Nearly everybody's seen the television commercial where a husband and wife talk about how they don't want to be a burden on their children when they're old. Every time I watch it, I hear a voice deep inside raging against the message.
"My children are exactly the ones I want to be a burden on," I say to the TV screen (and to anyone else watching with me). "Not a burden to oppress, but a burden like little children are burdens."
I don't like day care for babies, and I don't want to be in a nursing home when I'm old. I want to be close to my children in a loving give-and-take arrangement.
I'm fortunate because four generations of my immediate family live within four blocks of me. My 91-year old mother lives in an apartment next door. My daughter and son-in-law and their two sons, ages 5 and 2, live two blocks away.
We sound a little like "Our Town 2001," an old-fashioned nurturing neighborhood with ups and downs. The boys fall off their scooters and scrape their knees, their great-grandmother falls in her living room and breaks a bone. My mother is one of the fortunate few. She enjoys days warmed by the familiarity of family relationships.
But how many of the elderly can do that? The boomers will soon make up a huge elderly population of the "young-old" and the "old-old," and few of their children are prepared to take care of them as they slowly surrender to the infirmities of age.
Until a few months ago my mother lived by herself next door, one flight up. That was until I found her lying on the floor, asleep, in the middle of the day. Sometime during the previous night she had got up, eaten a spoonful of chocolate ice cream from the freezer (an insomniac's ritual), gone to the window to see "what's cooking," and as 5-year-old great-grandson put it, "went boom."
Why she fell is not exactly clear. She could have tripped, suffered a ministroke or merely fainted. When she broke her shoulder she couldn't get up. That's how we found her.
She can't live alone any longer. Medicare covered a short hospital stay and periodic visits from a social worker, a nurse and a rehabilitation therapist who helped her with physical exercises. After two weeks she could walk up and down steps again and up the street to the store or to the park - but she needs 24-hour oversight, and I've hired someone to live with her. No matter what physical capacities she regains she can't be left alone again.
Medicare does not cover such supervision, and such oversight is very expensive. If an elderly person has no money, a move to a mediocre nursing home with impersonal help is reimbursable through Medicaid. But Medicaid does not reimburse home care, and Medicare limits home-care payments to short-term hourly visits of a short duration.
While paid care is tax-deductible, voluntary care by blood relatives is not. Love may be priceless, but it demands a huge expenditure of time. The values underlying care for the elderly - both economic and emotional - create the wrong incentives.
The old-old, in fact, make up the fastest growing age group in this country. In less than 50 years, 5 percent of the population will be over 85. Freud stressed the need for maturing children to break away from parents, to cut the invisible umbilical cord, and move away. We talked endlessly as teen-agers about how to become independent. Those of us grown up with aging parents now talk endlessly about how to bring parents back into our lives.
The role reversals are draining and difficult for both generations. An informal survey of my friends suggests that daughters more than sons take on the responsibility for an aging parent. "The best thing I ever did was move next door to you," my mother frequently tells me.
I remember how my mother's mother called out for her every night after she moved in with us in the last year of her life. I was in high school, and it must have been hard for my mother to balance being mom to me and a parent to her mom, but in those days before two-career families such arrangements seemed natural.
Hardest of all is the absence of friends and other family members in an aging parent's life. Everybody's busy, and it's easier to phone than to visit. Of seven children, Mom's the only one who lived to be old-old. She recites the names of brothers and sisters in order of their birth. "Once there was Mary, Charlie, Annie, Sadie, Abbie, Jakie, Benny," she says plaintively. "Now there's only me."