Aged care in purgatory

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'Aged care' by Chris JohnstonSigmund Freud once wrote that the only feeling that doesn't lie is anxiety. This is a hard thing for us to hear, because few feelings terrify us more than anxiety. Anxiety is the way we are affected by the things that we can't change. We might try hard to suppress it, deny it or ignore it, but deep down, it never goes away.

As Freud explained, anxiety is immutable because, ultimately, it is the chill of death's own inevitability. So what happens when we try to do to death what we do to other, more contingent sources of anxiety? How do we try to forget our own mortality? The answer is devastatingly simple: nursing homes.

While there are, no doubt, wonderful aged care facilities that provide community and dignity for those who have entered their twilight years and need additional care, this is not the experience of the majority of our elderly.

Increasingly, the elderly have become ritual sacrifices that we as a society offer to the most implacable of our modern gods: what Hervé Juvin described in his mordant masterpiece, L'avènement du corps, as a kind of provisional immortality, a death-less existence realised in unlimited consumption.

Precisely because they are painful reminders of our mortality, many of our elderly are consigned to substandard, often degrading care as a way of classifying them as not really alive, but 'not yet dead'. Institutionalisation has become a mechanism of our desire to forget death and to go on living unperturbed in our capitalist nirvana.

Our failure to care for and honour our elderly degrades us all. The systemic forgetting of the elderly is one of the great causes of weakness and moral impoverishment in our culture. Lives tempered by age and shaped by hard-earned virtue are gifts from God. It is to our detriment that we ignore them.

Perhaps it is time to revive the long Christian tradition that regarded old age as a theatre of virtue and courage. Ageing was imagined as a kind of final transaction, whereby the elderly show what the good life looks like, having reached the point where they can drop all pretence and start telling the story of their lives honestly.

But the elderly also bear witness to what good death looks like: how to face the completion of one's life with courage and faith. Those gathered around in loving community express their humble gratitude for these lives well lived, and urge the dying not to waver in their faith as they sprint toward their final prize.

There is a surprising fictional counterpart to this Christian tradition in the final volume of Philip Pullman's His Dark Materials trilogy. The children, Lyra and Will, have made their perilous journey to the world of the dead on the pretence that Lyra must apologise to a friend she betrayed, and for whose death she was responsible.

Once there, it becomes clear that their destiny is much grander than that: it is to defeat death itself by, quite literally, cutting a hole in the other side of this cavernous Sheol and thereby allowing the atoms of the ghosts of the dead to disperse into the benign indifference of the universe.

When one of the harpies — whose role is to torment the dead by hissing and spitting venomous reminders of failed lives — objects that releasing the dead would negate their very reason for being, one of the children's travelling companions makes a remarkable suggestion:

'Let's make a bargain with you. Instead of seeing only the wickedness and cruelty and greed of the ghosts that come down here, from now on you will have the right to ask every ghost to tell you the story of their lives, and they will have to tell the truth about what they've seen and touched and heard and loved and known in the world. Every one of these ghosts has a story; every single one that comes down in the future will have true things to tell you about the world. And you'll have the right to hear them, and they will have to tell you.'

Could not this purgatorial vocation be a model of the community's care of the elderly? To listen with humble gratitude to lives that have finally learned to tell the truth about themselves, that have stripped themselves of every last shred of pretence, and that now simply need a loving community to hear.

However much our death-defined culture may wish to deny it, there is life before death. It may be weak and frail, but so are the other gifts that God has given us in order to demonstrate his grace and confound our supposed strength. As the apostle Paul put it, 'the weakness of God is stronger than human strength'.


Scott StephensScott Stephens is the minister at Forest Lake Uniting Church and lecturer in theological ethics at Trinity Theological College.

Topic tags: scott stephens, aged care, purgatory, philip pullman, his dark materials, freud, anxiety, augustine

 

 

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A fine article. What a great sentence: 'Institutionalism has become a mechanism of our desire to forget death and go on living unperturbed in our apitalist nirvana.'
Joe Castley | 01 June 2009


Some may think Scott Stephens' views regarding our treatment of the elderly to be exaggerated, e.g.:

"Our failure to care for and honour our elderly degrades us all. The systemic forgetting of the elderly is one of the great causes of weakness and moral impoverishment in our culture."

Scott Stephens' views are in fact a fair assessment of a society that still fails to provide an appropriate and adequately resourced system of care and support for our frail senior citizens. Scott has proposed a respectful engagement with the frail aged, who too often end up in institutions due to a lack of the social and family supports that would enable them to live out their lives in their communities.

Scott’s proposed approach could be adopted by all of us, including residential care providers, as a model for our care of the elderly - "to listen with humble gratitude to lives that have finally learned to tell the truth about themselves, that have stripped themselves of every last shred of pretence, and that now simply need a loving community to hear."

Valuing appropriately the contributions of our frail elderly will enrich society. Such an attitude should also ensure better resourcing of aged care, so that we might no longer be degraded by our failure to care adequately for and honour our elderly.
Peter Johnstone | 01 June 2009


While I agree with your article, having a mother who is in third stage dementia, lingering in a nursing home, it seems cruel to me, to keep a person alive who whould under normal circumstances, hate the life they have now. Therefore, is it not kinder to let them die with dignity, rather than simply exist for who, for us or for them. I for one know that my mother would tell you she hates this state of stupor, not knowing anyone,unable to eat, see hear, totally incontinent, just a shell of someone who was. We talk about cruel and unusual punishment, this is one of the cruelest things that a person can do to another. However, until our laws are changed re keeping people alive just because, our nursing homes will be filled with people like my poor mother.
Philippa Jayne Boyington | 01 June 2009


It is a shame that in seeking to make a point about theology and society, Mr. Stephens on one hand criticises society (Our failure to care for and honour our eldereley degrades us all - a point with which I agree wholeheartedly) and then goes on to criticise those who do actually devote their talents and love to the needs of the elderly in providing such care, referring to what they do as 'substandard and degrading care'.

How many theologians or readers could deal, on a daily basis, with not only the challenges of care, but also with the prejudice received from those without a clear understanding of what is needed to provide such care, including journalists, politicians and ill informed onlookers. It is easy to criticise, and to let our Governments 'off the hook' by demonising those providing the care - it is certainly not sensationalist to recognise the tremendous work that is done. When your time for care does come, I hope there are people left to support you in your final journey, and have not been left at the altar of journalistic or theological sensationalism.
Glenn Bunney | 01 June 2009


Thanks for your comments, Glenn.

It was neither my intention to romanticize old age (and I do not believe I did that) nor to vilify those who provide care for the elderly. In fact, a considerable amount of my pastoral work has been given to those in aged care facilities, as well as with those who work in those facilities. The stress, scarce resources and extreme institutional apathy under which they labour is profound, and in many ways this article stems from my attempts to offer pastoral care and support to them. I'm not writing from the outside, or from the perspective of a detached observer.

My real concern is the current proliferation of privately owned, for-profit aged care facilities, which are in response to the current demand on the part of an aging population for some holding area in which our elderly can be forgotten (out of sight, out of mind). There is a kind of systemic logic at work here that transcends the logic and good intentions of individual persons, and comes to embody what John Paul II described as our 'culture of death'. These facilities - much like capitalism itself - destroy those who find themselves with them: those who provide the care, those who receive the care, and those who seek out the care in order to absolve themselves of the responsibility for their elderly.

The first step in changing this situation is to change the way we speak about it, by thus reorienting our ethical obligations and commitments. This is just a small contribution to that end.
Scott Stephens | 01 June 2009


Contrary to Peter Johnston I find Scott Stephen's views regarding 'our' failure to care for and honour our elderly to be a gross exaggeration. I can't speak for the Uniting Church in Victoria but in NSW & ACT one of UnitingCare Aging goals is to put the spirit into aged care. My own congregation puts this into practice by offering spiritul care and worship opportunities within our city's residential aged care facilities as well as supporting an older adults council.

Few persons, if any, who spends time talking with the elderly about their decision to place a loved one in an aged care facility would agree with Scott Stephen's statement that a Nursing home is a 'mechanism of our desire to forget death and go on living in our capitalist nirvana.' The people I speak to generally make the decision on the basis of maximising the good of the family and the person alike.
Geoff Flynn | 04 June 2009


Having to put someone into an aged care facility is a trauma for the family, it is usually a last resort. The people have to be assessed, no one goes into an aged care facility if they are able to care for themselves. Issues such as dementia, alhziemers, incontinence, tube feeding, multiple health complications, lonliness of living alone, disability, behavioural disorders etc. are just some of the reasons.

While your article makes well meaning comments on taking care of the elderly it does not address the day to day realities involved.

Before you make generalisations about the aged care facilities, perhaps you should try and take care of someone with obsessive compulsive disorder who is faecally incontinent, that can be the reality.

The dept of health, the dept of aging and disability, the aged care standards and accreditation agency, 7000 aged care facilities across the country who are regularly audited and must pass strict compliance to be licenced, you think we don't care?

Please remember it is the family who brings their relative to the aged care facility, not the other way around.

It is unfair to make headlines such as yours which scare family members into thinking their relative is getting poor care, many aged care facilities are doing great work. It is easy to make the comment, but you are making it about peoples homes and carers, be careful.
Cathy Holling | 05 June 2009


Let's not forget that most elderly people live out their lives in their own homes - it is only a minority who need to be admitted to a nursing home. These people usually come at a point of extreme crisis in their lives, and are relieved to suddenly have the support of caring and skilled staff. Of course, there are those with such profound dementia that they linger on in the most horrible torpor, but the alternatives are living in this way, without the 24-hour care in their "homes" (which become, not homes, but prisons) or euthanasia. The amazingly robust people who do the work of caring for the elderly are, on the whole, women. They are very poorly paid, and work under extreme stress. Scott denies that he is a detached observer. I imagine that, until he spends 30 years turning up to work to change 20 wet and dirty incontinence pads, he is indeed a detached observer. Staff who turn up year after year for this kind of work are the real theologians - their compassion is based in the realities of age and death, and not in "hands-off" theorizing.
Philomena | 06 June 2009


Scott if you see fault with aged care, there are ways to improve it. Visit the aged care facility, if you see something that upsets you such as substandard care of a relative, perhaps they are not assisted with showering, their diet is inadequate, they are left in soiled sheets, then report it to the staff on duty, if this issue is not addressed then go to the owner of the aged care facility, if no response then go to the aged care standards and accreditation agency who will audit. It is your right and responsibility as a family member to care and advocate, but you need to be specific in your complaints for action to be taken and issues to be addressed, the generalist criticism achieves nothing. Improving aged care starts with us.
Cathy Holling | 06 June 2009


Amazing article.

I have recently commenced a study into boredom and social isolation in aged care. It amazed me to discover that 1 in 3 elderly will not see a visitor in a 12month period. Boredom, depression, social isolation a rife in aged care. Furthermore, the average length of stay is 187 days (80% of persons pass away).

I wholeheartedly believe that we need some form of care for frail, elderly people however, the care we offer now is substandard. After what i have seen as an aged care nurse, what i've read and learnt from interviewing elderly ... i never want to go into aged care.
jessica thomas | 07 October 2009


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