I live in a community of old people simply because I, too, am old and have chosen to live out my years in a place I hope will care for me when I can no longer care for myself.
The place I have chosen is a continuing care retirement establishment, a place that has all the amenities that are said to provide a salubrious ending to a life well-lived and even to prolong the process of leaving it. We are fed, kept dry, amused with activities more numerous than at a summer camp for kids albeit at a somewhat higher intellectual level, provided with a state-of-the-art wellness center and equally sophisticated assisted living and nursing home facilities should we need them.
As a rule, the inhabitants are educated, sociable, mutually supportive and, as required to live here, financially well-off. What then is the concern?
In a community like mine surrounded by the aged aging, the perspective on dying changes. It is seen from close up, not as some distant event that happens only to parents and grandparents. The salient thought that now nags is that here the time line of our existence may be longer and more comfortable, but the ultimate outcome is unchanged.
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So despite the things that make my life more comfortable and give me the assurances that I will not become a burden on my loved ones, the menu of causes for my passing will likely be little different from most who are significantly less fortunate. How will they, the vast majority, be cared for? That is the burning question.
Save for a catastrophic terminal lightning bolt, most people, as they live out their increasing life span, will need expanding levels of supportive care. Physically, emotionally and financially, they will likely burden their spouses, their families and the communities, states and countries in which they live. This is truer for Alzheimer’s than for many other illnesses because it is already epidemic in proportion, slow to kill and without effective treatment or prevention for the foreseeable future.
In the socioeconomic structure of modern society, it will be impossible for the vast majority of these older people to be cared for at home. Even the best of home health aid will be inadequate, and nursing home care will be necessary.
The financial drain of providing for this tidal wave of infirmity is already huge – 15 percent of GDP – and will continue to grow at an astronomical pace. Yet, what plans are there to deal with it? What in the proposed budget for the next 10 years addresses this significantly? The costs will bankrupt Medicare and Medicaid and sorely reduce monies available for education, R&D, infrastructure repair and all other forms of discretionary spending.
Medical science is making even more strides to prolong life, but what of the ethical and moral dilemmas such longevity causes? Where is the end-of-life debate, the critical thinking, the sound financial policy planning? The cost of foreign wars may be “chump change” by comparison.
George Washington warned that if the country faltered and failed, it would be from within. This is a major internal assault. Current solutions are grossly inadequate. Leadership that rises far above partisan bickering is lacking.
Compromise is the meeting of prepared minds to solve a complex problem for the common good. The magnitude of this demands solution. We, the citizenry, must be involved, and politicians must be made to realize the magnitude of our concern.
We cannot allow Pogo to be right.
Charles R. Merwarth, M.D., is a retired internist who lives in Pittsboro.