Dr. Atul Gawande is a guest columnist on the New York Times Op-Ed page this month. Today's column is titled "Rethinking Old Age." It's a
(i.e., available only to paid subscribers). Here is an excerpt:
At some point in life, you can't live on your own anymore. We don't like thinking about it, but after retirement age, about half of us eventually move into a nursing home, usually around age 80. It remains your most likely final address outside of a hospital.
To the extent that there is much public discussion about this phase of life, it's about getting more control over our deaths (with living wills and the like). But we don't much talk about getting more control over our lives in such places. It's as if we've given up on the idea. And that's a problem.
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Certainly, nursing homes have come a long way from the fire-trap warehouses they used to be. But it seems we've settled on a belief that a life of worth and engagement is not possible once you lose independence.
There has been, however, a small band of renegades who disagree. They've created alternatives with names like the Green House Project, the Pioneer Network, and the Eden Alternative ? all aiming to replace institutions for the disabled elderly with genuine homes.
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"The No. 1 problem I see," Dr. Thomas told me, "is that people believe what we have in old age is as good as we can expect." As a result, families don't press nursing homes with hard questions like, "How do you plan to change in the next year?" But we should, if we want to hope for something more than safety in our old age.
"This is my last hurrah," the woman I met said. "This room is where I'll die. But it won't be anytime soon." And indeed, physically she's done well. All she needs now is a life worth living for.
Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston and a New Yorker staff writer, is the author of the new book "Better."
