The quiet cost of family caregiving
nytimes.com
nytimes.com
However, other tech has really prolonged things. Fall detection, maps, hearing aids, and everything else has really allowed her to live a life relatively unchanged from when she was younger.
She still lives on her own, can walk unassisted, volunteers helping old people (which apparently doesn’t include herself), still has a far better memory than I do, etc.
I'm not a fan of self driving cars as the solution to this problem space.
I've studied city planning. I run r/UrbanForestry on Reddit where I talk at times about city scale passive solar design.
Middle Eastern desert cities were historically designed such that daytime street temps were bearable by design.
It's doable. We just aren't bothering.
I carried an old lady with a walker stuck in the middle of the road. It was brutal on them even with the plowing, without zero ability to move around.
If if we designed public transportation so it was convenient and usable by everyone older people would have more options in all weather.
If we had consistent (24/7), frequent, high coverage public transportation that was subsidized at the same rate as car infrastructure, everyone would use it. If it was faster than driving in traffic rich people would use it and support it as well.
We choose to build a society that only works for a tiny segment and makes all of our own lives more difficult (and eventually impossible).
- eagerly clears the snow
- provides capillary public transportation
- provides city-wide heating
- encourages the development of large buildings (even connected with each other) instead of isolated homes
Deleted comment
https://www.theguardian.com/cities/2018/may/16/welcome-cycle...
What amount of home care and nursing home care is purely down to our reliance on personal motor vehicles?
I'm commenting on tech trends.
One should not be leading the elderly to believe that self driving cars are going to be dramatically enhancing their mobility any day now.
It's really unfortunate that people accept the status quo.
Currently, I have a reminder on my phone to give them to her and watch her take them, but it’s not sustainable long term.
Ideally the solutions is something that enables her to take the meds on her own.
Of course every kid/situation is different and needs to be met where things are at (and not where you wish it would be), but I think it's worth trying if you have bandwidth. They may surprise you.
When you think about it, most 5 year olds have ready access to very dangerous things; they can turn on the oven, toast things (not necessarily food), they often have access to sharp knives with a minimum of effort, etc. What keeps them safe is their understanding of the risks of those things. The real problem with grandma's pills is that the risk of them is not "accessible" to a child in the way those other things are.
In the long run, I think that a family providing such support should consider adopting some of the best practices of care staff who do medication management for clients. You want a physical log sheet that is formatted like a 2D matrix with recurring doses as row labels and dates written as column labels. The rows should also be sorted and grouped chronologically, i.e. the first row is the first dose to take after waking and it is ordered through to the last dose to take before bed. You typically also want to leave blank space after each dosing period so you can potentially write in new medications when there are changes ordered during the tracking period. You also want to keep a digital copy of the form that you can easily revise and print again as the forms are filled to completion.
The responsible party measures out the doses and marks/initials the cells of the grid for the individual dose and date being administered. In a professional setting, they might mark once for preparing the doses and once again after witnessing that they were consumed. The active log sheet is kept in the same storage area as the medications, readily accessible to the ones administering them. If there are multiple people taking medications, a separate series of sheets is used for each person.
In a professional setting, this supports audit. But in any setting, it also provides a simple process to help minimize dosing mistakes. There are no more questions like, "wait, did they already take this?" after a distraction has interrupted the normal, habitual process. This written formalism can also help you manage refills. Learn to think in terms of "N days' supply" to note on the grid when a bottle is opened, predict when it will be depleted, and mark down when it should be reordered.
Put only one dose at a time in the firesafe so if it's left open, it's empty and no one cares?
I think there are might be some tweaks to make it suit your purpose. But it is worth looking into how it can help senior care as a follow bot.
P.S: I did a ton of research for small farm robotics and met very interesting startup founders in the healthcare/robotics area on the way. If anyone wants to brainstorm or even simply chat about senior healthcare and robotics, please reach out. This is something that is very close to my heart and if I can help make connections even if I can’t help in any technical/material way, it would make me very glad.
I mentioned this idea to my wife and she said it will only make our five year old want them more... maybe we will make a kids version that releases gummies :).
I think we already have a timed version for pet food in the market for portion sizes.
https://www.fiercehealthcare.com/tech/from-billions-to-bankr...
We have all the technology in the world to make humanity live better. But the people who control it get to decide if it’s profitable enough.
But really, the solution is more research into anti-ageing science. Not how to maintain the ill and the aged until they die.
I encourage all young people in geriatric healthcare to wear ageing simulation suits to understand the problem first hand to come up with better solutions. It’s less than 3k and can also be rented.
Please reconsider your comment if you would like me to engage in any meaningful exchange with you.
At the beginning, he was mostly frustrated because he couldn't drive anymore (falling asleep too much) and so he was very bored. He took up some hobbies (mostly carving or drawing) but even then, he was restless and often wanted to make dramatic changes to the living arrangements. He thought he could work a part-time job, but because of his other physical issues (he was very weak and it was hard for him to go up stairs or walk or stand for any length of time) he didn't really have much he could do.
We got to know each other well, and my daughter was a saint in helping him a lot when we weren't there (especially during the summers). He cooked for us a lot, especially at the beginning, but towards the end, we had hospice care and he was essentially helpless.
I don't regret it for one second. It was difficult, but we were there to help him with the medical system (it's a zoo), insurance, and just helping him with his phone or his tablet really helped calm him down. We all got to know him really well, and he and my wife were able to reconcile a lot of old issues they had.
He died peacefully at home, surrounded by family, with a stomach of home-cooked food he loved, listening to his granddaughter play the violin. Again, I don't regret it for a second, even though it's emotionally very difficult.
He fell a few times, and just recently fell down the stairs and broke four of his vertebrae and three ribs. When they were x-raying his ribs, they found the cancer on his liver and on his lungs, so we immediately signed him up for hospice. As soon as he was able to get around with a back brace, we brought him home and he died just a couple of days after coming home.
We all learned patience, sacrifice, love, and devotion to someone you love, no matter how hard it is. That lesson alone for my daughter is worth any level of sacrifice it took for my wife and I. I think it's also very healthy for children/young people to confront death and mortality and to go through the grieving process while they are at home with their parents. It's much more difficult to face it alone as an adult.
I also am grateful we could provide a happy environment for him. His granddaughters and their spouses came over frequently for family meals (once or twice a week at least). He expressed how much he loved those times. And he was able to die at home peacefully and without struggle, surrounded by family. May we all be so blessed.
That previous sentence wariness too clinical, I can’t do it justice, but thank you, seriously. It relates to my experience, and maybe future experience, and I think your perspective will stick with me. Be well.
old age can be like wealth and power in that it magnifies character defects.
Many awful people are going to get old and I kinda wish they could be written off the same way they would in middle age, without the social pressure to be compassionate.
There is no innocence regained.
Brings out a lot of underlying personality/ cultural /freudian entitlement in people who barely enjoyed getting thru life but are afraid of death.
Some old people, it's like they can't wait to regress... (I did my part, I get to be the baby now!)
also, immigrant kids have a special hell
lots of cultural/ethnic and class differences that makes this burdensome, suffocating, manipulative, and "politically incorrect" to talk about in ways that feels lonely.
A lot of these kids never got to be kids, since immigrant parents become low-agency children in practice: can't speak english, can't fill out basic forms, often too poor to do basic stuff by the book (legal, banking, etc), don't know the area to have risk assessment or make decisions adults are supposed to make. The kids have to grow up fast without help, succeed in some way without financial or cultural capital, and then take care of their parents without help. They are often being criticized and their decisions undercut the whole way.
Offensive to say but real for many, some immigrant parents often just have god awful personalities: poverty and war and refugee trauma have misshaped them into people that can be hard and unpleasant. Depending on age, many are closed-off, unwelcoming by default, they feel too old to learn new things, racist and endlessly judgmental especially if they never moved out of the self-segregating enclave many start out in the host country. The next generation often feels embarrassed or ashamed of them while having to assimilate, can't bring friends or dates around. Growing up with two different sets of norms and expectations.
Leads to simmering resentment and anger covered with guilt and duty and never ending ethnic responsibilities of the religious, Confucian, and/or gendered type. (Women expected to be servant-nannies for their middle-aged in-laws makes me fume.)
A lot of immigrant kids who 'made it' despite their crummy families can't really share/talk about it with middle-class suburban Americans... I feel this loneliness and often rage myself and see hints of it just go unspoken in my 'scholarship kids' peer group (asian, indian, latino and post-soviet kids in city gifted programs) now that we're all grown up.
Eh, take even good natured people as they are now and add chronic pain, feeling useless, disrupted bodily systems, and have it go on for years and you'll get a lot of the same thing. End of life care is really really hard.
If all your parents did was give you the opportunity to grow up stateside as opposed to some communist hellhole or third-world slum, that itself is worth a lifetime of gratitude that you can never hope to pay back. As hard as first generation parents may be on their kids, they have almost certainly endured through far worse in their childhood. Second generation immigrant millennials would have parents who grew during or in the aftermath of the Cultural Revolution, Indo-Pakistani War - under dangerous third world conditions with a daily struggle for food.
Yes some of the crude comments they express may be excessively judgmental and even bigoted, but no more than their former compatriots back home. Had they never emigrated, our generation too would have grown up to adopt the same perspectives. It is precisely because they gave us the opportunity to grow up in the (relatively) liberal and free Western world that we can adopt a different (and hopefully better) value system.
I've yet to ever change anyone's mind via an online forum but it doesn't stop me from trying: let your parents know you recognize the sacrifices and suffering they endured to make it to the states, it would mean the world to them. It's far from easy to immigrate to the states today, and it was even harder a generation ago. They truly had to be exceptional in so many respects to make the extreme cutoff it took to beat out an entire country of peers competing for the opportunity to come to the states, and give their kids, you, a far better life.
It's ok to not be ok with abuse and neglect, despite the sacrifices those who hurt you made for you.
My parents left primarily due to not being able to provide for us during a period of unpredictable instability which was largely due to privatization of many industries and international corporate meddling (after having voted in a Socialist government that was upended by Capitalist powers). They left because they felt deeply betrayed and were ill equipped for the transition. I remember the struggle for food- that struggle was still present in America. Personally, I know they themselves struggle with having left their family (and children, for some years) behind- my father has regrets he voiced after his mother passed away, that despite all his accomplishments and hard work he is still not valued as he deserves but on top of that (most importantly to him) he is a continent away from most of the people he grew up with and loves. They do put the weight of that decision on us to accomplish and validate their sacrifices (or "make their sacrifice worth it").
One can be grateful and also still struggle with generational trauma. You can love your parents unconditionally and still have a hard time with them refusing to get help, refusing to listen, refusing to take you seriously because "children listen to their parents and listening is a one-way street". I can be as clear and patient as humanly possible, present all the research patiently, beg them to take me seriously, but what I say still won't hold the same weight as anything their friends say, despite my ability to explain misinformation or bias. I can only imagine how they will be in their later years. I hope they will mellow out over time but, as the last few years have shown me, I find this increasingly unlikely. I'll still take care of them and love them, fully knowing they are unable/unwilling to accept me as a person (LGBTQ+ wise), but no I don't think they are judgemental "no more than their former compatriots" because people exist everywhere (and I know for a fact in our country of origin) who don't hold the bitterness and hostile defensiveness they do. I think perhaps being immigrants made them even harder as people, and I'm old enough to remember what life was like before they had to live with the resentment of leaving everything they knew to give us opportunities.
Also I completely disagree with the sentiment of holding "a lifetime of gratitude" that can never be paid back over someone's life. Surely there are ways of reciprocating that amount of love and care, ways that don't involve conforming to your parents ideas of who they want you to be, especially when their ideas make no room for who you actually are.
Not to say all immigrant parents are the same, but I do think it's incredibly common to have immigrant parents who genuinely have no interest in knowing/appreciating you as a person, who live with so many layers of trauma that they refuse to even acknowledge their toxic traits, that they don't endeavor to heal from because they wear their suffering like a badge of honor. Their sense of self-worth is embedded in their fight to make it and prove themselves, and they create hurdles so you have to fight to make yourself worth their time and fight to prove yourself worthy of their sacrifice. I don't believe this is necessary and I wish they would care enough to get out of that mindspace. I do love and appreciate them enough to understand them compassionately and empathetically despite them not extending the same- my parents fully know this and they expect it and take it for granted because "it's the least I can do", it does not mean the world for them because their pain has nothing to do with me and everything to do with their continuous grief for everything they lost along the way. I just wish they would take the time to consider that despite their adamant stance of "I put a roof over your head, food in your mouth, clothes on your back, and that's all you should want"- we, their children, are also people with valid things to say and our struggles also matter.
I would add that our parents generation faced far more extreme versions of the same challenges/tensions we faced in our childhood. For example, I certainly relate to the "listening is a one-way street" mentality, but for our parents generation growing up in their conservative, ultra-traditional societies, they would have been expected to abide by a far more obedient social norms. Likewise, they may be intolerant of minority races/orientations, but grew up in societies that were far harsher on their own quirks, or distinguishing features that put themselves in the minority (which can be as innocuous as being left-handed). I think it would be hard not to envelop one's self in "layers of trauma" growing up in such adverse conditions and societal upheaval, and to take pride in overcoming such adversity such that it became part of one's identity.
On a good day I try to see things from other side's perspective, and my very crude guess, based on my own family experience, is that these are just some of the sentiments first generation immigrant parents may feel: -my kid has no idea how good he has it, my childhood was a constant struggle. My children's generation can never comprehend how much better their life is than my own growing up -the chief beneficiary of my lifetime of struggle, sacrifices, hard-work is not myself but my kids (and posterity), who express little to no gratitude for my incredible contributions towards their well-being and success. -in return for everything I have done, my kid is trying to impose this alien (Western) ideology over dearly held cultural values/beliefs I have practiced for a lifetime -in addition, my kid is trying to impose practices/perspectives (i.e. LGBTQ+ marriage) that are anathema to my corely held religious beliefs/moral worldview These are crude extrapolations based on limited information that can be easily misinterpreted (social cues, obviously a lot is not said out loud) with a sample size of 1 - basically meaningless data that I nonetheless feel compelled to share because my gut feeling is that the themes are applicable to our cohort. When looking at things from this perspective, and imagining if my own kid was exhibiting this same mindset/attitude interacting with me in my own old age, I become much more empathetic for my parents feelings/positions when it comes to these subjects.
Again, I can't hope to understand your family situation in any depth via typed text over an online forum, but I can't help but feel the sentiment that your parents are really expressing through "I put a roof over your head, food in your mouth, clothes on your back, and that's all you should want" is that they are sorely in need of some degree of gratitude for everything they've done for you. I know you have expressed that gratitude before - but I think its something we should return to time and time again. That you recognize the challenges and struggles they overcame so that you all would have a much better life.
You’re supposed to have a lifetime of gratitude towards somebody who willfully brought you into your self described hell?
…weird, yo.
However, the kids did not ask to be brought into this life - which OP seems to describe as a hellhole overall. Why should the kids be grateful for anything after being forced into this world?
Are you saying the kids wish their parents never brought them into the world? That seems more extreme than what I read in the comments.
Also my mum saw what happened to her patients as they got old: they became quite lonely because they couldn't get out as much to see people; they didn't have as many visitors because the same was true of their friends. Becoming bedridden was very isolating, and if your spouse died and you fell, you might not be found for a while.
So I helped them move into a retirement home. They have friends, meet new people (everybody's in a hurry to do that because people are "departing" all the time). It's basically a nice apartment building with a gym snd such and I doubt there's anyone there under the age of 75. It has various affordances for older people. Attached to the apartment is another building for people who need more assistance, and beyonf that a "memory care" center and one for people who are bedridden. They are quite happy with it.
OTOH my grandmother sold her house and moved herself into a "senior apartment complex" when she was about 80, but she kept on delivering meals on wheels into her mid 80s. When she really couldn't look after herself in her mid 90s she moved into senior care centre but she hated it -- she didn't really like old people. But she'd been a widow for almost 50 years, and those of her friends who weren't dead were all disabled one way or another, so she just offed herself.
I have another friend (mother of my friends) who is in her late 80s and stuck at home. Her kids pay for round the clock in home care and the one who lives nearby is over there a lot. Fortunately she is losing her marbles a bit so it all works out.
So everybody is different. Also, financially, everybody is different. They have an actuarial life expectancy of another decade. If one of them loses their marbles it could be $250K-$500K per annum to look after them well.
I don't think it's "old people" per se. These places gather around people in the sorriest possible states, most of whom are in (understandably) horrible psychical condition. Every time I visit, I feel bad for at least the remainder of the day. Living there must be terrible.
My dad was easily scared and cognitive decline was, for a while, outpacing the physical decline. Having him at home, with my mom nearby and in familiar surroundings, was a comfort to him and -- despite my mom constantly being scared of having medical strangers in the house -- I'd like to believe she preferred it as well. And it's hard to argue with the cost; my parents didn't have much money and think 18 months (three six-month cycles -- dad held on longer than anyone thought) of at-home hospice resulted in <$1,500 out of pocket. At the end, he died with three generations of people he loved literally standing over him and holding his hand.
My mother-in-law? She was always proud of her health and, to be fair, it was well earned. So after her second hip fracture, a planned rehab stay turned into permanent nursing-home residence as it became clear she needed 24-hour care. Could she have gotten that at home? Yeah -- but she once said, years ago, that death was very private and she decided to stay in a facility. It ran about $8k/mo for moderately-OK care and she passed in her sleep about a year later.
I don't know there's any wisdom to be found in any of this other than the obvious: Have clarity about what you want before you're too old and too incapacitated to make a nuanced choice. Write it down. Communicate it with your kids and loved ones.
Anything else is just creating needless pain.
>Anything else is just creating needless pain.
I've had experiences with those who planned and those who didn't and the former is better. My dad planned and so we could spend time doing things he wanted until the very end. My MIL didn't and for a few years it was a constant struggle to be patient. I'm glad I was there with both but man, I'll take planning any day.
I stayed with my parents during my divorce and my dad had Alzheimer’s. I and my sons were able to effectively model how to interact with my dad via respecting his routines and stress levels for everyone came way, way down.
It was an intentional decision (based on a couple years of conversations) to enable my kids and my parents to spend a lot of time together, and to make it “easy” for us to care for my parents at the end of their lives.
I’m well aware that there will be a lot of tough moments. I’ve got a background as a paramedic, and have spent more time in nursing homes than pretty much anyone who isn’t a resident of staff at a facility.
I think the most important step we’ve taken so far is to have a lot of open and honest conversations about how we want things to go.
How is this acceptable for a sane society?
Both sides have experienced taking care of their previous generation and saw the tensions it caused with their significant others. Now neither want to be a burden to our generation so they prefer to live independently.
Unlike their parents who were poor immigrants to NA with little to no retirement savings, they held decent jobs for most of their adult lives and have the financial means to live comfortably for the remainder of their lives.
So sometimes it isn’t the kids who prefer to send their parents to retirement homes. Some seniors take pride in taking care of themselves.
That said, the savings which had seemed perfectly sufficient when he'd retired from a big solid American company (pension, etc) were just obliterated by the black swan of American medical costs, and we had to sell the home which had been in our family for generations.
A good starting point when trying to understand other cultures is to drop pretences of universal sanity or even morality. American culture values independence. Many senior citizens in old folks’ homes pay for their own stays. They’re choosing to be there. I’d start there to understand why this happens, and how it isn’t a story of heartless holidaying kids dumping their parents on someone else.
I base this on watching my parents (especially my mother) spend their entire youth taking care of my paternal grandparents, who lived far too long (101 and 97). To boot, my grandfather had my dad in his 50s, and my grandmother was 15 years younger than him, so my mother basically spent ages 20 to 50 as a maid/nurse/cook.
They spoke no English (living in the US) and they did not drive, and they detracted from my parents’ ability to do what they wanted to do for their kids.
They are well regulated, and residents have a good mix of privacy, care and social interaction.
I prefer vastly to end up in one of those one day then living in with my daughter and her future family. On workdays I'd still be alone and helpless for a good part of the day, waiting like a puppy for them to come home and tend to my physical and social needs. How miserable is that?
It’s very difficult to have mobility (chose your own life, follow opportunity) and very tight-knit family at the same time.
She told me she plans to not put that burden on anyone else, and has prepared for that situation exactly.
People change as they go through suffering and some of the nicest people become quite difficult to deal with after years of physical problems, pain, etc. People also have lives and having someone around to deal with medical issues, or even wipe them in the bathroom, or make them a meal etc becomes challenging especially if the person's kids don't have other people around to help.
That doesn't make putting someone in a home better, but its not simple like you seem to think it is.
And
When you’re a burden to your own I wonder if they feel like “nothing is better than being with family”
With that said, even in the most tight knit families, some people don't see each other often because they're busy, live far away, can't afford the trip or don't have enough days off.
There are communities all over which are lovely for empty nesters but dead ends for young adults.
The alternative seems more insane to me.
It's a society so individualistic that deprives one of the main pleasures of human life: making a difference in the lives of those you love.
I'll happily care for my mother as she ages - she's been a wonderful parent all my life. But I have friend whose parents basically just kept them alive to adulthood, kicked them out, and are now expecting years of "payback". No thanks.
I'd rather have my incontinence diapers changed by a care worker than my children.
I know people who were so effected by their experience of caring for an elderly relative that they checked themselves into a senior living community in their 50's so their kids would never have to feel like they needed to do the same for them.
Doing it while working full time was the most stressful thing I have ever done. It was so difficult, dealing with doctors and nurses and care people calling every day. Keeping his doctors informed on what was going on. Keeping track of his prescriptions. Keeping his appointments up. And he had a lung disease, and it was during COVID, so it was super isolating, as I could not fuck around at all with exposing him. I could not leave him at home alone at all. It would take 30 minutes to load him into the car... I got maybe a couple of hours a week to leave the house. I also lost my partner of 10 years.
But would I do it all again? Most definitely. Despite how hard it was, it was a life-changing experience. I have never felt such love and support from my dad and all the people around me. I'm so glad that I got to spend so much time with him and be with him up to the end. He was so scared of going to a home, there was just no way I could let that happen, and I'm super glad that I didn't.
MIL passed just before the lockdowns. After lockdown, I did my WFH at my FIL place, until he was hospitalized for a bleeding ulcer(while on blood thinners not good). Then I lived there full time until he passed 10 months later. He never expected to outlive his wife and would not consider a senior facility. In the end he had kidney failure, bile duct cancer, and lest body dementia.
My advice take care of what you can now. Get someone added to the title of the house NOW while they are still mentally able so that you can avoid probate. If they have other property, sell it now. We had to open ancillary probate in Florida for real estate they owned for 30 years - making us miss the best market in years. Get their power of attorney and medical power of attorney in place and active NOW. They can’t sign after having a stroke or when unconscious.
And realize things can go downhill quickly. Every illness, or hospitalization takes more out of them, and a lot longer for them to recover.
On a serious note, I had the TALK with my parents. I reminded them of how, as a child, I was told having a pony was a foolish luxury and that needed to learn the value of money. I told them I remember that lesson and plan to utilize it when the time come for them to move into a facility. They may want to move in with their other children, because who really needs more than 2stars for a long term care facility.
For us, having him in our home was better because we had the responsibility and opportunity to do our best to make him comfortable. It was also easier for our adult kids and their spouses to come over and visit him. The food was also much better, and many memories will live on of sitting around the dinner table together.
We also got the invaluable lessons on patience and self-sacrifice that come with caring for an older person. They're not fully aware of the burdens they are placing on you. They really do regress in many ways to being like children. We would often joke that it was like living with a toddler who wanted to also cook dinner.
We felt that we could provide a more comfortable environment in our home than anything we could afford in a care center. My youngest daughter still lives at home, and she also got many important lessons about patience, self-sacrifice, and love. And respect for our parents and grandparents who have already sacrificed so much for us. Taking care of them at the end of their lives is a small but important way of being able to show gratitude to them.
It's not an easy decision for anyone, and the challenges and struggles you face will be unique and unpredictable, but I have zero regrets and much gratitude for how our family has grown together as a result of all of us participating in the end of life care for my father-in-law.
Some issues, like dementia, can quickly become impossible (requiring essentially constant availability in addition to the emotional grind that comes with the decline of a close family member).
Lots of people seriously undervalue what homemakers do.
This is a very serious issue with America's current manifestation of capitalism. You have people who are ESSENTIAL to society, EMTs and the like, not even being paid what they would make at walmart or mcdonalds
To say nothing of teachers. I've been saying for years that becoming a US public school teacher is a massive mistake. Now the very same ignorant people who ran their teachers off by accusing them of teaching their kids to be gay or something like that, completely unironically, seem to be becoming only more relevant to the lives of normal people as time goes on. That's the sort of shit you should be afraid to say in public, it really doesn't matter if they actually believe it or even really know what they're saying.
they genuinely believe the shit they see on the TV or are told by Alcoholic bob down at the local 7-eleven parking lot. and now that can't figure out why nobody wants to go to school for 4+ years, likely taking on a substantial amount of debt, to make less than a mcdonalds cashier while dealing with massive political pressure from truly shockingly ignorant people (depending on the state)
I look back on what I remember seeing grown fucking adults say to/accuse teachers of, why would anybody who is genuinely educated ever, ever voluntarily choose to deal with that sort of (in some cases, quite literal) violent ignorance
McDonalds and Walmart jobs are often valued less by people (such as yourself) who see them as some sort of hell-on-earth so the wage reflects the value to the organization and what has to be paid to keep competent people there. McDonalds has created more Latino millionaires than any other company on earth, and I enjoy their food once in a while. I don’t denigrate people who work there. Maybe you should try and see that workers at all jobs have value and don’t hate their lives despite people poo-pooing their careers.
Here is an EconTalk podcast about what working at Walmart is actually like. It may be illuminating to the HN crowd https://www.econtalk.org/platt-on-working-at-wal-mart/
McDonalds isn’t too bad if your need for shifts lined up with their demand peaks. The managers are the most exploited.
Just call the next salesman.
Having said that, I have no answers and try never to judge. Every situation is unique.
To remove the wearables, makes it much more likely to get the measurements. Makes the data more reliable because it’s less likely to be null. I’ve been using Eight Sleep’s sleep tracking gear for a while for this reason too.
So what is it?
Plug in "night light" smart devices that detect pattern of life and deviations from it, reporting to a connected smart phone.
I like it.
Long story short, we are moving to another country where she can easily afford 24 hour care by a nurse.
Home health (non-skilled) here in the states is about $25/hour, out of pocket that adds up quick.
I wouldn't want to continue living if I was a burden on society and my family.
Most importantly: even to the very last second, the patient's decision matters and is final. And procedure requires to iterate reminding patient's agency over and over again.
Having that moral debate out of the way, far more interesting is that euthanasia only ever has a place in a functioning healthcare system and social security system that puts the person's interests in the center. That is, by the time an elderly person do becomes eligible, it's never because they are a "burden" to their families or society.
In fact, it's extended to psychiatric patients as well. People with severe clinical mental illness can be eligible. Paradoxically, it's been observed that a sizable chunk of patients do have the paperwork, but actually don't go through with it. Just the mere thought that it's a non-controversial, accepted option which negates taking matters in your own hands is enough for them to keep going. Again, it's not a "get out of jail free" card. You do need to go through a lengthy procedure with many evaluations, and only after all other options are exhausted, before you become eligible.
I would want to be euthanized if in my old age I lost who I am. That is, severe dementia or Alzheimer's. The moment I can't remember who my kid is, that's when I'd want to be euthanized because at that point, it's a living death. (I saw my mother go through this with her mother).
However, at that point, I'll have lost the ability to consent to be euthanized. Heck, I might even fight someone trying to put me down.
The idea of making such a 'death wish' as a middle age person for your old age seems fine now. But the 80 year old you will be a different person than the 30-year-old, 40-year-old, 50-year-old, 60-year-old, and even 70-year-old you.
There is such a thing as nuance in the world and we can use that to decide when a death wish could be executed. In fact, we already have some limited forms of such death wishes in the form of DNRs. That hasn't caused the extinction of humanity from 14yo fantasies and most people don't see it as some terrible slippery slope.
If I had such a directive on myself I could revoke it at 50, 60, 70, or 80 while I still have my faculties. That moots the "I'm a different person" argument.
But, I should point out how horrible dementia is. It's a disease with no cure that causes you to be a different person, one with partial memories of the world that is constantly upset and confused because nothing makes sense or lines up. Imagine constantly wandering out into the street trying to head back to your childhood home or trying to find a long dead spouse or childhood friend and wondering why you never see them anymore. Imagine constantly reliving the death of a spouse if someone can't redirect the questioning. Imagine waking up old and not remembering how you aged. Imagine not recognizing yourself in the mirror. Now imagine your child crying at your bedside because you don't remember them. (all stuff that happened to my grandmother).
Yup, if I get dementia I'd be a different person, one that is in constant pain and confusion and causes constant pain to the ones I loved the most. I'll choose in that scenario for the rest of my life to be put down (even though I know it's not something I could necessarily choose).
For a variety of reasons I won't go into, 14- year old anon291 would think 30-year-old anon291 had lost his mind and was speaking gibberish...
From my own perspective 16 years ago I'd be incapable of making decisions.
Your point lacks nuance.
How would you address DNRs? Do you think they are wrong? Why or why not?
You said:
> I would want to be euthanized if in my old age I lost who I am.
I pointed out that, from my perspective 15 years ago, the man I am today has 'lost who I was'. Thus, if I were to apply this generally, 14-year-old me should probably want to kill myself.
Now, perhaps at age 60 I say 'I want to die if I lose myself'. But then, as dementia sets in (if that happens, most old people do not necessarily experience it). Who exactly determines that? How do you know I don't have agency as a potentially dementia-stricken 90 year old? What if at 91, in my dementia, I say I don't want to die. Who do you go with? 60-year-old me that you've determined has 'agency'? Or the person standing in front of you, who may have changed his mind.
Probably an uninterested 3rd party like a doctor with family consent.
> How do you know I don't have agency as a potentially dementia-stricken 90 year old?
I assume you've never even met someone with dementia. It's beyond obvious.
> What if at 91, in my dementia, I say I don't want to die.
Fine, revoke the order. However, had you ever met someone with dementia you'd know that's not something they'd come up with.
> Who do you go with?
You keep trying to make this a "the decision was made years past controlling today" argument, but what you go with is the most recent decision. Even erring on the side of "well, they may or may not be lucid when they rescinded their death wish so just to be safe we won't follow through".
> 60-year-old me that you've determined has 'agency'?
WTF are you talking about? I never said that "60 year old me has immutable decision making capability!" You keep trying to make that argument, but again, that's a strawman. What decision do you go with? Well, just like DNRs or organ donation, you go with the most recent decision made. Every day you have a "death wish" order you have the option to revoke it, so present day you ALWAYS has the option to revoke it. In otherwords, this isn't a decision controlled by 60 year old you, but instead controlled by the daily choice to keep or eliminate it. In otherwords, 90 yo you with all your faculties by doing nothing continues to approve of the order. If you don't approve of it, you can terminate it at any time.
And again, because it is exactly analogous but you continue to dodge answering the question: How do you feel about DNRs? What if the person after an accident changes their minds and they do want medical intervention. What happens?
It's a simple answer, medical intervention is given.
Strawman: That I'm arguing such directives can't be changed. My argument, that such directives are completely changeable at any point in time.
That is the nuance you ignore and avoid with your silly "14-year-old me decision". 14 year old you can decide to be a firefighter, 15 year old you can change that decision.
60 year old you can decide to die if they get dementia, 70 year old you can undo that decision.
It's not complicated and we handle this sort of thing all the time in medicine and life.
It translates to: “We are all free to make decisions for ourselves, but not “you”..and not “that”..”
At the end of the day, we can only live our lives. And can’t control others. We have to be consistent when it comes to the definition of ‘free’.
It is not dissimilar to the idea of children choosing gender transition. Do I have an opinion? Yes. Does it matter? No. Ditto with reproductive rights.
We have to define ‘freedom’ and stick to that definition. “My body, my choice” should fit to all bodies.
If living is pain, physically or mentally..let them go. It is an act of compassion. We do it for animals all the time. Suffering is suffering.
No it's not, and these sorts of reductive absolute statements completely turn me off against allowing any kind of euthanasia.
This is an incredibly difficult problem that causes us to question the existence and causes of free will.
If freedom to make decisions about one’s own body is conditional, then it’s not ‘Freedom’. There ought to be another word for it.
The real question is why are governments so keen to legalise euthanasia?
My view is its about population management. It eases the expenses, clears out the dead wood, etc. Governments really do think it is right that they should choose how long their citizens are around for, even if they say otherwise - its about control. I don't even think it's the only strategy they have to manage the population, nor even the most common one.
I will say there are tons and tons of programs for people in this position. I haven't taken advantage of any of them but most areas have some kind of "navigator" to help you find the ones best for you.
I have no idea what to do. They’re both healthy and active, but pushing 80.
I guess we need to have some difficult talks. It’s terrifying.
Then they'll be eligible for Medicare after a year, I think. Before then its very dicey. Medicare also has decent coverage, but is super annoying to navigate.
Your input here would be most appreciated and ping me if you wanna talk about it!
I like the efforts by California and Biden to expand leave, but just take issue with the framing of parts of the article.
(I wonder if the decision to exclude child rearing and other family contributions from GDP calculations was one of the most dehumanizing long-term forks in the world's history. But I'm far from well-informed on these complicated economics issues.)
Don't even get me started on the costs related to take care of someone in a nursing home 5-8k minimum, per month.
Assisted suicide is terribly difficult to do properly; to certify that the decision was made free of external influence, and that the person is of sound mind at the time the decision is made is in most cases impossible.
It's an incredibly cruel thing to do, and yet it keeps happening wherever it is allowed.
As for extreme pain, there is hospice. Calling assisted suicide medical care is so fraught with perverse incentives that it will certainly cause more harm than good.
I'm not religious, myself, but I think that's a better way to think of it than dollars and cents, or the societal burden.
As for "voluntary" euthanasia: don't even start. There is no such thing. Your old father doesn't want to be a burden, but he's helpless, and it's all too easy to "convince" him to take the pill.
I'm for the right to die. I've spoken of this periodically on HN.
I don't imagine I'm the only one. It can't be that hard to learn that there are people that feel this way -- that they just want their torment to end and death is the only apparent path out.
When the police are trying to determine if a spouse was actually being beaten by the other, they get them alone. That's not perfect, but at least it's better than just saying "Are you OK? Good then, carry on."
Until you give all the "voluntary" people:
1. the chance to say, without coercion, that that's what they want, with the aid of a counselor who acts as their advocate (since many of them are not articulate enough to speak for themselves).
2. an actual alternative that isn't artificially made to seem as horrible as possible.
you have not established that it's "voluntary."
In your case, Doreen, it sounds like you would pass #1, and #2 might be "a lot of drugs" with no other alternatives, so that does sound like it's really "voluntary."
That means that you're wrong to say anecdotes aren't data. An anecdote is a single data point, but a single data point is all you need to disprove an absolute (like the one you just gave). One person's anecdote that they would voluntarily choose euthanasia is sufficient data to prove you wrong.
Please kindly find a quote from me saying I'm glad I didn't die.
I don't think I have ever said that. Anywhere. In two fucking decades.
And I sure as hell haven't said it in this conversation.
You weren't asking "How do we sort out who genuinely wants out of their suffering and who is conveniently being offed by overburdened family?" That's not the question I was replying to.
As for "the world is failing to give them a better answer than death" -- what would that be? Other than drugs or curing the disease, of course.
My mother died in a hospice room at the assisted care facility. Her hospice nurse said "there's no reason why anyone has to suffer anymore." I was also around when her mother died, and that was much, much worse.
I've seen articles that suggest that many coma patients are aware and it's a living nightmare to be aware and trapped in a helpless body.
Anyone saying that no one has to suffer anymore is full of shit.
Yeah, a means to actually be healthy is the only real answer and if the world can't give you that and your condition is torture and you want out, you should have the right to end your suffering.
As for the third paragraph: I don't know, this lady deals with dying patients for a living. I'd tend to go with that.
It was claimed "Lots of people are driven by pain and discomfort, not guilted, into euthanasia." It's incumbent on the person making an assertion to support it.
> As for "voluntary" euthanasia: don't even start. There is no such thing. Your old father doesn't want to be a burden, but he's helpless, and it's all too easy to "convince" him to take the pill.
This claim can be refuted by providing even one case of voluntary euthanasia, which at this point you can see in the replies.