The Last Ghetto

One thing the Greatest Generation has, which my generation does not, is ghetto memory. And at the end of their lives, they are back where many started.

Before World War II, most American families lived in a single room, often without running water, let alone electricity. Millions were plunged into such conditions by the Great Depression, and this scarred people for life. It was reflected in their attitude toward living, toward money, and toward pleasure. It is the nearly universal experience of this nation’s immigrants.

My American baby boom generation is a product of those attitudes. We grew up in rooms as big as many of our parents’ houses, surrounded by luxuries they could not have imagined when they were kids. We took what was needed for granted, and grabbed for what we wanted. Our parents gladly indulged us, living vicariously, conscious that life is short, that time is fleeting, and hoping it would render us generous, grateful, and loving in our turn.

It didn’t happen. My generation has been greedy, self-centered, and faithless, to our parents, our planet and our children. Not all of us, certainly. There are saints everywhere. But as we have aged many of us have hugged our advantages close to our chests, dismissing the fears of our children and re-ghettoizing our parents.

What else can you call the modern senior center? It’s sold as superior to living at home. It’s said to be clean, there’s running water and electricity, and there’s a staff to take care of physical needs. But not emotional needs, not spiritual needs, not the need for companionship and belonging. It’s all about animal needs, not human needs.

What makes a ghetto isn’t just poverty. If there is community in a ghetto it can be green in memory. A true ghetto is isolation, the feeling of being constantly alone and on guard. It is a spiritual loneliness and uselessness that gets deep into your bones. This is a constant in what is called “senior living,” but really amounts to “see ma dying.”

The need for constant, and accelerating, hands-on medical care is what leads people to the Last Ghetto. We measure the success of a center by the amount of physical care provided to patients. We care nothing for spiritual or mental health.

My mother is in an “excellent” center right now. (I did not choose it, but I question whether I could have chosen anything better.) She will be 92 next month, and has suffered from dementia for a decade. By conventional measures it’s an excellent center, a white home on a cul de sac a mile from where she lived for over 40 years. It is clean, the staff is patient. Physical needs are met, always.

But even someone with dementia has emotional and spiritual needs. My mother has no one to talk to. She’s blind and can’t see the TV that is left on all day for entertainment. She cries when I call, demands on good days that she be taken away from the place and, on bad days, that I fly cross-country right now to visit. When people do visit, of course, she crawls into an emotional shell, helpless and unresponsive.

“How do I get out of here?” she asks plaintively. We both know the answer to that, but neither of us can say it out loud.

Yet my mother is lucky. Very lucky. There are relatives nearby, she is visited. The place, as I say, is clean, the physical care generous and kind-hearted. I have other friends who are not so lucky, struck down by wasting diseases. One has lived horrors beyond imagining yet still survives. The other is stuck, by Medicaid, in a facility far from his loved ones, where he has to lock up what possessions he has, or else they will be stolen. I have seen places where Americans sit in wheelchairs, in their own filth, because there isn’t enough staff to tend to them, because they can’t make themselves understood, or because the staff can’t understand English. These are Americans, mothers and fathers who were once as hearty as you are today. This is your future, people.

Caring for your mother doesn’t pay. It’s one of the jobs Americans don’t want to do. Those who do it are often recent immigrants, people who can’t find other jobs. If they are native-born, they may be deeply resentful of their own situation, of how little they make compared with how much their patients, the families, or the government is forced to pay for this “care” – an average of $8,000 per month. That’s where the thefts come from, and the abuse. It’s a hobo jungle, and your mother is helpless against those who are able bodied.

Meanwhile the need for what is called “senior care” or “senior living” keeps rising. Every city in America is dotted with centers, many with brand names. Most are organized as Real Estate Investment Trusts, a legal structure that aims to extract the maximum profit from the business, every year, and hand that cash to shareholders. It’s a growth market run like an oil pipeline. It is a racket.

This is where your mother has gone, it’s where your father is if he’s still around, and it’s where you’re headed unless something is done to change it, starting right now.

We can either expand these ghettoes or find another way to age. I’ve suggested that my generation use technology to build friendships, use those friendships to share homes in the early stages of need, and use the technology to find the best possible solution when home care is no longer possible. I know that as technology advances we can dramatically improve the productivity of care workers, we can find mechanical substitutes for a lot of physical care, and we can create new way of meeting our emotional and spiritual needs. But it will take the concerted effort of millions to bring the caregivers their fair share of these gains, assure them of a decent wage, and prevent abuse.

All this has to be done, unless you want a lifetime of hard work to leave you broken and helpless, in a ghetto of someone else’s making, at the end of the end. This is the last great struggle of our lives and one which, if successful, will yield the best present we can possibly give to our own children, dignity in old age.

Death takes us all, in time, and there’s no good way to go. “This seems real clear to me, no one dies with dignity. We just try to ignore the elephant sometime.”

What will your life be like when the elephant’s footsteps grow louder in your ears, when the footsteps  can no longer be ignored?