Today almost 35 million Americans are 65 or older, and more are added to the frail side far faster than birth or death can balance the equation. This is good news, sort of. Thank you, folks who rode Joe Camel out of town. Thank you, oh mighty and victorious modern medicine: antibiotics and vaccines, C.A.T. scans and M.R.I. machines. Ah, dear diet books and exercise plans and indoor plumbing, I could kiss you all, saviors of our lives. I forgive you for being costly–for up-in-the-sky insurance rates. You can’t take it with you, as they say.
But on the other hand, more negatively, we know that some enormous percentage of women over the age of 80 develop some kind of dementia. We know that losing your mind is not pretty or sweet. We know that families grieve the loss of the former person, and the parent becomes the infant. And there is nothing poetic about it, except perhaps for the continued loyalty amid despair of families who stay the course, who hold the hand of the person who no longer recognizes them, who can no longer find the way home.
Everyone pictures themselves as independent right to the grave’s edge, and everyone assumes that their own mind–that familiar apparatus, that unique and precious bundle of synapses that is the pride and joy of self, even if it teases, torments, with nasty urges or bad dreams–will last until the dying breath, do its mainframe work as long as it’s needed. But we hear bad news, reports from the aged front of adults reduced to infancy, reduced to zombies, shells reduced to diapers and mashed bananas and yet living on for years. We shiver and shrug it off. We consider noble John Bailey and tragic Iris, and we sigh and turn our attention to the fashion ads, the news from East Timor. You can’t get through the day anticipating every terror that the future might or might not hold for oneself, or for parents you love, or for the aunt who brought you candy for your birthday, or for the uncle whose stock tip once allowed a mortgage payout.
In this city, Mayor Giuliani may have swept Father Time off to wherever he hid the squeegee men and the derelicts who used to sleep on the church steps. In this city where everything rushes by without pause–buses, pedestrians, children, runners, Rollerbladers, construction cranes, backhoes–time, too, seems to need a permit to go about its business. In New York the quarter of an hour of fame is handed back and forth like a hot potato, and we believe we run too fast for time to catch us in its net. New Yorkers who know not to look a crazy person in the eye can pretend for a while that old age is something that happens to other people, in Des Moines, perhaps, but the truth is that we, too, need to plan, to consider, to weigh the expenses, to insure ourselves against an unwanted or burdensome longevity.
I’m thinking about this because my friend Stanley Diamond tells me that his company is opening a new facility on East 80th Street dedicated to Alzheimer’s disease and other memory-impairment care. It will offer private suites, housekeeping, delicious meals, a garden, a tea room, parlors and apartments. There will be discussion groups, creative writing classes, gentle exercise and hobbies. The staff will offer encouragement to preserve skills and provide needed stimulation. There will be trips around the city to movies and museums. The nearby New York Hospital-Cornell Medical Center will provide medical services at all hours and will supervise treatment plans.
Of course, there is a price. Everything good in New York has a tab, including Jean Georges or Jo Jo’s, an apartment at Trump Tower, an apartment anywhere, a drink at the Hilton, a horse-and-carriage ride through Central Park. Someone gets a bite of luxury, and someone else nibbles on their own fingernails. There are winners and losers, and no doubt I would consider it winning, although a bitter win, if I were taken care of elegantly, graciously, in my dementia.
In New York City I have visited some sad and sorry excuses for nursing homes in search of a place for a sick relative, and I know that the dreariness and the cheapness and the smell of Lysol and ammonia drove me near mad with longing for a speedy death at a nice young age. It’s not fair that everything, including disease, should have an upper end and a lower end, but on the other hand, what if we had lost the Cold War and all we had were understaffed, gray and gloomy dungeons for our final years?
Yes, Alzheimer’s disease itself, or just plain dementia, is not pretty or kind or elegant. The decaying of life, soul loss, is not all right, and in a just world God would have to answer for his sins. Nice furniture in the rooms or in the lobby will not change that, but there is an edge to be gained in gracious surroundings, in good medical care. It can, I imagine, hold the land longer against the rising waters, it can make the last days not so incongruent with the days that went before.
We are coming to the millennium with some startling new industries on the Big Board. Most of them are very high-tech and virtual and cyber and all that. The rise of assisted-living homes, Alzheimer’s disease settings, senior communities–this, too, is our future, and those companies that do it with true caring, with attention to what people really need, with as much personality and humanity preserved as possible, in the caregivers, in the environment they create, with as little callousness and bottom-line cutting as possible–will be the winners of our affections and our pocketbooks.
Mr. Diamond got his interest in this field from his experiences taking care of his own elderly, beloved mother. Once, on a vacation, he accidentally wandered into a Jewish home for the aged in Amsterdam and returned the next day to bring roses to the women in wheelchairs he had met there. He spent hours with them renewing his Yiddish. Here we have an enterprise in which investment rules and hard-edged business structures bloomed because of, not despite, the decent feelings of the heart. Who, as they used to say in the 20th century, would have thought it?