The day’s surprise came in the sixth meeting of NRC Health’s marathon series of interviews with clusters of long term care (LTC) residents and families. Life-long experience had prepared my wife, Mary, and me to lead this study. Still, we had not anticipated that so many new twists on old truths would set so many neurons firing full cylinder.
The Resident Surrenders
The surprise came when Marcie, a wizened 94-year-old, narrated the story of her first days at her LTC community. She felt anxious when she first arrived.
“It was not long before I got into the new routine. It came easy, I lowered my expectations.”
Marcie’s words were an electric jolt. I wondered what maledictions would have rained down if trial lawyers, regulators, and advocates were here listening to Marcie? These critics bemoan that LTC communities run on institutional logic; they do not support resident autonomy. Residents all too quickly surrender personal choice. Institutional routine asks new entrants to sacrifice individual lifestyles.
Did Marcie lower her expectations, and thereby surrender her independence? For a true answer, we need to look beyond what advancing age does to our body and see how far, how wide, and how deep its effects echo.
Self-Demolition In Slow Motion
When aging signals, my body starts to fall apart. The self-demolition occurs in slow motion, it is relentless, it spares nothing. Old age disables the body, dulls the best talent, blunts well-honed skills, and clouds beautiful minds. Worse, it chips away my self-image. I desperately grasp at any symbol that prolongs the illusion that I am still self-sufficient and in control.
As I stumble along on my final lap, the prospect of LTC threatens to uproot me and make me spend my last days among strangers. LTC centers are modern-day public symbols of human life at its most undesirable. They broadcast to the world that I am on my last legs; I am of little value, am a drain on resources. My life has no purpose, has no meaning, is not worth living. Many elders try to escape the humiliation and take the exit through suicide, active or passive.
Victories Of The Spirit
The dread prospect that drives many to despair, paradoxically, is also the test that vindicates the resilience of the human spirit. Research offers many a glimpse into human fortitude that can ride out the roughest waves and into the human quest for transcendence in the meanest conditions.
Meditate on the wisdom that shines through in the following findings of good research.
One in four Americans spends some time in a nursing center. One in three dies there after a stay of two years. Two in five of the lucky ones who live to be 85 die in a nursing center.
The 100 elders in 15,000 nursing centers who each year die by suicide, make up a lower rate than the suicide rate for elderly in the community. Half of the nursing center suicides occur in the six months after admission.
Up to 40 percent of nursing center residents and their families rate their satisfaction as “excellent;” 2 percent rate it as “poor.” Their judgment correlates with the state survey
Residents and families praise the staff for their care and concern, for their respectful ways, and for making residents feel safe.
Most LTC staff are satisfied by the quality of their workplace. Their greatest joy is knowing they make a difference in the life of the elders. LTC staff turnover is lower than in many service industries.
Fantasy Versus Reality
Three significant themes run through these scattered findings. First, the image of LTC in the public imagination is a cruel caricature starkly contradicted by the testimony from residents, families, staff, and state surveyors—the most credible witnesses to quality at ground zero.
The negative stereotype adds to the fear and anxiety of many elders. It is particularly unfair to the caregivers who, day in and day out, allay the fears of frail elders and make them feel safe, wanted, and respected.
Although mediocrity dogs LTC, a second underlying pattern shows through. The kindness of staff touches residents and families so deeply that they take in stride the irritants of group living. They do not blame a kind caregiver; they see the rush, delays, and missteps as normal to the give and take of life.
Beth, a feisty centenarian uncovered yet a third truth when she responded to Marcie. “It is like getting married,” Beth said wisely. “You fall in love, you get married, and you fall into reality. Sharing your life with another curbs your independence. You love each other, so you make the sacrifice and live happily ever after.”
You Get What You Negotiate
Our survival instinct has taught us well: When you cannot control the wind, adjust your sails; let not the best be the enemy of the good. Elders know the survival strategy too well: In life, you do not get what you deserve but what you negotiate.
The human spirit is indomitable in its quest for happiness. It adapts, accommodates, compromises, and concedes—shrewd tactics hidden under the guise of surrender. Many fail to recognize the silent victories of human ingenuity.
V. Tellis-Nayak, PhD, is senior research advisor at NRC Health, Lincoln, Neb. He has been a university professor, whose scholarly work has been published in national and international professional journals. He has conducted research in the United States and abroad, and his major findings have reached a wider public through his writings in trade magazines. He and his wife, Mary Tellis-Nayak, have co-authored a book, “Return of Compassion to Healthcare,” which upholds humanity as the ultimate measure of success of any human endeavor. He can be contacted at firstname.lastname@example.org.