ANNOUNCER: Tonight on FRONTLINE: Americans 85 and older are now the fastest growing segment of the population.
ESTELLE STRONGIN, 94 Years Old: I remember being repulsed by wrinkles and gray hair, and now they're just a part of life.
ANNOUNCER: Medical advances have enabled us to live longer, but not always better.
DAVID MULLER, M.D., Dean of Medical Education, Mt. Sinai: Another bypass surgery, another transplant. Nobody's bothered to think about what the repercussions are of trying to keep people alive longer and longer with such a limited ability to function.
LEON KASS, M.D., Chmn. President's Council on Bioethics `02-`05: It's an economic as well as a human demand on strapped, middle-aged and middle-class families. They're still caring for their children when they're also caring for Mom and Dad.
ANNOUNCER: But this is really a story about confronting the inevitable—
MARY ANN DiBERARDINO, Daughter: I keep trying to fix things, even though my head says I can't. Your heart— your heart wants to fix everything.
ANNOUNCER: —and coming face to face with our own hopes and fears about living old.
CLARA SINGER, 99 Years Old: I like life. I like it. But that's not up to me. It's not up to me.
ESTELLE STRONGIN, 94 Years Old: I'm Estelle Strongin. I was born on May 30th, 1911, which if my arithmetic still serves me, makes me 94-and-a-half.
[on the phone] All right, so who else has it? Who else has it?
I'm what was once called a stock broker.
[on the phone] Buy 500 each.
Today we have the rather elegant title of Financial Adviser.
[on the phone] Buy 500 HOLX for 82836.
And I still— even though I'm 94, I still have ambitions, and one of them is to do the job well.
[on the phone] I know we're chasing it, but they missed it, so we're going to chase it.
I was never one of the people to be horrified as the decades passed, except I have to admit that 90 was a little intimidating. I thought 90 meant The End, and I'm a little surprised that it hasn't.
LAURE ANGE GAECKLE, 99 Years Old: I'm 99 years old. I'll be 100 in two-and-a-half months.
INTERVIEWER: How does that feel, to almost be 100?
LAURE GAECKLE: It's just the same as 99!
ROSE CHANES, 96 Years Old: Never, never, never did I think I'd live so long. I couldn't even think about ever living so long.
CLARA SINGER, 99 Years Old: I'm a little frightened. I don't know— I never knew anybody who was 100. Is there a change? Is there change? Yes.
LEON KASS, M.D., President's Council on Bioethics `02-`05: We're on the threshold of the first ever mass geriatric society. And it is in many respects, really, a wonderful time to be old because people are not only living longer but they're living healthier into their 70s, 80s, in some cases even into their 90s. That's the good news. The bad news is the price that many people are going to be paying for this extra decade of healthy longevity is up to another decade of anything but healthy longevity. In fact, more and more people are living long enough to suffer from the as yet incurable diseases of body and mind.
DAVID MULLER, M.D., Dean of Medical Education, Mt. Sinai: I think the biggest issue facing the population of patients is loss of function. You begin to learn that not everyone has cancer, not everyone has Alzheimer's or Parkinson's, but almost everyone loses function. And by "function" I mean it could be something as simple as slowly worsening vision or really bad arthritis in one knee that makes it harder to get around.
AUDREY CHUN, M.D., Dir. Coffey Geriatrics Practice, Mt. Sinai: People want to live longer, but they want to live longer in the self that they have at that moment. And so if there was a way that we could keep you in your 40-year-old body until you were 100 and then you dropped dead, that would be a major medical advance. But unfortunately, as time goes on, these chronic diseases take a toll on the body.
Dr. LEON KASS: I don't think that any of the lessons of gradual loss of one's bodily powers really are preparation for some of these long-term conditions of enfeeblement and frailty. One should just simply tell the truth. It's— no one wishes that for oneself or for one's loved ones. The question is, it's here. And if it's not going to go away, how can we still make something out of it?
Coffey Geriatric Clinic, Mt. Sinai Hospital, New York City
Dr. AUDREY CHUN: Over the next 30 years, the number of people over the age of 65 will actually double, to the point that they're about 20 percent of our population, about 70 million people. Years ago, people died of pneumonia and flu and tuberculosis, infectious diseases, and we've become much better at treating these sorts of things. And now people are dying of their chronic diseases, things like high blood pressure or hypertension, heart failure, stroke, diabetes. These are all things that require management over time.
JEFFREY FARBER, M.D., Geriatrician, Mt. Sinai: Now we're dealing with older folks who have multiple chronic illnesses but are still kind of able to maintain their status quo, but any little something's going to tip them over. You know, it's that frailty where anything happens on top of it, you expose all of the underlying disease and disorder that was kind of masked by the other systems that were compensating for it.
Dr. AUDREY CHUN: Our system is set up to really treat acute diseases. Our system is set up to treat with procedures. And it's not set up to treat chronic diseases and to take time to figure out what's going on. Oftentimes, you can't get to the heart of the problem until 15 minutes into your conversation, and with the way health care is today, you may only have 15 minutes for your entire visit.
MOSHE MICHAELOWICZ, Patient: I have terrible with the urine.
Dr. JEFFREY FARBER: You have terrible what?
MOSHE MICHAELOWICZ: With the urine.
Dr. JEFFREY FARBER: Yes. What's happening with the urine?
MOSHE MICHAELOWICZ: I don't know. I make wet.
Dr. JEFFREY FARBER: OK.
MOSHE MICHAELOWICZ: I no can hold.
Dr. JEFFREY FARBER: You can't hold it in.
MOSHE MICHAELOWICZ: No.
Dr. JEFFREY FARBER: How long has this been going on for?
MOSHE MICHAELOWICZ: For a while.
Dr. JEFFREY FARBER: Like a few months, or just a couple of weeks?
MOSHE MICHAELOWICZ: A few months.
Dr. JEFFREY FARBER: OK. Does it happen every day?
MOSHE MICHAELOWICZ: Yeah.
Dr. JEFFREY FARBER: Yeah. Let me close the door.
MOSHE MICHAELOWICZ: And I want this— you see, I forgot. You see, I forgot.
Dr. JEFFREY FARBER: That's OK. That's all right. Take your time. It'll come up. It'll come up. Don't worry.
The number of geriatricians right now that are in a training program for geriatrics, in a two-year program, the number that are in their second year, that started this year, is about 50. You know, so it's nothing. You know, it's really nothing. So one out of five people are going to be older adults, and there's not really anyone trained to care for them.
NARRATOR: With fewer doctors now available to care for the rising number of elderly, many worry we're on the verge of a national crisis in care.
Dr. DAVID MULLER, Dean of Medical Education, Mount Sinai: Nobody's bothered to think about what the repercussions are of trying to keep people alive longer and longer — another bypass surgery, another transplant — without anyone worrying about how do you get them physical therapy? Will they ever walk again? Can they swallow their food? You know, it's not a very thoughtful way, I think, of providing health care.
Medicine has changed, I think appropriately, in terms of the technology that's become available and the fact that we can diagnose people and we can treat them and we can cure them, in some instances. The problem, I think, is that the pendulum has swung too far, and so the focus over time became predominantly diagnose, treat, cure. Even when there's nothing — quote, unquote — "medical" to do, you still need to be there for someone.
NARRATOR: As more and more people are becoming too frail to leave their homes, many doctors are once again making house calls. David Muller, one of the founders of Mount Sinai's Visiting Doctors, provides medical care to a growing number of the city's homebound elderly.
Dr. DAVID MULLER: I'm going to write him some notes so I can at least say good morning.
HENRY JANOWITZ, Patient: [reading note] "My name is Dr. Muller."
NARRATOR: For the past three years, Henry Janowitz has been wheelchair-bound. A former physician, he is now nearly deaf and has severe arthritis.
HENRY JANOWITZ: OK.
Dr. DAVID MULLER: Yeah? How about your knees? Pain? Here.
HENRY JANOWITZ: Here.
Dr. DAVID MULLER: Here?
HENRY JANOWITZ: No.
Dr. DAVID MULLER: No. Only here.
Each of us, whether we're in the Baby Boomer generation or not, has parents, and we watch our parents get a little bit older. And if even if they're relatively healthy and functional, you sort of see the slowdown and you anticipate. You try to plan ahead for being able to be around and care for them. And at the same time, you've got a family of your own and kids and a job and career aspirations. And so it's an unavoidable part of life.
And I haven't figured it out for myself, either. As far as my parents are concerned, I'd like to believe that, you know, I'll be there and be available for them, whatever they need and whenever they need it, but I don't know if that's really going to be the case.
INTERVIEWER: What are their expectations of you, do you know? Have you had those conversations?
Dr. DAVID MULLER: We've had the beginnings of those conversations, probably mostly because of the work that I do. I think their expectations are very typical and very traditional: none, zero. You know, they don't have any expectations that they'll move in with us. They don't have any expectations that we'll have to do anything extra for them. They don't want to be a burden. They'd like to stay independent.
NARRATOR: Dr. Janowitz is a widower, and his daughters live too far away to be involved in his daily care, so he pays $150,000 a year for the 24-hour help that he now needs to stay home.
[www.pbs.org: Read more about the cost of care]
LILLIAN GLEASON, R.N., Visiting Nurse Service of New York: The level of home care has gone up because we have so many medical procedures now and interventions that we didn't have before. Often, there are, you know, really complex things going on that have to be done in the home. So it's become much more complex. It's not just taking blood pressure and filling up the medicine box.
LILLIAN GLEASON: How's she doing today?
AIDE: All right.
LILLIAN GLEASON: That's good. Hi, Mrs. Enoch. How're you doing?
MARGARET ENOCH, Patient: I'm doing OK.
LILLIAN GLEASON: I'm Lillian, the nurse.
MARGARET ENOCH: Yes.
LILLIAN GLEASON: I came to check your blood pressure and do your dressing on your leg.
MARGARET ENOCH: All right.
AIDE: OK. I've just got to lift your leg a little, Mrs. Enoch, OK?
LILLIAN GLEASON: Our goal is to make whatever time the person has left be the best and most comfortable it can be because a lot of these things have been going on for years and years and years and they're never going to go away. Everybody has the fantasy of dying, you know, by just going to sleep and everything— you know, not feeling anything and everything's great. You just don't wake up. But it doesn't always happen that way. Sometimes people live a long time with serious, serious problems.
NARRATOR: Nearly two years ago, Antero Pallaroso was sent home from the hospital with a tracheostomy and a feeding tube. But even with the help of two home aides paid for by Medicaid, his daughter, Carmen, still quit her job to care for him.
LILLIAN GLEASON: You have very good technique, just like a hospital— better than a hospital.
The care that she gives him is really expert care. I mean, she hasn't had medical training, but she's learned everything about his care, to the Nth degree. So she knows how to take care of all of the equipment that he has. She knows how to feed him. She knows how to take care of his skin, how to take care of his trachea.
But think about it. I mean, it's a one-to-one caregiver-patient relationship 24 hours a day, 7 days a week. You can't get that in any institution. He just never would have been taken care of that way.
Some people feel that their kids are their ace in the hole. They'll take care of them. It's not always the case. But I don't have kids, for instance. I really seriously have to think about what's going to happen to me when I get older. And it's not— it's kind of a scary question. I think we all want to postpone it. I know I do. I don't really want to think about it right now, but I'm faced with it every day because I see it in my work.
Dr. LEON KASS: America is still a country which believes that the people who should care for the elderly are members of their own family. But that is now an increasingly difficult task for families. People are having fewer children. Families are smaller, less stable, geographically spread out, and the time of caregiving has gone from months before death to years, and in some cases, up to and decade or more, where people simply are living longer in conditions that are deeply needy. One study, a very, very telling study, shows that only those people who have three or more daughters or daughters-in-law have a better than 50 percent chance of not finishing their life in a nursing home or an institution.
1st NURSING HOME RESIDENT: What people like us need is love.
2nd NURSING HOME RESIDENT: I wrote to the maharajah, and I printed it up in the page so they will see it out. You don't have to worry. I don't have to— they don't even know it's me. I just didn't give them my name. I gave them another name.
1st NURSING HOME RESIDENT: What I'm trying to say is—
LAURE ANGE GAECKLE, 99 Years Old: Even though I'm a nurse, I never imagined I would be in a nursing home as a patient. Came in with a fractured hip, and been here seven years now. No sense in crying over spilled milk. Just take things as they come.
INTERVIEWER: Are you frightened of what's ahead?
LAURE ANGE GAECKLE: No, I'm not afraid. I don't want to live forever. I hate to— I don't know. I hate to leave my daughter, that's all. She's 72 now, but she's doing all right.
NARRATOR: Nearly 60 percent of those who live past 85 will go into a nursing home, and if they stay longer than six months, the vast majority will never leave.
[www.pbs.org: More aging issues and statistics]
JEFFREY FARBER, M.D., Geriatrician, Mt. Sinai: One person I visit on a regular basis in the nursing home calls it, you know, just the "waiting room," and she views it as, you know, this is where we all come to wait to die. And you know, in some perspective, she's right. I mean, that's what happens, you know? Other folks— I've seen people, you know, who thrive there. You know, I've had patients that were at home and then went to a nursing home, and they're much better off. The socialization — you know, they're participating in groups, having all these people around for meals — is tremendous. And they live off of it and thrive from it. So it's not always, you know, a downturn for some people.
CLARA SINGER, 99 Years Old: Why did I leave my home? Because I was lonely. When I reached 95, 96, it was a little hard. So I had a friend here. So he said, "Come over, Clara. Come over." It was all right. He was on the 7th floor. When I came, I said, "Look, you're not alone here." They're not friends. They don't know how to be friends. But they're people. They're people. And I have my— I get beautiful magazines. I get U.S. News & World Report that for 50 years we have in our home. So I have the magazines. I have the newspapers. And they're people. They are people.
The hardest time is, I miss— I miss my old friends. And I miss my home. And I say, "Look, you can't have everything." So I try to be happy.
WILLIAM COCH, M.D., Family Physician: I don't know if growing old is easier here. In some ways, I think it's more difficult. It gets a lot harder, in some ways, to keep your independence here. So you're much more dependent on family. Giving up independence is the worst. It is what everybody fears. It's what I fear.
You have the cane in your left hand. And you move your cane forward and your right foot forward, and then your left foot.
NARRATOR: Dr. Bill Coch opened his practice in upstate New York over 30 years ago. He's one of the few family physicians left in the area, and he sees thousands of elderly patients every year.
More aging issues and statistics: It's the doctor. So where's Mother?
HUSBAND: She's in her— in her chair.
Dr. WILLIAM COCH: OK.
We still have lots of three-generation households, four-generation households. It's rare that people will give up and want to put someone in a nursing home at the first sign of trouble. Most people will go through a long period of trying to take care of them in their own home, or in the family home or even extended families.
Yeah, it's Dr. Coch. How are you? I'm happy to come out and see you here.
Having a family really drives everything. I think it really gives people a reason to be better. It's really what their life is about, often, at the end of life, when their career is gone and— it's what's important to them.
ROSEMARY HAAK: I'm trying to think and think and think, so that you won't forget it again. Do you hear me? Can't you do it? Can't you do it?
CHESTER HAAK: Do what?
ROSEMARY HAAK: What you were going to say. You were going to say, "Merry Christmas, Merry Christmas to you"—
NARRATOR: Chester and Rosemary Haak, married for 68 years, now share a room in a nursing home. Both in their 90s, he has advanced Parkinson's and she's been diagnosed wi