History > 2009 > USA > The elderly (I)
When You’re Your
Suburbs See a Challenge
as Residents Grow Older
December 6, 2009
The New York Times
By LIZETTE ALVAREZ
THE trash talk on the boccie court at the Hamilton Township Senior Center was
“What’s the matter, you can’t bend down?” Natale Gigliotti, 71, shouted to an
opposing player who lunged as he tossed the ball. “Corto, corto” — short, short
— Mr. Gigliotti said as the ball landed. “That’s a boo-boo.”
“Ohhhh, they love to talk,” said Ray Fink, 79, Mr. Gigliotti’s boccie partner
and a regular at the center’s billiard tables and boccie court.
Hamilton, in Mercer County, is a pleasant suburban town, not far from Trenton,
with a smattering of historic homes, the requisite big-box stores and a
pre-Revolutionary pedigree. It also has more residents who are 65 and older than
many other towns in New Jersey — 15 percent of its nearly 94,000 people, while
in some towns the proportion is 5 percent or less — and that demographic fact
has forced Hamilton to pay close attention to the needs of its elderly.
This is not to say that other towns and counties are far behind.
In just two years, baby boomers will start to retire, and by 2030 the number of
America’s elderly is expected to reach 72 million, more than double the number
in 2000. Demographers expect the suburbs to age particularly quickly, as
residents retire close to home, or as those who have already moved to the Sun
Belt return to live near relatives as they grow frail.
Some towns are already feeling these effects: Twenty percent of Glen Cove, in
Nassau County, is 65 and older, for instance, as is 23 percent of Somers, in
This increase in the number of elderly will place unparalleled strains on many
“In the Northeast, we have to look at it as if the clock is ticking,” said Brian
M. Hughes, the Mercer County executive. “We have an aging housing stock and a
population that is not increasing as much as the rest of the country. We need to
figure out how we’re going to provide more services with a smaller tax base.”
Mercer County, with its grayer population, offers a peek at the future in terms
of preparing for its aging residents.
On the housing front, the county has seen a sharp rise in developments for
people 55 and over. These adult communities, some with house prices reaching
$500,000, pay homage to the retirement villages of Florida, only on a smaller
scale. They offer gardens, large clubhouses and swimming pools, games and a
built-in social life.
An estimated 13 such adult communities have been built in Mercer County since
2002 — a much brisker pace than in previous years. Almost all their homes,
usually one story and requiring little yardwork, are tailor-made for the aging.
The county has also seen a boom in assisted-living facilities, said Sherrill
Senter, a real estate agent with the Keller Williams Hamilton firm, who added
that builders are planning for older people even in the general housing market.
Many newer houses, she says, have a bedroom on the first floor or a study that
can easily be converted into a bedroom for an aging parent.
Real estate agents, eager to learn of plans that will affect them, now attend
meetings between nonprofit groups and the Mercer County Office on Aging.
The county has also supplemented its network of shuttle vans for the elderly by
arranging to use other vans, borrowed from the Association of Retarded Citizens
and other groups, when available. And the Hamilton senior center is offering its
own transportation service — something such centers do not often do.
“As the population ages, we have to find a way to get them mobile,” said
Kathleen Fitzgerald, a nurse and the supervisor of senior services at the
Last year, also with its eye on a grayer future, Mercer Community College
started to offer a certificate in gerontology for health care providers, social
workers, caregivers and others. The required courses include such subjects as
the aging process, memory loss and a holistic approach to aging.
Eileen Doremus, executive director of the county’s Office on Aging, said that a
gerontology certificate would become essential to doing business. “It doesn’t
matter what realm you work in and live in,” she said. “You will be interacting
with people who are older, be it in real estate, health care, retail.”
Local governments like Mercer County are not alone in their efforts. Over the
past two years, the state of New Jersey has instructed 400 chronic disease
health managers in training the elderly to avoid costly trips to hospitals.
Trainers teach the elderly how to keep tabs on their ailments and cope with pain
Senior centers are another important aspect of elderly care, and so it is in
Mercer County. As he took a break from one of his regular billiards games, Mr.
Fink — Mr. Gigliotti’s boccie partner — explained how he ended up at the
Hamilton senior center.
“I didn’t want to move into the city; I have always lived in the suburbs,” said
Mr. Fink, a former quality control manager for an electronics manufacturer. He
also wanted to be near his son, who lived in Hamilton. Then, he said, “I met a
couple who told me about Mercer County and said they had the best senior center.
I’m very active.”
The senior center moved to a spacious building in 2001. To be successful, such
facilities must shake off their stigma as depressing places where the elderly
come just to eat a hot meal and shuffle about. In Hamilton, that stigma remains,
but less so every year, Ms. Fitzgerald said.
The center, which is publicly financed and has a hard-to-get national
certification by the National Council on Aging, provides the requisite lunch,
health checks and help with paperwork. But visitors can also sit down at
computer banks to learn how to design Web pages or post photos online; they do
the cha-cha with a dance instructor; sing in choral groups and on karaoke night;
swim in the small pool; smack down dominoes and stage plays.
There are even a few younger patrons, whose needs differ from those of older
ones. One example is Paula and Jack Beiger, who practiced the rumba one morning,
keeping impeccable time to the music.
“Some people our age are almost embarrassed to come to the senior center,” said
Ms. Beiger, 54, who is allowed in only with her 63-year-old husband (members
must live in Hamilton and be at least 60). “We come just for the dancing and
have such a good time.”
As for Mr. Fink, he does not plan to leave Hamilton Township. But he does worry
about the aging of the baby boomers. He waited a year and a half for his current
apartment — in a subsidized building for the elderly called Pond Run — and that
was before the rising tide.
“As a nation, we have to set up more volunteer programs to support these
people,” Mr. Fink said. “There will be so many of them.”
Suburbs See a Challenge
as Residents Grow Older; NYT, 6.12.1009,
Helping the Aged
Leave Nursing Homes
for a Home
September 19, 2009
The New York Times
By JOHN LELAND
PHILADELPHIA — Walter Brown never wanted to live in a nursing home, but when
he had a stroke two years ago, he saw little choice. Mr. Brown, 72, could not
walk, use his left arm or transfer himself into his wheelchair.
“It was like being in jail,” Mr. Brown said on a recent afternoon. “In the
nursing home you’ve got to do what they say when they say it, go to bed when
they tell you, eat what they want you to eat. The food was terrible.”
But recently state workers helped Mr. Brown find a two-bedroom apartment in
public housing here, which he shares with his daughter. “It just makes me more
relaxed, more confident in myself,” he said, speaking with some difficulty, but
with a broad smile. “More confident in the future.”
A growing number of states are reaching out to people like Mr. Brown, who have
been in nursing homes for more than six months, aiming to disprove the notion
that once people have settled into a nursing home, they will be there forever.
Since 2007, Medicaid has teamed up with 29 states to finance such programs,
enabling the low-income elderly and people with disabilities to receive many
services in their own homes.
The program in Pennsylvania provides up to $4,000 in moving expenses, including
a furniture allowance and modifications to the apartment, and Mr. Brown has a
home health aide every morning and a care manager to arrange for services like
physical therapy. The new programs, financed largely by $1.75 billion from
Medicaid, are a sharp departure from past practices, where Medicaid practically
steered people into nursing homes.
“Medicaid has had an institutional bias in favor of nursing homes,” even for
people who do not need them, said Gene Coffey, a staff lawyer at the nonprofit
National Senior Citizens Law Center. “Federal law requires states to provide
nursing home services. They don’t have to provide home or community-based
For Mr. Brown, the transition to his own home has changed his life, he said.
Now, with his motorized wheelchair, he travels the city on public buses,
visiting friends in other neighborhoods.
“It’s a great feeling,” he said. “In the nursing home I got up at 5 o’clock in
the morning, then the rest of the day was just watching the TV or my VCR. I
wanted to be able to get out and see people, see the world. I didn’t want to be
confined. Now I go where I want to go.”
States and the federal government hope to save money, though research about cost
savings has so far been inconclusive. A recent study by researchers at the
University of California, San Francisco, found that home care costs taxpayers
$44,000 a year less than a nursing home stay — though this number cannot be used
to estimate total savings, because often home-based services replace family
care, not nursing home care.
About 1.5 million Americans are living in nursing homes.
“It’s amazing how quickly people can end up in a nursing home,” said Jean Janik,
the director of community living options at the nonprofit Philadelphia
Corporation for Aging. “Say you’re a single man and have a stroke, and need to
go into a nursing home to rehab. You’re elderly so you don’t quite bounce back
quickly. After 60 days, Medicare doesn’t pay any longer, so you need a Medicaid
grant to stay in the nursing home. Then your Social Security will go to the
Many lose their apartments and regular support from family members, Ms. Janik
“We meet people who say, ‘I went to the hospital and next thing I know, here I
am. I don’t know what happened to my apartment.’ ” Ms. Janik added, “We go and
check, and it’s not in their name. Especially if they don’t have a strong family
support system in place. A lot of people just think, Uncle Joe fell and broke
his hip and now he’s in a nursing home, so be it, that’s where he’ll be. People
don’t realize they can get services in their home.”
Each participating state has designed its own program, called Money Follows the
Person. The federal government, which shares Medicaid costs, provides extra
financing for the first year.
Some experts worry that the programs will end up transferring some of the
expenses of caring for the elderly or the disabled to their family members.
Carol Irvin, a senior researcher at Mathematica Policy Research has been
contracted by Medicare and Medicaid Services to study the costs of the program
in its first five years.
“It could be shifting costs onto a person’s relatives,” Ms. Irvin said. “But
even if it’s not saving money, a lot of people believe living in the community
is the right thing for individuals.”
Elizabeth Kamara, 72, spent 18 months in a nursing home after having her left
foot amputated because of diabetes. Mrs. Kamara can get around using a walker,
but in the nursing home she spent whole days in a wheelchair.
“I just let people do things for me,” she said. “They say, ‘If you fall, we’ll
get in trouble. Please sit down.’ ”
Mrs. Kamara has moved into a independent living facility, where she cooks dishes
from her native Sierra Leone and navigates the hallways on her own. She gives
herself insulin injections and gets a friend to drive her to doctors’
appointments. An aide comes twice a week to help clean. “This is my home; I’m
free,” she said. “In the nursing home it was two persons in one room. Here I
have my privacy. I can get my hair done, my nails done.”
Susan C. Reinhard, a senior vice president of the AARP Public Policy Institute,
said of Money Follows the Person: “It’s gotten Congress’s attention, and shown
that people can leave a nursing home. That is a wake-up.”
For Esther Pinckney, 88, who ended up in a nursing home after a stroke, moving
out has been literally a breath of fresh air. Ms. Pinckney now lives in a bright
subsidized apartment where home aides visit twice a day.
“What didn’t I like about the nursing home?” she asked recently. “What would you
like about smell, smell, smell, morning, noon and night?”
Because Ms. Pinckney lost her apartment and furniture while she was in the
nursing home, the Philadelphia Corporation for Aging bought her new furniture
and a microwave oven. Before, she said, her Social Security check went to the
nursing home; now she pays 30 percent of her check for her rent. “I couldn’t
even buy a soda,” Ms. Pinckney said. “You want to be independent, don’t you?
That’s what I wanted.”
Life on her own has not been perfect, she admitted. Aides often fail to show up
or spend their time talking on the telephone.
But her pastor takes her to church four times a week, and she can go to stores
near her building. If her health should fail again, she said, she did not like
to think about going back into a nursing home.
“Don’t mention it,” she said, her face tightening. “I don’t want to do that.”
Helping the Aged Leave
Nursing Homes for a Home, NYT, 19.9.2009,
Experiencing Life, Briefly, Inside a Nursing Home
August 24, 2009
The New York Times
By KATIE ZEZIMA
MAMARONECK, N.Y. — For 10 days in June, Kristen Murphy chose to live
somewhere she and many others fear: a nursing home.
Ms. Murphy, who is in perfect health, had to learn the best way to navigate a
wheelchair around her small room, endure the humiliation that comes with being
helped in the bathroom, try to sleep through night checks and become attuned to
the emotions of her fellow residents.
And Ms. Murphy, 38, had to explain to friends, family and fellow patients why
she was there.
Ms. Murphy, a medical student at the University of New England in Biddeford,
Me., who is interested in geriatric medicine, came to New York for a novel
program that allowed her to experience life as a nursing home patient.
Students are given a “diagnosis” of an ailment and expected to live as someone
with the condition does. They keep a daily journal chronicling their experiences
and, in most cases, debunking their preconceived notions.
The program started in 2005 after a student approached Dr. Marilyn Gugliucci,
the director of geriatrics education at the medical school. “ ‘Dr. G,’ ” she
recalled the student saying, “ ‘I would like to learn how to speak with
institutionalized elders.’ What came out of my mouth was, ‘Will you live in a
nursing home for two weeks?’ ”
To Dr. Gugliucci’s surprise, she found nursing homes in the region that were
willing to participate and students who were willing to volunteer. No money is
exchanged between the school and nursing homes, and the homes agree to treat
students like regular patients.
“My motivation is really to have somebody from the inside tell us what it’s like
to be a resident,” said Rita Morgan, administrator of the Sarah Neuman Center
for Healthcare and Rehabilitation here, one of the four campuses of Jewish Home
“But she is really there to study herself, her own feelings about living in a
nursing home,” Ms. Morgan added, referring to Ms. Murphy.
Geriatric specialists hope the program and others like it help generate interest
in the profession, one of the most underrepresented fields in medicine. Medical
schools and residencies require little to no geriatric training, and many
students are reluctant to get into the field because it is among the lowest paid
In 2005, there was one geriatrician for every 5,000 people over 65, according to
the American Geriatrics Society; by 2030 that ratio is expected to increase to
one for every 8,000 patients. Geriatricians must participate in a two-year
fellowship program after medical school to become certified. In 2007, only 253
of 400 fellowship slots were filled, and only 91 of the physicians graduated
from medical school in the United States.
“It’s kind of a crisis,” said Dr. Cheryl Phillips, president of the society. “I
don’t think many seniors recognize this.”
Like many medical students, Ms. Murphy was scared of nursing homes. The feeling
began when, as a young adult, she visited her grandmother, who had Alzheimer’s
“I think nursing homes are scary,” she said, “but I don’t think you can be a
good doctor if you’re scared of the place where a lot of your patients live.”
The first few days, which included filling out paperwork, undergoing a full-body
mole and sore check, eating pureed foods and being raised out of bed with a
lift, did nothing to validate her decision. When she wedged her wheelchair into
a corner and could not get out, she cried in frustration.
“All I wanted to do was shut my door and stay in here,” said Ms. Murphy, whose
“diagnosis” was a mild stroke that affected her right side, difficulty
swallowing and chronic lung disease. “But I understood I had to go out.”
Not everyone does. Some patients want to talk for hours, while others act out,
like a woman who pinched Ms. Murphy as hard as she could. Many sit in the
hallway by the nurse’s station each day because it is a hub of activity.
Emotions run high.
Ms. Murphy said she soon learned that many patients cried because they knew that
they would most likely never live anywhere else, or because they missed family
and their old life.
“At times I felt really lonely and got depressed,” she said. “Sometimes it was
an emotional roller coaster, up and down, up and down.”
No one said a word the first time Ms. Murphy showed up at the daily bingo game.
She started to talk to anyone who would listen. And she was surprised what
First she bonded with Camille Stanley, the “queen bee” of the social scene. Then
she found Dr. Thomas N. Silverberg, 89, a former internist and arthritis
specialist with advanced rheumatoid arthritis. “My specialty is slowly killing
me,” Dr. Silverberg said.
The two talked for hours about life and medicine. Unlike the friendships she
makes as an adult, slowly nurtured over dinners and drinks, bonds in a nursing
home, where there is nothing to do but talk, are forged quickly and deeply.
“When I came in, I was worried about working with older folks because I was
afraid I wouldn’t be good at it,” Ms. Murphy said. “Now, if anything, I’m
worried I’ll love them too much and it will really hurt to work with folks at
the end of their lives.”
Most residents knew why she was there. During her going-away party they
presented her with a big card, and shouts of “We love Kristen” were heard
The program has solidified Ms. Murphy’s desire to work with older people. And
the hardest lesson she learned — that for some people, it is better to be in a
wheelchair or to have limited mobility — will make her become a better doctor,
“As a doctor, my job is to help patients live the life they want to,” she said.
“And if they’re in pain, you have to say ‘That’s O.K. if you want to spend your
time in a wheelchair.’
“For me that’s such a different place to be. Because I hate this chair. It still
startles me that that’s the choice.”
Ms. Murphy said the care she received at the home was outstanding. But there
were things that could use improvement: she did not realize she could ask for
things like soda, and she felt that shower bars were too high for someone in a
wheelchair. She also told the staff at a debriefing session that families should
be included in more activities.
Dr. Phillips of the American Geriatrics Society, which is not involved with this
program, said the challenge was to see “how this replicates everywhere else and
how enthusiastic medical students are to take this on.”
Another of the 10 students who have gone through the program, William Vogt,
spent 10 days last summer in a nursing home at the Veterans Affairs hospital in
Augusta, Me. Mr. Vogt, who spent a day wheeling around with petroleum jelly
smeared on his glasses and cotton stuck in his ears, said he was particularly
struck by the fact that many patients considered the nursing home to be home and
the staff “a second family.”
Mr. Vogt said the little things counted, like lowering nameplates so patients
could locate their rooms and not putting a remote on top of a television, out of
“There’s a little part of it that works its way into everything I do, from
patient interaction and awareness of how I come across to what I say,” said Mr.
Vogt, a medical student doing clinical work at a hospital in Watertown, N.Y.
“There’s this shift of the humanity of it.”
Briefly, Inside a Nursing Home, NYT, 24.8.2009,
When You’re Your Mother’s Keeper
August 23, 2009
The New York Times
By MICHAEL WINERIP
UPPER SADDLE RIVER, N.J.
WHEN Suzanne Cooper’s elderly mother moved in three years ago, her Alzheimer’s
was in an early stage. The 84-year-old was still fairly lucid, so Mrs. Cooper
could leave her home, while picking up her son, Griffin, from nursery school or
going food shopping.
But in time, the mother turned more inward, having long conversations with
herself at the kitchen table or just staring. “She goes into the other world and
you try to pull her back, but it gets harder,” Mrs. Cooper said. She would come
home with Griffin, 5, and find her mother sitting by the back door holding her
blanket and looking lost.
Soon, the 49-year-old Mrs. Cooper couldn’t leave her alone and the days became
logistical brainteasers, as she tried to balance the needs of her son and those
of her mother.
If she had errands, it could take three hours to get her mother fed, groomed,
bathed, dressed and out the door. “Mom can still brush her teeth,” Mrs. Cooper
said, “but I have to put the toothpaste on the brush.”
“In fall and spring I could take her on errands and she was content to sit in
the car,” Mrs. Cooper said. “There’s no law against leaving an 84-year-old woman
in the car with the windows down. But summer and winter, I can’t do that — I’m
tied to the house.”
Mother and daughter were sitting on the back deck recently, when Mrs. Cooper
jumped up and said, “I need to check on Griffin.” He was supposed to be playing
a computer reading game inside. “Sometimes, he finds his way onto the Internet,”
she said. “I’ll be back.” Her day is all back and forth: Comfort her mother,
mumbling and sobbing at the kitchen table; stop Griffin from biting the sofa
While she was inside, her mother, Irma Stitz, a retired nurse, carried on a
conversation with herself: “God bless you, but you know that. There will be a
tomorrow. Yes, because of your hate, hate, hate.”
When Mrs. Cooper returned, her mother said, “The people all may be changing.”
“Mom, can I get you to come in the house and have some soup?” said Mrs. Cooper,
moving to help her up.
Mrs. Stitz shooed her away. “I can do it myself,” she said, and she walked into
the kitchen and ate her soup.
Mrs. Cooper’s mantra had been, “I want to be a stay-at-home mom, and a
stay-at-home daughter,” though for a long time she worried she did neither well.
She spent 20 years building a career, rising to become a corporate vice
president, and was finally ready to be home. Married late, at 43, to Peter
Cooper, an architect, she felt blessed to become pregnant right away. Mr. Cooper
was also caring for his parents — now deceased.
They loved this about each other. “Family loyalty,” Mr. Cooper, 55, said. “Other
women said, ‘Oh, he’s never married, caring for his parents.’ Suzanne found that
appealing.” About 20 percent of baby boomers — 14 million — take care of an
aging loved one, according to a Natural Marketing Institute report done for the
AARP, and as the Coopers know, it can be a struggle.
Mrs. Cooper was determined not to put her mother in a nursing home. “I don’t
want someone else to be there when Griffin scrapes his knees and I felt the same
about my mother as she comes to the end.”
“I was sure I could do this myself,” she said. The remodeled house — on a
cul-de-sac in an upscale suburb — provides Mrs. Stitz with her own bedroom,
bathroom, laundry room and living room.
A widow for 30 years, she had been independent, hard-working and proud, taking
care of herself in her Pennsylvania home. It was a long time before the daughter
realized the mother had been masking the disease. If the mother came for a
visit, she would leave the next morning, before anyone could notice lapses.
During one stretch, she and her dog repeatedly had the stomach flu; Mrs. Cooper
figured out they were eating spoiled meat. When Mrs. Cooper made stuffed
artichokes, a favorite family dish, her mother couldn’t remember how to eat one.
Mrs. Cooper loved her mother’s sense of wonder and her laugh, but this last
year, the joy kept contracting. They used to go to the beauty parlor together,
but the other day, Mrs. Cooper couldn’t get her mother to their appointment.
“Where are we going?” Mrs. Stitz asked. “How will we get there?” She sat back
and closed her eyes.
“That’s when I back off,” Mrs. Cooper said.
The less the mother would do, the less the family could do.
“We became increasingly isolated, it was unbearable,” Mr. Cooper said. Nor did
the economy help; Mr. Cooper’s firm went from three employees to one. He worked
long days and often had night meetings.
The Coopers — attracted by a shared commitment to their elderly parents — began
seeing a marriage counselor. “My husband tolerates an awful lot,” Mrs. Cooper
said, “but he was worn down.”
She had trouble hiring help; they live three miles from a bus stop. When her
mother had heart problems, a home health aide came, but it wasn’t much relief.
The mother always took baths; the aide was only supposed to give showers. “If
Mom refused to take a shower, the aide wouldn’t come back,” Mrs. Cooper said.
“So I gave her a bath before.”
“I kept making phone calls,” Mrs. Cooper said. “There were pages and pages of
options. Home aides, nursing facilities — some insisted you have $125,000 before
they’d talk to you.”
In June, Mrs. Cooper finally pressed the right button. She found Nancy
Bortinger, a geriatric social worker for 33 years. Mrs. Bortinger — who works
for Vantage Health System, a local nonprofit agency, and advises
parentgiving.com, a Web site aimed at people caring for elderly parents —
interviewed Mrs. Cooper for three hours and a few days later made a home visit.
“Suzanne was stuck seeing this in black and white — put Mom in a nursing
facility or keep her home,” Mrs. Bortinger said. “We needed to get her unstuck
fast, before the family and marriage had a crisis.”
Mrs. Bortinger suggested an Alzheimer’s respite program, where the mother could
spend an occasional day, and Mrs. Cooper could get a break. It still took three
hours getting Mrs. Stitz out the door. When she resisted, Mr. Cooper suggested
to her that as a nurse, she would be able to help with the patients there, and
Mrs. Stitz agreed.
Mrs. Cooper savored the day alone with Griffin. Mr. Cooper noticed. “Suzanne’s
mood improved enormously, knowing she has choices,” he said. “She gets a break,
but doesn’t feel she’s shirked her responsibility.”
Two weeks ago, the Coopers took the next step. They signed up Mrs. Stitz for a
week of respite, so they could go on vacation to New England. While not covered
by insurance, the cost was manageable — $190 a day. When Mrs. Stitz resisted,
Mr. Cooper was able to summon a lucid moment. “Irma, we’re going to take a few
days to see my family, you don’t mind?” he said.
“By all means, Peter,” she said.
Mrs. Cooper spent the week before with a Sharpie marker, labeling clothes as if
her mother were going off to camp.
The first few days, Mrs. Stitz’s stay was shaky; her doctor was on vacation and
there was a mix-up with her medications. But after that, things went smoothly.
The Coopers were supposed to pick her up last Sunday, but the traffic back from
Boston was horrible. When Mrs. Cooper called to say they’d be late, a supervisor
suggested that instead of rushing, she could let her mother stay one more night,
and Mrs. Cooper agreed it was a good idea.
When You’re Your
Mother’s Keeper, NYT, 23.8.2009,
Health Care for the Old, and the Young
August 23, 2009
The New York Times
To the Editor:
Re “Health Care’s Generation Gap,”
by Richard Dooling (Op-Ed, Aug. 17):
While I wholeheartedly agree that overtreatment in the United States has reached
epidemic proportions, pitting health care for older adults against care for
children is a mistake. Age should not be a marker of a less valuable life. Many
people continue to live with a high quality of life well into their later years.
Mr. Dooling’s revelations of high-cost intensive care should instead point us
toward better financing for home care, hospice and palliative care programs that
provide all patients with treatment that is person-centered and cost-saving.
And, really, shouldn’t everyone have access to preventive care? Whether we are
putting programs into place to reduce falls, or financing pediatric
immunization, preventive health can be beneficial at every age.
Health care financing should be aimed toward evidence-based, cost-effective
programs, not simply at those deemed most “deserving.”
Pittsburgh, Aug. 18, 2009
The writer is a doctoral student in the School of Social Work at the University
To the Editor:
I commend Richard Dooling for having the courage to utter the unspeakable truth:
Despite our vast medical/technological hubris, we cannot cheat death, and shame
on those who cling to the belief that we can. Shame also on the many readers who
will inevitably excoriate Mr. Dooling for a perceived lack of compassion for the
elderly, and the self-interested politicians who will foolishly accuse him of
supporting “death panels.”
The fact is that old people eventually die; they are supposed to. Yet the
medical establishment makes huge profits peddling the notion that the end of
life can be delayed indefinitely. Economics aside, this is inhumane.
We must somehow conjure the common sense to allow people to die with dignity,
without suffering, and at the reasonable time when their bodies give up even if
their families refuse to do so.
Bowdoinham, Me., Aug. 17, 2009
To the Editor:
After reading Richard Dooling’s Op-Ed article, I made my usual morning rounds on
my patients. They are — almost to a person — exactly the kind of people who the
author feels do not deserve the advanced health care that I am privileged to
It saddens me to know that my octogenarian — and yes, even nonagenarian —
patients, who have paid a lifetime of taxes, fought for their country, live
independently and often even still work — have raised the generation that now,
increasingly, seems to feel that the surgeries I routinely perform that save
lives and enhance their quality are wasteful expenses that our selfish society
Albert C. DiMeo
Fairfield, Conn., Aug.
The writer is a doctor and the director of minimally invasive cardiac surgery at
St. Vincent’s Medical Center in Bridgeport, Conn.
To the Editor:
In 2006, I learned that I had myeloma, a bone-marrow cancer that is treatable
but at present not curable. I am 68 and have led a most satisfying life, but
myeloma will most likely shorten that life.
The treatment I have received has been very expensive, but it has kept me
robust, and I am thankful. But Richard Dooling’s Op-Ed article is enlightened:
if the quality of my life makes me no longer want to live, I want someone to
pull the plug on me; I do not want my misery prolonged by any treatment,
particularly “insanely expensive procedures.”
I hope that then, I, or someone I designate, will insist on my wishes now: don’t
keep me alive for misguided reasons; let me die for enlightened ones. And spend
the money thus saved on preventive medicine, making it more likely that younger
folks will live long and satisfying lives of their own.
Exeter, N.H., Aug. 18, 2009
To the Editor:
As an ageless, 40-something woman who cares equally about people of all ages, I
must object to Richard Dooling’s suggestion to cut “some of the money spent on
exorbitant intensive-care medicine for dying, elderly people and redirect it to
pediatricians and obstetricians offering preventive care for children and
He may not be, as he states, “talking about euthanasia.” But his suggestion
reflects the unloving philosophy of ageism that so many elderly encounter daily.
Our elders have just as much right as any to life, liberty and the pursuit of
happiness, as they see fit and to their very last breath, however and whenever
Helena Babington Guiles
San Francisco, Aug. 17, 2009
To the Editor:
Richard Dooling’s Op-Ed article is both timely and accurate. It points up the
importance of advance directives, so disparagingly and wrongly referred to as
“pulling the plug on Grandma.”
I’m a 73-year-old grandma. As is the case with many elderly people, my fear of
hospitals is directly related to the fear of being put in some sort of time warp
of machine-generated life support, tortured with tubes and left to rot in an
undignified and helpless state with no hope of recovery, a heartbreaking burden
to my children.
The conversation about end-of-life care should be held in all families. Everyone
should provide his or her family, as well as family physician, with a health
care proxy and a living will. A lawyer who can help put on paper the necessary
directives to conform with the person’s wishes and with the law is helpful, but
Grandmas of the world, take the responsibility for your own end-of-life care
now. Tell your families what you want and put it in writing.
Flushing, Queens, Aug. 17, 2009
To the Editor:
I’m an elderly person, have worked professionally in care of the elderly, and
have helped and visited several friends and relatives at the end of their lives.
I wish Richard Dooling had not expressed the problem in terms of generational
conflict, but his statements about end-of-life medicine are accurate and
trenchant. If people have enough money, they can (and will, unless they have
well-expressed medical directives) buy themselves prolonged and excruciating
deaths. That is the main reason for reconsidering what we’re doing now, not an
analysis of what else could be done with the money.
Friday Harbor, Wash., Aug. 17, 2009
To the Editor:
Richard Dooling writes that we are “incurring enormous debt to pay for bypass
surgery and titanium-knee replacements for octogenarians and nonagenarians” and
suggests that the money be spent elsewhere.
I will be 82 in several months and have had bypass surgery and a hip
replacement. Any time Mr. Dooling would like, I will race him swimming,
bicycling or kayaking. I would race him running also, but my orthopedist says I
mustn’t run. I further suggest that Mr. Dooling bring along an oxygen tank and a
well-fitting mask for his own post-race use.
Paul R. Packer
New Rochelle, N.Y., Aug. 17, 2009
The writer is a doctor.
Health Care for the
Old, and the Young, NYT, 23.8.2009,
Health Care’s Generation Gap
August 17, 2009
The New York Times
By RICHARD DOOLING
IN the 1980s, I worked as a respiratory therapist in intensive-care units in
the Midwest, taking care of elderly, dying patients on ventilators. I remember
marveling, along with the young doctors and nurses I worked with, over how many
millions of dollars were spent performing insanely expensive procedures, scans
and tests on patients who would never regain consciousness or leave the
When the insurance ran out, or Medicare stopped paying, patients and their
families gave the hospital liens on their homes to pay for this care. Families
spent their entire savings so Grandma could make yet another trip to the
surgical suite on the slim-to-none chance that bypass surgery, a thoracotomy, an
endoscopy or kidney dialysis might get her off the ventilator and out of the
hospital in time for her 88th birthday.
That was back in the mid-’80s, when the nation was spending around 8 percent of
its gross domestic product on health care. I and other health care workers
solemnly agreed that the spending spree could not continue. Taxpayers and
insurance companies would eventually revolt and refuse to pay for such
end-of-life care. Somebody would surely expose the ruse for what it was: an
enormous transfer of wealth based on the pretense that getting old and dying is
a medical emergency requiring high-tech intensive-care intervention and armies
of specialists, which could cost $10,000 or more per day. (Europeans have so far
resisted this delusion, one reason they spend much less than we do on health
care, with far better results.)
But we were wrong. Health care spending has since doubled, to around 16 percent
of our gross domestic product, and in the next 25 years or so is projected to
reach 31 percent of G.D.P. Despite having those figures in hand, Congress might
still pass legislation calling for spending more, not less, on health care, even
though we’ve been told for decades that what we spend has almost nothing to do
with the quality of care we receive.
In fact, expensive care is often worse care, because it snowballs into what some
are calling an “epidemic of overtreatment,” in which unnecessary procedures,
tests and medications all spawn more tests, more meds (to treat the side effects
of the first batch) and more follow-up scans and procedures (in stand-alone
clinics owned by the same doctors prescribing the tests, scans and procedures).
With so much evidence of wasteful and even harmful treatment, shouldn’t we
instantly cut some of the money spent on exorbitant intensive-care medicine for
dying, elderly people and redirect it to pediatricians and obstetricians
offering preventive care for children and mothers? Sadly, we are very far from
this goal. A cynic would argue that this can’t happen because children can’t
vote (even if their parents can), whereas members of AARP and the American
Medical Association not only vote but can also hire lobbyists to keep the money
One thing’s for sure: Our health care system has failed. Generational spending
wars loom on the horizon. Rationing of health care is imminent. But given the
political inertia, we could soon find ourselves in a triage situation in which
there is no time or money to create medical-review boards to ponder
cost-containment issues or rationing schemes. We’ll be forced to implement
quick-and-dirty rules based on something simple, sensible and easily verifiable.
Like age. As in: No federal funds to be spent on intensive-care medicine for
anyone over 85.
I am not, of course, talking about euthanasia. I’m just wondering why the nation
continues incurring enormous debt to pay for bypass surgery and titanium-knee
replacements for octogenarians and nonagenarians, when for just a small fraction
of those costs we could provide children with preventive health care and
nutrition. Eight million children have no health insurance, but their parents
pay 3 percent of their salaries to Medicare to make sure that seniors get the
very best money can buy in prescription drugs for everything from restless leg
syndrome to erectile dysfunction, scooters and end-of-life intensive care.
Sir William Osler, widely revered as the father of modern medicine, said, “One
of the first duties of the physician is to educate the masses not to take
medicine.” Perhaps the second duty should be to administer an ounce of
prevention instead of a pound of cure.
Richard Dooling is the author of “Critical Care,” a novel.
Generation Gap, NYT, 17.8.2009,