"Grow old along with me, the best is yet to be." Robert Browning was an indefatigable optimist when he wrote those lines more than a hundred years ago, when life expectancy was much shorter than it is today. Although we can look forward to a longer life in the 21st century, the aging years bring with it anxieties Browning could never have imagined.
When you ask seniors about their concerns, their fears and forebodings, they rarely talk about death. But you'll hear lots about their worries about how they'll spend their autumn years.
Nothing I've written evoked more reaction from my aging readers than when I wrote here that I didn't put my children in day care when they were babies and I don't want them to put me in a nursing home when I'm old. The nursing home is perceived as the last resort, literally and figuratively. Senior citizens invariably talk about the high cost of medical care and prescription drugs. The politicians are right. That's a hot-button issue. But the greatest health-issue concern of the elderly is over where - and how - they will live.
Those who can't live independently or with family prefer assisted living facilities, the popular alternative to nursing homes. But assisted living means just that, and someone who requires 'round-the-clock watching won't always qualify. Between assisted living and a nursing home falls a scary gray area.
In the category of good intentions gone awry, there's what's happening in Iowa. After a widely read series of newspaper articles describing poor care in assisted living centers appeared, the governor looked closely at what was going on in them. He instructed state inspectors to determine who among those on state aid would be better served in a nursing home. This led to several painful "evictions."
Doreen Sparks, age 92, who has Alzheimer's disease, was designated to move from an assisted living facility and into a nursing home. The move is taking away her "dignity," her daughter tells National Public Radio. She's being deprived of her "freedom" and "independence," she says. But her mother has a deteriorating disease that requires attentive supervision. What else is there to do?
I remember the depressing odor of the omnipresent disinfectant when I visited an elderly aunt in her expensive upscale nursing home. Even in places where there's a high staff ratio to residents, old people are often neglected, slumped over in their chairs, sleeping for lack of having anyone to talk to. How can an outsider get information to help the elderly make a choice? What criteria are crucial?
Tommy Thompson, secretary of Health and Human Services, aware of these questions, has taken an important step toward informing the public of the quality of care in nursing homes. What he calls the national Nursing Home Quality Initiative is actually a report card on the quality of care. The Web site (www.medicare.gov) enumerates such things as the numbers of patients suffering from bedsores (which means they aren't moved often enough), the percentages of patients in physical restraints (which are used when there's not enough staff attention), and rates of infection, pain and mental confusion.
"This is a new approach to bringing about better quality care in our nation's nursing homes," Secretary Thomson says. "Not only will consumers be better informed, but nursing homes will be able to see more clearly what they must do to make the quality grade." A scorecard is no panacea, of course, but the aging population craves up-to-date information about its options and this could be useful in shopping for the best of what's offered.
Estimates of nursing home populations vary, but about 3.5 million people will live in a nursing home over the course of a year, according to U.S. News and World Report. State and federal payments to nursing homes added up to $58 billion last year. Private payments added another $34 billion. The government pays for about 82 percent of the beds through Medicare and Medicaid. That's a huge sum of money and it's important to know just how effectively that money is spent - what's the ratio between direct care and administrative costs.
Although nursing homes complain that they need more government money, many nursing homes are highly profitable under the present system. The Government Accounting Office finds that the level of federal payments aren't the problem, but poor business practices are.
Robert Browning might still invite us to grow old with him, but we would be well advised to check out the rate of bed sores before we move in.