Orthodox America


  Caring for the Aged and Ill – Practical and Spiritual Considerations


Priest Alexey Young

When thou wast young, thou girdest thyself, and walkedst where thou wouldest: but when thou shalt be old, thou shalt stretch forth thy hands, and another shall gird thee, and carry thee whither thou wouldest not. (John 21:18) 

Until only a generation or two ago, most families remained physically quite close together, and it was not unusual for three generations (grandparents, parents, children) to live in the same house or, at least, in the same neighborhood or city. Fifty years of social revolution--of divorce, job instability, war, materialism, the "me-first" generation, and, more recently, raging feminism--has now virtually destroyed this once-secure and healthy, if old-fashioned, Christian way of life.

    Whereas it was once common for children to remain at home until marriage (or even longer, if they never married), parents now cannot wait to eject their children out of the home and into the workplace or college as soon as possible (and children cannot wait to escape parental supervision, either). Whereas, not so long ago, nearly every family had at least one "maiden aunt" or "bachelor uncle" and one or more widowed grandparents living together with the younger generations of the same family----all of whom helped to raise the children and care for home and garden--we now consign the elderly to isolation and loneliness wherein they often feet useless, sad, and unwanted. (And we send our children off to be raised by strangers in day-care centers as soon as possible.) It is not surprising that, under these circumstances, the suicide rate and incidence of alcoholism and serious depression are rapidly rising in the older generation.

      The problem is now especially acute for those who are chronically ill or dying; it has become one of the great and shameful scandals of our late twentieth century "progressive" society. Partly this is because we usually feel so terribly "put upon" to have to "make arrangements" for Mom and Dad when they are no longer able to care for themselves. This reflects our selfish, un-Christian mentality. It is part of the violence of our times that we care so little for our children and the unborn, at the beginning of life, and so little for our elderly, at the end of life. Sadly, even some priests do not understand this; they do not realize that the proper care of the aged is less a financial concern (although this does enter into the question) than it is both a Christian responsibility and an opportunity for spiritual growth.

      Then, too, part of the problem is that we no longer address this issue in our parishes, our church publications, our own families. As individuals, we often wait until it is almost too late or there is a crisis, before we begin to think and talk about how to care for our parents and grandparents. The elderly have contributed to this scandal, too: they have often been too ready to say that they don't want to be "dependent" on their children or live with them. They often say this because they sense that their children really don't want them, anyway. It's a vicious cycle.

      We need to re-educate our families, from oldest to youngest. This could be done along the following lines:

      1. As children, teens, and young adults, we need to be taught that honoring our parents does not end when we leave home and start our own families. We have a responsibility to stay in close touch with them, to be sensitive to their needs, and to help them in whatever circumstances they may be in. This is more than sending Christmas or Pascha cards, the occasional long-distance phone call, the family get-together at Thanksgiving or some other holiday. Much more. As they and we grow older, relationships with our parents change, to be sure; but they are still relationships and all successful relationships take work, an investment of time, energy, and selfless caring, if they are to survive and thrive. Not least, we must never forget to pray for our parents, just as they continue to pray for us even into the next world. This is where we begin. This is the foundation.

      2. Assuming that there is no catastrophic illness or other tragedy before reaching retirement age, we seniors need to do some honest and realistic thinking and planning or our own: What happens when we become infirm? Do we need to look at the option of a retirement home or center where we can still live with a good deal of independence and yet have our basic needs taken care of? [1] Should we think about selling the house and sorting out our belongings now, while we are still capable or doing so, rather than leaving it for others to do later? Perhaps a modest apartment somewhere near one of our children is a good idea. Have I thought about how I will live when my husband/wife dies or has to enter a hospital or nursing home? [2] Is it a possibility that we could buy a larger house, with a separate apartment or cottage, where we could live with one of our children and his family? These are NOT frivolous or impertinent questions!

      3. Even if parents and grandparents seem unwilling or disinterested in talking frankly about their own future in this way, their children and grandchildren still have a responsibility to raise these questions with them. But this must be done sensitively, carefully, and patiently--not in a controlling or disrespective manner. After all, the job of adult children is not to tell their parents what to do, no matter how old, frail, or incapable they might seem. Except in a crisis situation, where one or both parents are unable to make any further decisions for themselves (such as a coma or paralyzing stroke), no one else should "take charge." This, however, raises the question of a living will---a legal document wherein individuals specify what kind of medical care they want in the event that they are unable to communicate their own wishes. This, of course, can be an invaluable document, but it must be framed within the principles and values of Orthodox Christianity, which does not permit any kind of euthanasia.

      4. For all of the above reasons, families--both parents and adult children--need to think seriously about the question of living far apart, in different cities or states, as so many of us now do. As the infirmities of old age begin to close in, the issue of distance becomes critical, and it is often difficult or impossible for children who are living far away to be in proper supportive roles to their parents. Sometimes it is possible for older parents to relocate-especially if they are already retired--to the same town as one of their children; occasionally, the children are in a better position to make this change. In any case, it's a question that should be addressed.

       5. Are there adequate insurance polities or savings to cover the enormous expenses of hospitalization or long-term nursing home care? If not, one needs to know at least a little in advance about the Medicaid and Medicare laws in each state-which can be overwhelming and frustrating to deal with in a crisis situation. [3] (In this regard, it is, frankly, dangerous foolishness to suppose that the Government will now "soon" take care of the financial health-care problem and we needn't think about it. What the Government will or will not do misses the point, anyway, which is, "What is the loving and Christian thing for us to do now?"

       Also, are there sufficient funds to cover the cost of a funeral and burial?--in itself no small consideration. Even very inexpensive funerals are seldom less than $2500, unless one is a pauper and buried by the State.

       6. Finally, is it really possible and practical to care for a dying parent in one's own home? Possible? Yes. Whether or not it is practical depends upon the individual family. While insurance and other sources will pay for a certain amount of nursing and health-aide care at home, there must still be at least two other adult family members (who are not encumbered by outside jobs) to make this practical. One will also have to have at least a small network of support from other relatives, neighbors, the church community--people who will step in to help out when required, even if it's just a desperately needed few day off. (In the days when we still valued multi-generational nuclear families, this was not at all a problem.) This can be especially important when there is a long-term illness and the parent is bedridden. In-home hospice care is often tremendously helpful when there is a terminal illness, providing even hospital beds and other essential equipment; this greatly reduces the cost of nursing home or hospitalization, and so most insurance companies (as well as Medicaid or Medicare) are quite willing to pay for this. More important, it can be a great comfort to a dying parent to be with his or her family, at home, surrounded by grandchildren, pets, and all of the normal sounds and activities or daily life, rather than in the sterile and lonely environment of a hospital or nursing home. [4] 

    Because we don't like to "put ourselves out," rearrange our schedules, carry bedpans, or whatever, the option of caring for an invalid or dying parent at home is not very attractive. It is, in fact very hard work, and puts unusual stresses on the family. Spiritually speaking, however, it is one of the best ways in which we can learn and grow and acquire real virtue in our otherwise very self-centered and pampered lives. It is the carrying of a real cross, but one which can transform and transfigure those who bear this cross with cheerful self-sacrifice. Therefore, where this is possible, it is the "recommended option'' for Orthodox Christians but it should not be entered into lightly or without much thought, prayer and planning. It is for sure, however, that no one should ever have to die alone as long as there are followers of Christ in the world--but, especially, our parents should not be left to grow old and sick and die unattended and alone--those who sat up by our cribs and bedsides so many nights when we were sick and frightened children.

      This is only a brief overview or outline of the kinds of things that could be part of our "reeducation" as conscious Orthodox Christians. It is not a complete "program" or even a full examination of all the questions and issues involved. We can, at least, start to talk about it--parents and children, pastors and parishioners---and out of this may come ideas and solutions that reflect very much the true spirit of the Gospel--that sweet yoke of Jesus Christ which, ultimately, is both "light" and "easy," as He Himself has promised us……


Notes:

1. Today's retirement centers are a far cry from the "old age homes" of yesteryear. These are often very pleasant places, where people still have a great deal of independence and freedom. And, contrary to popular opinion, they are not always prohibitively expensive but are often within the reach of middle-class retirees. 

2. It is not uncommon, among the older generation, for husbands to become sick or die without having shared with their wives (or children) even the most basic information about finances, bills, insurance polities, etc. And too often, older women do not ask about these important things, either. In the same vein, it is extremely important to have a will that spells out what is to be done with one's estate and who is to be the executor. This should neither be left to chance or put off to "next year." 

3. This is a complicated situation all its own and beyond the scope of this article. I first encountered it when my mother was in a rehabilitation center for a month, following a stroke. The bill was $55,000----and this wasn't even the regular hospital bill! My parents' savings were meager, and so my mother had to be under Medicaid. In her case this meant that my father had to "spend down" his very modest lifetime savings (which wouldn't even have paid for one-tenth of her total medical bills over the last two years of my mother's life) se that she could qualify for Medicaid. 

4. In our case, we cared for my invalid mother in our own home for two years. During the last six months, when she was bedridden and clearly dying, we moved her hospital bed into the dining room so that she would be literally at the center of the house and could interact with everyone at all hours of the day. Even when she could no longer eat, she could see into the kitchen and liked to make comments about what was being prepared for dinner!


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