By Jack Cumming
Life Plan Communities (CCRCs) are so promising in the beginning. We’re not thinking of the developer perspective, construction, opening, fill up. We’re thinking instead of new young residents and the buoyant vitality that comes with new experiences and new friends.
Party Time
The most comfortable CCRC residents are outgoing people who thrive at parties and who are masters of small talk. They are naturally gregarious. They move in and thrive with dress-up parties and resident committee meetings.
Then, there are the quiet ones. They, too, can do well. They may stay most of the time in their apartments, but the feeling that there are others just beyond the door makes them feel secure. They love knowing that help is merely a call button away. They also provide the followers that the social leaders need.
This article, though, is about the forgotten souls. These are the ones who did well in the beginning but who have grown jaded with repetitive meal plans, with a lackadaisical care response that leaves them insecure, and with just the wearing toll of time. They may no longer fit in well because they have grown older … often very old.
“I’ll Never Grow Old”
Vibrant new residents don’t feel old. They don’t have much in common with the very old. Changes in senior living exacerbate this disconnect. At one time, the very old had their own neighborhood in assisted living, but now, increasingly, assisted living services are provided everywhere.
At one time, the assisted living concept was new and a competitive advantage. It gave the very old their own place. Then, that ministry shifted to a more businesslike outlook. “Aging in place” was repurposed to mean “aging in our place,” not your family home.
For providers who charge extra for care services, i.e., those that don’t have Type A, care-inclusive contracts, on-campus “aging in place” can increase revenues per resident. Admitting people who already need care services, for which the enterprise can charge, is a profit opportunity. Many of these people are more patients than residents, and they may seldom be seen. They are forgotten souls.
But, There Are the Doubly Forgotten
Within the group of forgotten souls dwells the most forgotten category of all. Try to imagine who they might be. If you can’t conceive of where this is going, that’s evidence that this subgroup of the very old is indeed forgotten. And that’s tragic.
Make a note here of what you think this category is. Go ahead. Take a second to make a note, preferably in writing, but a mental note is okay, too.
Who Are the Forgotten Forgotten Souls?
Got it? Do you have your guess firmly in mind? Those forgotten souls are the spouses of the residents with emerging cognitive decline. You may think of those spouses as unpaid caregivers. You may not even know who they are since they shield from public humiliation the failing capabilities of the person they love.
Before cognitive decline is diagnosed, its early ravages are evident to spouses. That is a burden that spouses carry alone, unaided. The stricken person is often unaware of what is obvious to the person who has long lived closest to them. Doctors, if asked, may be reassuring since there is little that the medical profession can do. They are thinking of their patient, not the spouse.
Not only is the stricken person unaware, but they may take any suggestion of problems as evidence of spousal disloyalty. Anger is not uncommon. That can be devastating to the protective spouse who has nowhere to turn. It can be exasperating to pause life to help another when that person has no idea that they need the help. There’s no support group. Healthcare professionals are concerned with the “patient,” not with the spouse.
For Better or Worse
Spouses who have long admired and loved their mates may blame themselves. It’s not uncommon for the fully functioning spouse to come to believe that they are the ones who have become a burden. They may believe that they are the cause of their partner’s loss. A kind of downward spiral of codependency can undermine the marriage itself.
This is where the mythology of the Life Plan Community, née CCRC, falls short. The name change only masked, but didn’t address, the many challenges of aging that are overlooked. The plight of the unacknowledged caregiver spouse is only one of many challenges that thus go unaddressed.
A Broken Covenant
Not only do many challenges go unaddressed, but ignoring them leads to the negation of the implied covenant of lifetime care and security. A cognitively challenged couple or person may be asked to leave because other residents, employees, or directors view them as disruptive.
Paradoxically, that which merely causes discomfort can be characterized as “disruptive,” leading toward an unjustified eviction. Most residency agreements allow eviction for “disruptive behavior.” What’s seen as “disruptive” is often in the eye of the beholder, and, too often, that is the provider’s business eye. Even constructive suggestions can be seen as “disruptive.”
Old age care is about as human a service as there is. Greatness in human services belongs to those who proactively meet the need. The easier, self-serving alternative is to defend “what everyone knows” and to keep a blind eye toward the shortcomings.
Will the industry that will be there when you are older, and you are the one needing care, be no better than the industry to which you have dedicated your career? Is change possible? Let us hear from you. The allusion to Gogol is not entirely coincidental.
