Laws and Care Facilities Thwart Wishes of Dementia Patients

“It’s not something that I am willing to endure,” she said. “I don’t want my life prolonged beyond the point where I’m participating in life.”

But when Saran submitted the document to her New York continuing care retirement community, Kendal at Ithaca, where she has spent more than $500,000 to live, officials there said they could not honor her wishes.

Diagnosed with dementia, she documented her wishes for the end. Then her retirement home said no....

It’s a cruel quandary for Saran and other Americans who have turned to dementia directives that have been created in recent years. Even when people document their choices in these directives — while they still have the ability to do so — no guarantee exists that those instructions will be honored, said Stanley Terman, a California psychiatrist who advises patients on end-of-life decisions.

When You, That At This Moment Are To Me

When you, that at this moment are to me
by Edna St. Vincent Millay


When you, that at this moment are to me
Dearer than words on paper, shall depart,
And be no more the warder of my heart,
Whereof again myself shall hold the key;
And be no more—what now you seem to be—
The sun, from which all excellences start
In a round nimbus, nor a broken dart
Of moonlight, even, splintered on the sea;
I shall remember only of this hour—
And weep somewhat, as now you see me weep—
The pathos of your love, that, like a flower,
Fearful of death yet amorous of sleep,
Droops for a moment and beholds, dismayed,
The wind whereon its petals shall be laid.

A Prison Hospice in California

“I listen to people’s regrets, their stories, their happiness, their joy. I listen to their confessions,” Murillo says.

“I befriend somebody when they’re perfectly healthy, walking around, I’ll take care of them when they’re unable to talk and eventually hold their hands when they’re taking their last breaths.”

He and his fellow inmate workers take that work seriously. When someone under their care has 72 hours left to live, they never leave his side. “No prisoner dies alone” is their motto.

Inside the prison hospice where no inmate dies alone

We’re Getting Old, but We’re Not Doing Anything About It

Susan Jacoby writes about the failure to address the impact of an aging population:

Like climate change, the aging of America demands serious reconsideration of the way we live. Confronting the issue and its many implications, from Medicare’s failure to cover long-term care to the ethics of physician-assisted dying, requires what seems to be the most difficult task for human beings — thinking about the future...

In certain respects, the crisis is already upon us. A study published this year by Gallup and West Health, a research organization dedicated to lowering health care costs, showed that people over 65 had withdrawn an estimated $22 billion from long-term savings accounts in the previous year to pay for health expenses Medicare didn’t cover. A recently published article in The Journal of the American Geriatrics Society underscores the sobering likelihood that one out of seven 65-year-olds today can expect to be disabled for at least five years before death. The largest increase in the disabled population is projected to occur in the 2030s.

Although there has been considerable talk about health care during the Democratic presidential debates, nearly all of the focus has been on the young with inadequate insurance coverage. That Medicare as we now know it fails to work for many retirees, leaving them in danger of going bankrupt, gets short shrift....

First, it is vital to address the disturbing human realities behind the statistics. An aging society affects everyone, but it affects women most because of their greater longevity. How can we continue to count on women to provide two-thirds of unpaid caregiving? I gnash my teeth every time I encounter one of those ubiquitous television ads for a business called “A Place for Mom,” which provides much-needed service by helping people find long-term care for parents. It’s not called “A Place for Dad” for a very good reason. We assume that Mom (or Daughter) is caring for Dad at home.

Second, public programs and private companies need to cooperate to provide opportunities for old people who want to and are perfectly able to go on working. That’s an important objective of AARP, which held town halls on aging in Iowa last summer. Most candidates attended at least one of the meetings, but the discussions received little national publicity.

Third, a healthier attitude toward aging also means examining moral issues. Physician-assisted suicide, for example, is the source of a fierce ethical debate that matters greatly to anyone who can imagine growing old. Questions about the end of life, like those about abortion, should be posed in every national forum. According to a Gallup poll conducted last year, 72 percent of Americans agree that doctors should be allowed to help end a patient’s life painlessly if there is no hope of a cure and the medical assistance is requested by patients and their families. The support drops to 65 percent if the phrase “doctor-assisted suicide” is used instead of “end a patient’s life” — yet another case of the American preference for euphemism.

We’re Getting Old, but We’re Not Doing Anything About It

Mary Pipher on the Joys of Being Older

The only constant in our lives is change. But if we are growing in wisdom and empathy, we can take the long view. We’ve lived through seven decades of our country’s history, from Truman to Trump. I knew my great-grandmother, and if I live long enough, will meet my great-grandchildren. I will have known seven generations of family. I see where I belong in a long line of Scotch-Irish ancestors. I am alive today only because thousands of generations of resilient homo sapiens managed to procreate and raise their children. I come from, we all come from, resilient stock, or we wouldn’t be here.

By the time we are 70, we have all had more tragedy and more bliss in our lives than we could have foreseen. If we are wise, we realize that we are but one drop in the great river we call life and that it has been a miracle and a privilege to be alive.

The Joy of Being a Woman in Her Seventies

Dying May Be Easier Than Talking To Your Family About Dying

The New York Times has been following a small group of vitally engaged people over 85 since 2015. Now, only one of them is left.

For the elders and their families in the Times series, the deaths were all different, the emotional preparations even more so. None were what anyone had hoped. As predictable as death in old age has become, families still have little guidance for the last stretch of life.

Fred Jones died just days after one of his daughters died, in April 2016; John Sorensen, who said on every visit that he wanted to die, died in June that year, missing his partner of 60 years. Jonas died with finished manuscripts around him; Ping Wong had a stroke and refused her daughter’s entreaties to eat; Helen Moses closed her eyes in early December and never opened them again, dying five days later, a talkative woman reduced to silence.

The one left is Ruth Willig, age 96.

Finally, she said, “I’m ready, I am. But I worry about my children. They’re so devoted to me. It scares me.”

It is one of the most vexing chapters of old age: how to navigate not just the inevitable ending, but the days and months immediately before it. As the bonds of support and dependency change, how do we tell our children that it is O.K. to say goodbye? And how do we tell our parents that it is O.K. to go?

...

The vocabulary of loss and grief, which can bloom into eloquence after someone’s death, is of no use in the weeks or months leading up to it. Instead, there is language suited to war: the battle against illness or refusal to quit, the heroic struggle whose linguistic alternative is failure or giving up.