in their loved one’s care
\nManagement reacts to suggestions defensively
\nReacts to issues offensively
\nBlames resident or family
\nBefore considering their own responsibility<\/p>\n

They all exhibited a top-down culture
\nIn which management behavior
\nWas imitated by staff<\/p>\n

Dishonesty, manipulation, and retaliation were common
\nManagement always spoke with authority
\nOf residents’ conditions and mood
\nWhen they never spent time alone with residents
\nNever engaged residents in substantive conversations<\/p>\n

They get away with all this
\nBecause it’s a seller’s market
\nThey have waiting lists
\nCan reject you and move on<\/p>\n

Family Relations<\/h2>\n

Again and again, I’ve heard from friends
\nAbout what a wonderful home they found
\nFor their parent<\/p>\n

And over and over, in care facilities
\nI’ve met residents who are lonely and bitter
\nBecause their loved ones abandoned them there
\nAnd seldom if ever visit<\/p>\n

I did meet a few \u2013 less than ten percent
\nWho say they’re content<\/p>\n

In my grandparents’ generation
\nIf elders went into a care facility
\nTheir children and grandchildren
\nLived only a few blocks away
\nVisited after work or school<\/p>\n

In our highly mobile society
\nWhere families are dispersed across continents
\nSometimes across oceans
\nChildren are used to going months
\nWithout seeing their parents<\/p>\n

Most care facilities are designed to replace the family
\nEncourage residents to trust staff
\nAttempt to foster community among residents
\nWhy do families accept that?<\/p>\n

Because most families have no room for elders
\nThey have careers, children of their own
\nOr want to enjoy their retirement
\nVisit their loved ones only at their convenience<\/p>\n

In our blind worship of progress
\nWe’ve abandoned native traditions
\nElders no longer accumulate stories and wisdom
\nThat could help us and keep them engaged<\/p>\n

Different facilities have different policies
\nSome allow visits 24\/7
\nSome provide meals for visitors
\nA few may even have overnight accommodations<\/p>\n

Many facilities, designed for staff convenience
\nCreate barriers against both visits and outings
\nLong walks from parking
\nLong interior hallways
\nA series of locked doors or gates
\nSome requiring staff to open<\/p>\n

\"This <\/a>
This long-term care facility requires keycards and a long walk to rooms <\/div> <\/div> <\/div> <\/div> <\/div>\n

Others, like your final home
\nOnly allow visits during limited hours
\nDon’t allow family to share meals<\/p>\n

Conditions<\/h2>\n

Facilities are typically designed and managed
\nFor staff convenience first
\nResident comfort second<\/p>\n

At the time in your life
\nWhen you’re least resilient, least adaptable
\nThese facilities force you into a schedule
\nFor their own convenience
\nConfusing you, making you feel helpless<\/p>\n

The hearts of these facilities are the nurse’s stations
\nAnd the dining rooms<\/p>\n

Once you’re identified as a fall risk
\nFearing liability, institutions will confine you to bed
\nLimit your mobility to a wheelchair
\nMay even confine you to the nurse’s station
\nSleeping all day, slumped in your wheelchair<\/p>\n

The hearing impaired
\nCan’t communicate adequately with staff
\nSo their health conditions
\nAre never fully known or treated
\nAnd they’re frustrated in group activities and events<\/p>\n

Many facilities advertise chef-cooked meals
\nMade from healthy, fresh, even local ingredients
\nBut even at the highest-rated facilities
\nThis is often merely marketing hype<\/p>\n

The only way to tell is to visit at mealtime
\nDay in and day out
\nWho can do that?<\/p>\n

Even the best facilities lack the ability
\nTo offer personalized food
\nOn a personalized schedule<\/p>\n

Dysphagia (difficulty swallowing)
\nAnd aspiration (accidentally inhaling while drinking or eating)
\nAre common among elders<\/p>\n

We can easily train ourselves
\nTo eat and drink safely
\nBut with the liability of choking
\nInstitutions force residents onto a pureed diet
\nWhere, unable to recognize their food
\nThey lose weight and weaken<\/p>\n

You literally starved to death
\nBecause your home could not give you
\nWhat you liked, when you needed it<\/p>\n

Many homes have no way
\nFor residents to call for help<\/p>\n

Even with call buttons
\nWith 8-12 residents per aide
\nIt can take up to 45 minutes
\nFor a resident to get help
\nLying in a soiled bed<\/p>\n

If you yell, staff get angry
\nOr make fun of you<\/p>\n

Good staff are hard to find
\nWith high burnout and turnover<\/p>\n

Some are good at what they do, and care
\nMany of them are studying, for higher pay
\nAnd will move on soon
\nMost are just burnt out, collecting a paycheck<\/p>\n

What they call activities and entertainment
\nAre designed for the lowest common denominator
\nBingo, juvenile cliches, celebrities
\nInsecure, embarrassing volunteers<\/p>\n

I always found wonderful people
\nBoth staff and volunteers
\nWho deserve endless praise for showing up
\nGiving their heart, soul, and time
\nBut they were in the minority<\/p>\n

Hospice<\/h2>\n

When you are admitted to hospice
\nYou fall under the care of a doctor you will never see
\nTheir primary function to prescribe medications
\nAt the request of a nurse
\nWho visits you weekly<\/p>\n

Under Medicare rules
\nYou’re ineligible for most therapies, treatments
\nOr visits to doctors
\nYou can still get them on a private pay basis<\/p>\n

For us, the result was that I became your doctor
\nI saw you the most, spent the most time with you
\nSince I was the only one you trusted
\nI had the most accurate experience of your symptoms<\/p>\n

I studied and requested your medications
\nIf I hadn’t been available
\nSymptoms would’ve been missed
\nYour care would’ve suffered<\/p>\n

Our big-city hospice provider was wonderful
\nProfessional help available 24\/7
\nOn call nurse within 30 minutes
\nSocial worker helped find resources, completed paperwork<\/p>\n

Small-town hospice had limited staff
\nCompletely lacking some functions
\nNo help in a crisis
\nTheir social worker a disaster<\/p>\n

We loved your hospice nurses
\nAnd some of your hospice aides
\nWho came to bathe you two or three times a week
\nProvide personal care as needed<\/p>\n

Hospice promises to provide comfort at the end of life
\nI discovered that was a lie
\nNot even morphine could relieve your suffering
\nIn the final days<\/p>\n

Closing the Cycle<\/h1>\n

The colonial tradition brought by our English founders
\nAnd still observed in conservative families
\nIs to preserve the body by chemical embalming
\nHold an open casket funeral for viewing by the community
\nFollowed by underground burial officiated by a pastor
\nWith the goal of protecting the physical body
\nFrom returning to its natural elements<\/p>\n

Indigenous societies worldwide
\nImplemented a variety of practices
\nRanging from burial to abandonment and cremation<\/p>\n

Our bodies came from the earth
\nEvolving and rebuilding constantly
\nFrom the resources we ingest
\nUltimately originating in nature
\nClouds, rocks, rivers, soils, plants, animals<\/p>\n

Burial and cremation, while practical in some habitats
\nDeny nature the resources she gifted us
\nThis is recognized today in colonial society
\nBy a tiny minority in the natural burial movement<\/p>\n

You asked for cremation
\nI planned to honor your wishes
\nBut when the time came I was unprepared
\nHad no idea what would happen<\/p>\n

I had to choose a funeral home
\nThe funeral director came, I had to leave
\nThey took your body away
\nPut you in cold storage, as found<\/p>\n

I had to get permission from the state
\nTo have you cremated
\nI waited all week
\nWanting to be with you<\/p>\n

I vaguely knew that in our ancestral tradition
\nFamily and others from the church
\nWashed, dressed, and casketed the body for burial
\nI had no idea what would happen to your body
\nWanted to be a part of that
\nBut had never been trained<\/p>\n

It turned out that you would just be conveyed from storage
\nInto the chamber, for incineration
\nBy strangers
\nBurning and cooling would take hours<\/p>\n

I thought of waiting outside
\nBut it’s a big building
\nThere would be nothing to see<\/p>\n

In the end, I received your ashes
\nIn a plastic bag
\nInside a plastic box<\/p>\n

Human Nature<\/h1>\n

An institution is only as good as its people
\nWhat happens to the people
\nWhen society itself is dysfunctional
\nAnd its institutions are failing?<\/p>\n

The villains of your story
\nThe corrupt police and prosecutor
\nYour troubled second husband and his insecure daughter
\nThe arrogant, ignorant doctors and facility managers
\nThe cruel and thoughtless aides<\/p>\n

They all hurt us
\nIn some cases terribly
\nIn some cases repeatedly, over time<\/p>\n

But we understood them, you and I
\nNone of them is all bad<\/p>\n

Like you said, most of them were two-faced
\nSometimes kind, sometimes cruel
\nInsecure, damaged people
\nTaking out their own fears on the weak, the helpless<\/p>\n

Their jobs some of the most difficult
\nShouldn’t be jobs in the first place
\nShould be traditional roles in a healthy community
\nNot careers in an economy<\/p>\n

What Are We to Do?<\/h1>\n

Our statist, capitalist model
\nFor elder care as a commodity
\nThe result of what we believe
\nTo be generations of “progress”
\nWorks no better than our other institutions<\/p>\n

The only healthy way to care for elders
\nIs within healthy families
\nWithin healthy communities<\/p>\n

Which our society fails to create or cultivate
\nWhich our “progress” actively destroys
\nVia technologies of mobility and long-distance communication<\/p>\n

What we are left with is institutional care
\nSubsidized by the state at generally low standards
\nOr purchased by us at from $36,000 to $144,000 per year
\nDepending on the level of care we need<\/p>\n

A decade ago
\nI fought your husband’s estate
\nFor a settlement that would keep you secure
\nBut there was no way I could predict
\nYour ultimate needs<\/p>\n

During your last year
\nWhen you were nearing the highest level of care
\nNot knowing how long you would last
\nI worried about running out of money<\/p>\n

I assumed that if you had a prognosis of a few weeks
\nAnd if I could find home help
\nWe could afford to keep you at home<\/p>\n

But in the end, home help was only available
\nDuring regular business hours
\nLeaving me on duty overnight and all weekend<\/p>\n

I assumed that if you had a prognosis of a few years
\nWe could afford to keep you in a care facility
\nBut science can’t provide a prognosis that accurate<\/p>\n

I believe that as families
\nThe closest we can come
\nTo a healthy traditional model for aging and dying
\nIs to provide lodgings for our elders in our homes<\/p>\n

And when they need care, to enlist family
\nAnd community, providing care in the home<\/p>\n

But since technology disperses our families
\nAnd capitalism leaves us burnt out
\nAnd isolated, on a fixed income
\nWhen our elders need care
\nThis model is only available
\nTo the very wealthy<\/p>\n

Based on our experience
\nThe second best model is emerging
\nIn large metro areas
\nFamilies who convert their homes
\nInto private elder care facilities<\/p>\n

\"Private <\/a>
Private home converted to assisted living, Indianapolis <\/div> <\/div> <\/div> <\/div> <\/div>\n

With typically 4 to 6 bedrooms
\nThese facilities are in great demand
\nAnd typically have long waiting lists
\nSometimes years<\/p>\n

Hence they’re not options we can rely on
\nBecause who can plan
\nWhen their elders will need help?<\/p>\n

For those of you who worry about the future
\nWhat’s your plan for civil war?
\nWhat’s your plan for economic collapse?<\/p>\n

Science could not explain or treat your suffering
\nDrugs could not relieve it
\nCare homes could not provide loving care
\nHospice could not comfort you at the end
\nSociety does not allow our bodies to return to nature<\/p>\n

What are we do to?<\/p>\n

 <\/p>\n

\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Previous: I Tried to Help Beliefs, Plans, and Denial Healthcare Realities Home Care Realities Care Home Realities Life and Death in Long-Term Care Closing the Cycle Human Nature What Are We to Do? Beliefs, Plans, and Denial Our Family Papaw, my dad’s father Died quickly, in hospital Of heart failure Mamaw, his wife, widowed and […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[167,80,51,9,94],"tags":[],"class_list":["post-29824","post","type-post","status-publish","format-standard","hentry","category-our-journey-to-the-end","category-problems-solutions","category-society","category-stories","category-trouble"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/maxcarmichael.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/29824","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/maxcarmichael.com\/blog\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/maxcarmichael.com\/blog\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/maxcarmichael.com\/blog\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/maxcarmichael.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=29824"}],"version-history":[{"count":10,"href":"https:\/\/maxcarmichael.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/29824\/revisions"}],"predecessor-version":[{"id":30160,"href":"https:\/\/maxcarmichael.com\/blog\/index.php?rest_route=\/wp\/v2\/posts\/29824\/revisions\/30160"}],"wp:attachment":[{"href":"https:\/\/maxcarmichael.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29824"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/maxcarmichael.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29824"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/maxcarmichael.com\/blog\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29824"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}