Elderly Care, Death and Dying

Elderly Care, Death and Dying Reflects Social and Cultural Breakdown and Age Discrimination

In America, especially early in the American history, it would not be unusual to walk into a family residence and find extended generations of family living under the same roof, in the same environment with their first generation immigrant parents. The parents might be well into their last years of life, but they were surrounded by family members who shared in the care of their years of dwindling light. Much of it probably had to do with the expansive country that was to be populated in the following decades, even centuries since the arrival of the early colonists.

In the beginning, however, parents arrived with their families to a wide space of untamed wilderness, and the hardships of that wilderness took its toll. Families stayed together out of the necessity of contending with the problems presented by the wilderness, the needs of the family to sustain itself, and in order to increase their personal land wealth. Large families were commonplace, because it took many people and hands to clear and work the land to, first, self-sustaining, and then, later, to income producing land that would help to sustain the large families.

In America today, large families are very much a thing of the long forgotten past, along with the mule and plough. As technology increased, and untamed space disappeared in America, the American family shrank in numbers, until today, when the meaning of single family homes tends to be defined as the exclusion of all others other than the immediate family. There are no extended families living in single residences, no grandmothers, grandfathers, brother-in-law, or sister-in-law -- at least not on a permanent long-term basis. But noticeably is the absence of the elderly family member, who today maintains their own living until such a time as that individual must downsize to a smaller and more manageable living space reflective of their age and agility and general health. There remains, however, such a radical change in the family lifestyle in today's busy world of soccer moms and work demands, that the plight of the elderly has taken a back seat to the other more immediate family concerns. This has created a void, wherein the elderly family member often becomes lost to the institutionalized care of strangers, absent the familiar living and support of extended family. It is not a healthy situation, and it is social condition that has become a social anathema that is being experienced in other countries around the world.

On the elderly in America, Lillian B. Rubin (2007), in her book 60 and Up, puts it into perspective this way:

"It has become the baby boom generation's latest, and in some ways most agonizing life crisis: what to do when the parents who took care of you can no longer take care of themselves," Rubin quotes a writer from Time, Cathy Booth. Rubin cites Booth further, quoting her as describing the plight of American elderly as, "descended into elder-care hell, when my mother, then sixty-nine, was found to have Lou Gherig's disease (Rubin, p. 111)."

To describe elder care today, Rubin has chosen Booth as a summation of the plight of the elderly. She, however, has chosen, too, a person who expresses a conscience in the plight of her loved one. Perhaps even felt helpless to make choices for her mother other than those that equated to elder care hell. There are many elderly who are surrendered in the twilight years leading to final hours of life who are physically and emotionally abandoned from the love of their family. Something has gone very differently in the family as Americans have evolved to the present; something very disturbing that is a comment on not just American society, but society around the world.

Japan, a country where before World War II, the elderly were held in high esteem, valued for their life experiences, the knowledge that they carried with them, the contributions that they made to their families, and who remained a part of their family until they passed on; are today finding a very different culture in which they are no longer the valued members of a traditional and culturally inherited family way of life. This stark change in postwar traditional values was summed up in 1972 by a minister of labor, K. Hara, who was quoted by Takeshi Ishida (1989), in his book, Japanese Political Culture, as saying, "that if old people had to live in public homes for the elderly, it was their own fault (p. 33)."

The comments cited here give a perspective from both sides of the social plight of the elderly around the world today: political and emotional family insights. This paper explores the plight of the elderly, focusing on American society, as it exists today. It is an issue that receives little attention, because the elderly have weak voices, and comments on their lives and needs are expressed largely through institutional settings with a corporate leadership focused on profit lines. These corporations have more power and influence than any one American family, but the American family that surrenders their loved ones to these institutional settings has a role of responsibility too. They are faced with tough choices, choices that impact the lives they have made for their selves with the immediate family.

This essay will look at the question of whether or not the American elderly have, like much else in America today, become disposable in the lives of the American family, and the role that the government and economics play in the disposition of elderly to elder-care hell. This essay will also demonstrate that elder care abuse begin much earlier than some of the identified studies suggest, beginning at around age 50 with age discrimination, demonstrating that elder abuse arises out of a social breakdown and labeling theory, which, then, manifests in more intense and severe neglect and abuse as the person ages, and experiences the processes of dying.

The Deterioration of Traditional Family Values in America Regarding Elderly

Harold V. Cordry and Leslie Foster Stebbins (2001), in their book, Work and Family in America, write that just as child care emerged as a national need some thirty years ago, so too has elder care emerged along that same line of family urgency and priority now (46). Cordry and Foster Stebbins distinguish the level of care and care givers providing that care along class lines, saying:

"Although very wealthy families are able to purchase high quality services for their relatives, and families with very low incomes can receive institutional care, for middle class families there are few alternatives between informal home care and institutional care (England 1989) (Cordry and Foster Stebbins 46)."

This leads Cordry and Foster Stebbins to conclude that, during the 1990s, an estimated 22.4 million households in the U.S. were providing care to a parent, relative, or friend over the age of 50 (citing Harrington 1999, Cordry and Foster Stebbins 46). Cordry and Foster Stebbins cite Harrington (1999) again, calculating that 65% of disabled people (in the 1990s) lived at home, or with a relative, and that the primary care givers for the needs of those elderly family members was received from their family, and with minimal government support for that care giving (46).

While Cordry and Foster Stebbins might accurately have defined populations with the supporting statistics, that 22.4 million households provided care during the 1990s, equating to 65% of the disabled people in the country receiving that family care, it does not describe the quality of the care being given, nor does it state that the care was being delivered in a family setting. It is this population too that gives rise to concern about reports of elder care abuse, as well as in the institutional settings.

Cordry and Foster Stebbins cite Neal, et al., 1993, saying that it is a myth that adult children no longer provide care for their elderly parents and relatives as was once the tradition in the "good old days (Cordry and Foster Stebbins 46). However, the Cambridge Handbook of Age and Aging reports the problem of elder abuse in different countries around the world as on the rise (Johnson, Bengston, Coleman, and Kirkwood 2006 324). The authors of the handbook say:

"The socioeconomical breakdown has created an unexpected and inadequate way of living within a family, which promotes conflict when facing the new intergenerational exchange. These new forced living arrangements have generated a reversal of roles between family members that were culturally defined, structured, and programmed (WHO/INPEA 2001a 2001b) (Johnson, et al. 324)."

This description of studies conducted in South America and in Africa and other areas of the world, could ostensibly be likewise applied in logic and theory to aging, death and dying in American society. Especially at this time in American history and society, when we are witnessing the breakdown of economic structure in a way that adversely impacts all of the class groups cited by Cordry and Foster Stebbins, it would follow that we will see a rise in elder care abuse in America.

The problem that exists in attempting to better understand elder care abuse from a clinical and social perspective, is that there are not enough studies relative to these contemporary times from which to gain insight in order to benefit a clinical approach to protecting elderly from the abuse, and to identity and intervene with a clinical approach at risk elderly people. Johnson, et al., describe elder abuse as interpersonal violence, that has beginning in the latter part of the twentieth century come to be identified as a violence against an age specific segment of the population (325). It is, Johnson, et al. say, a problem that has drawn focus on the same plane as human rights, gender, equality and population ageing (325). This is a timely focus and concern, because in the next decade there will be an unprecedented number of elderly world-wide, and especially in America, who are the product of the baby boom generations becoming the elderly population in America.

Johnson, et al., say that researchers in developed countries, presumably America too, have created a situational model of elder abuse, attributing it to overburdened care givers (325).

"a dependent elder (exchange theory), a mentally disturbed abuser (intra-individual dynamics), or as learned behavior (social learning theory) (Bennett, et al. 1997). Others have used the imbalance of power within relationships (feminist theory) and the marginalization of elders (political economic theory) to explore this issue (Whittaker 1997). Early on, elder-abuse researchers realized that a single theory could not accommodate such a complex, multi-faceted phenomenon. For child abuse and more recently domestic violence, a similar realization has led to the adoption of the ecological model as a means of explaining interactions across systems (Johnson et al. 325)."

The ecological model would be consistent with Cordry and Foster Stebbins identification of class distinctions related to family care and primary care givers in elder care settings across those class spectrums in America. The ecological is the most recent and prevailing theory that helps experts to explain the problem of elder abuse (Johnson et al. 325). Since it is a theory that is explains elder abuse in correlation to the findings of Cordry and Foster Stebbins, who actually because of the number of primary family care givers cited in the studies they relied upon, tend to overlook the potential for a family member as a primary caregiver to the elder family member as potential abusers.

The weaknesses of any of these theories, especially one that treats the care of elderly as irrelevant because a primary care giver is an immediate family member; is that there continues to be a lack of extensive and clinically useful data that can be used to prevent elder abuse. The dynamics of elder abuse are, therefore, best explained using the ecological theory, which encompasses all of the other socioeconomic factors, but perhaps overlooks the medical factors that come into play when an immediate family member is the primary giver. How the immediate family caregivers arrive at choices they make on behalf of their elderly parent or family member when that family member suffers from conditions like Alzheimers, dementia, or other debilitating diseases and conditions that are not readily explained by the theories offered, and even the ecological theory seems inadequate in explaining in cases that might involve assisted termination of the elderly life by the family member.

This is a complex problem wherein no individual theory is sufficient, and each case must be examined on specific and individual case criteria. Perhaps this is the biggest obstacle, because we cannot group under an individual theory the vast number of case dynamics across the class structures identified by Cordry and Foster Stebbins. Therefore, we must closely examine existing studies, and cases in the literature to weigh the problems at the source, and to attempt to better define the directions from which abuse is being leveled at elderly, and group those directions into a study. Existing literature would be an essential first step in approaching a directional approach to understanding the problem. Thus far, these theories fall short, probably because there is insufficient research to understand the problem on a larger scale. But we cannot stop at these theories alone, and must look across a broader spectrum, as broad as the class lines cited by Cordry and Foster Stebbins, to gain a larger understanding of the problem.

Age Discrimination Social Breakdown Labeling Theory

That the elder abuse problem is widespread, and increasing, is indicative of age discrimination, social breakdown and labeling theory. The problem must be discussed in part with this theory, because elder abuse at the end stages of life is the culmination of a pattern of discrimination that begins at around age 50. None of the theories so far discussed have adequately taken into consideration the pattern of discrimination that people begin to experience at around this time in their lives, tying that discrimination into the culmination of elder abuse.