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Join the Discussion: What are your reactions to this program on Americans living an increasingly longer life, but needing more intensive, expensive and prolonged  caregiving?  What needs to change in order to address this looming crisis? How can we make change happen?

Dear FRONTLINE,

Thank you for this excellent and thought-provoking program. And thank you for making it available for watching on the web as I missed the first showing.

As an Elder Law attorney and Life Care Planner, my staff and I are constantly assisting clients facing many of the challenges that you presented, and more, such as financing long-term care. Our law firm takes an interdisciplinary approach as we employ an outstanding RN with decades of geriatric care to assist the family caregivers in their vital role of walking through the latter years with their parents, our clients. As our Geriatric Care Manager, she provides education, skills, motivation and encouragement along the path of life until death for those who engage us for Life Care Planning.

Our mission as a Life Care Planning Law Firms is to provide legal and care advocacy services to our clients as their circumstances and health care needs change. We are committed to helping clients and their families navigate the long-term and health care system and advocate for good care to sustain their quality of life during their loved one's journey through the elder care continuum. This approach to the legal needs of the growing geriatric population will become more prevalent among attorneys who care for this special segment of our society, like geriatricians do on the medical side.

Something I tell all family members would be good to include in your next Living Old program. No matter how much one wants to care for their loved ones, unless they have the appropriate and well-crafted legal documents coupled with knowledge about how to use them, they are not likely to be able to care for their loved ones to the fullest extent they would like. Existing privacy laws and HIPAA complicate the caregiving that family members would like to provide, unless they are properly empowered with legal documents. Your mention of Living Wills and Do-Not-Resuscitate Orders were good. Medical Powers of Attorney (Health Care Proxies) can be even better for the elders by allowing their most trusted caregivers to make the best choices for them. This can help them - and their physicians - overcome the hurdles of decision-making.

Thank you again for this enlightening program and we look forward to more on this important issue of our times. I'll purchase the DVD to share with my staff and will encourage our clients to watch the program.

Mark R. Ensign, JD, CPA
Amarillo, Texas

Dear FRONTLINE,

Thanks for your insightful, sensitive program and the web page you've set up to supplement it. Having just lost my 85 year old mother, whose Parkinson's disease had progressed rapidly and miserably over the last year, I found myself nodding along with the doctors and caregivers and family members you interviewed.

As stressful as the last year has been, my family was fortunate to be able to have 24/7 care at home for my mother, and I'm relieved not to have had to resort to one of the supposedly "nicer" nursing homes my brother and I visited where residents sat around slack-jawed in wheelchairs with no one attending to them. Whoever on your program described them as waiting rooms for death got it right. I've read recently about small group homes where elders live with caregivers, which provide non-institutional care and a real community. That sounds like an option worth encouraging.

What I also learned over the last year, and especially over the last weeks of my mother's life, was that dying doesn't necessarily happen suddenly, but, for my mother, happened over several weeks. Realizing that meant grieving started well before my mother's actual death, which while sad, was not as upsetting as I had anticipated. It also gave my family the opportunity not to leave things unsaid before she died, which has been a great comfort.

Again, thanks for showing the public what those of us who've watched loved ones decline have lived with. I hope the discussion that ensues encourages families to discuss the issues and some social reform to help us all get through the end of life in comfort and dignity.

Joan Markman
Philadelphia, Pennsylvania

Dear FRONTLINE,

Thank you for such a thoughtful, timely program. The looming healthcare crisis for the elderly in the United States is fast becoming a crucial test that will show us what kind of society we are---or are not.

There are no easy answers, of course, and we shouldn't look for them. For every vibrant 85-year-old who still walks and swims every day (blessed with good genes and a bit of luck) there are countless others disfigured by afflictions and disease, whose bodies and minds betray them at every turn. Nursing homes are far from ideal (all four of my grandparents ended up there), but for most families who can't assume the myriad responsibilities of caring for an aging parent, they are an option and offer a "soft landing" for the infirm where no other landing might exist.

We will always have to deal with the hard questions that surround aging, but in some sense I don't think we can begin to come to terms with its demands until we confront our culture's giddy romance with convenience and the warp-speed pace of modern life: fast foods, microwaves, cell phones, online shopping. Sated with decades of blinding medical breakthroughs, and having grown accustomed to ubiquitous diet pills and other "silver bullets," we expect science and medicine to engineer it all for us: Find the cure, make us younger, Botox the wrinkles out of our lives. And take care of our aging citizens. In a youth-obsessed society, small wonder the needs of the elderly are so poorly addressed.

Your fine program should be a sobering wake-up call to all of us: to pay attention, to our own health and that of our loved ones. We know that loss is inevitable, but last night's program was powerful proof how we often "forget" about loss, and that a more meaningful confrontation with it can enrich our lives.

Mary Cleary
Fairfax, VA

Dear FRONTLINE,

Your program caught me in the middle of this crisis. Until you have a person in your life who needs elder care, you cannot really understand the problem.

Also, the children and care givers are basically flying by the seat of their pants trying to make the right health decision and then wondering if you are making the right decision at all.

Our parents never discussed this situation and so we are wondering "what would mother want" when she is not able to make the decisions herself.

This has been a wake up call for my family as to have the proper legal documents state our wishes in order not to torment our children with life and death decisions.

The guilt a care giver feels is indescribable, it affects our health, our work, our family, our everything.

Johnson CIty, Texas

Dear FRONTLINE,

As a veteran hospice RN, I applaud your presentation "Living Old." As a culture we appear loathe to acknowledge the probability of declining independence and decreased function with advancing age. Thank you for bringing this issue into the living room, and out in the open.

One option for care which your program did not mention is placement in an Adult Foster Home, versus a long-term care facility (nursing home). When I can no longer independently care for myself, this is the option I will choose.

Adult Foster Homes offer a continuum of care for a small number of residents in a home-like setting. Frequently they are operated by immigrant families whose cultural foundations promote a deep respect for elders. Many accept Medicaid as payment.

Thank you for yet another thought-provoking program.

Karen Bell
Portland, OR

Dear FRONTLINE,

I found the show scary and not illuminating. Maybe I was so scared I didn't get illuminated? I don't know. I learned that my greatest fear about aging is true--but I already knew that.

I'd like to see a follow-up. I'd like to see a show that focuses on the forty percent who are not very infirm. On the forty percent who are still mobile and are still able to have a life. I'd like to know about how it is that they are the way they are. I'd like to know how they think they got to be so old and still so up and about. I'd like to know how they think they are different from other people their age or not.

I hope you will consider a show like I am suggesting because I need to know and I don't think I am alone in needing to know. I know I can get felled by disease and by old age and by both, but how can I live and still be an alive person when I am very old? I need to know.

amy kaplan
elk grove, CA

Dear FRONTLINE,

Your Living Old program came in a timely manner. My wife is currently furnishing home care for my 80 year old mother. Hospice met with them today. My wife called me last night and asked me to watch.

My mother spent 2 months in a nursing home after being diagnosed with terminal cancer. In the coarse of visiting her there, I ran into my 8th grade P.E. teacher and his wife. Both were admitted there. He is the teacher who had the most positive impact in my life.

My mother shared a room with one of my high school teachers, two of her daughters visited from out of state. I hadn't seen them in 35 years. My nephew's babysitter was admitted there, in her 90's and incoherent. Another schoolmate's mother was admitted next door to my mother. The daughter visited from Arizona, I hadn't seen her for 35 years.

Three months ago I was unaware of all this, now it is coming at lightning speed.

Vernon Steinkamp
Stockton, CA

Dear FRONTLINE,

Your program was informative and frightening. Your program confirmed my belief that we owe it to our families to make health and financial choices that will help us age responsibly. I look at the lives I have encouraged my children to build and my worst fear is that they will be compelled to cut short a career, take time from their children, or put their own physical well being at risk to care for me in the future. Family helping each other is wonderful and should be encouraged, but when the cost becomes overwhelming or destructive there must be other options.

We baby boomers must take action now to make choices that will maintain our health as much as possible and fight to put services and care options in place that we may need in the future.

Midge Rohman
Cincinnati, Ohio

Dear FRONTLINE,

Thank you for the wonderful program. Elderly care is such an intricate problem. Four elements that come to my mind from my experience are:

1. The living will: My father lived as a vegetable for 4 years after strokes and his living will said no resuscitation. A few months after the strokes he was given anti-biotics when he developed pnemonia to make him more comfortable. He did not want to live as a vegetable and he may have died if not given the anti-biotics. The living wills must address the simplest of decisions.

2. Drugs: My father was so doped up after the first stroke, I never knew what he would have been like without the drugs. It may be worth investigating what state a patient is really in naturally. The doctors use drugs to "control" the patient. Are the doctors always accurate? Are there other elements the caretakers should consider?

3. Defecation: Someone has to clean the patient. The nursing staffs select the new person on the block, probably the lowest paid, to do the dirty work. How does the patient respond? Who knows if the patient becomes agitated when being cleaned and how does the cleaning person react to the agitation. My experience tells me something not good happens. Is there abuse in nursing homes. The nurses or aides surely have the toughest job ever. What if they are in a bad mood or do not have the patience or knowledge to handle the abusive patient?

4. Community living: Nursing homes can be wonderful! People should learn to train themselves to accept the inevitability of life with care. Society can make it so. People can make their last days comfortable if they plan in advance. Otherwise, as I saw my father, who couldn't speak, mouth (just his mouth moving) two words of frustration, futility, despair, acceptance, and survival, all in one, "Oh Well!"

Andre Sheldon
Newton, MA

Dear FRONTLINE,

Your latest Frontline Program on aging was deeply meaningful to me since I lost my wife of 57 1/2 years of marriage on June 3rd this year. She died of Alzheimer's. There was one important issue you left out and that was dying for a Christian. Both my wife and I had and have living wills. In these wills we state that we want no heoric methods to keep us a live. We have stated that if two doctors agree that we have a life ending situation we want no attempt to prolong our lives. That means no tubes of any kind inserted into our bodies. Just medication to ease any pain incured in the process of dying. We both feel that prolonging life is selfish on the part of the living trying to keep the loved one from going home to the Lord where all ills and pain is gone. My wife had a wonderful going home which ended the fear and confusion brought on by Alzheimer's. Her entire family was with her at the end. Each said their individual goodbys and we prayed and sang for as she went home in peace. We all know in time we will see her again in perfect health and spirit. There are many people who feel the same as my wife and I feel and wished you had shown this part of the story.

Robert Williamson
Encinitas, CA

FRONTLINE's producers respond:

Unfortunately, there were many important, related issues to this report, such as having faith and a peace at the end of life, that time contraints meant the producers couldn't explore. However, this web site offers a special article, "Faith, Spirituality and Aging," that you might care to read.

Dear FRONTLINE,

Many thanks for your excellent work. "Living Old" is without doubt the best film ever produced on aging in the USA. I have spent several decades in various medical care installations,including a few nursing facilities. Here are a few observations:

1.Federal involvement: anyone who expects the "experts" inside the Beltway to improve "elder-care"(EC)will be disappointed. Whether you look at the VA system, Medicare,Medicaid,or any other healthcare system run the Feds,you will find ineffic- iency and incompetence.As an example,Navy medicine once was first-rate;I saw that thru the experiences of my aunt who served as a navy nurse for 31 years. As a civilian MD at a Navy base in the 1990s, I saw blatent incompetence daily.

2. Geriatrics: very few medical students choose this specialty for several practical reasons: the nature of the work is very depressing& the income is low.Doctors Farber and Coch in "Living Old" are exceptional human beings who have the personal commitment to their practice which one might find in a priest or rabbi.This is increasingly rare.

3. Misinformation:there are thousands of distorted or inaccurate stories floating around re EC. One such is the indictment of an MD in New Orleans for euthanizing her patients after Hurricane Katrina. Watch how that case develops.I expect that indictment to be dropped for lack of evidence. One of the reasons that a very acute shortage of MDs, in general,is developing is that many of us are fed up with harrassment from the media,trial lawyers,the government&the academics: all of whom seem convinced of their wisdom about healthcare but,in fact, are woefully ignorant.When Doctors Farber and Coch retire or expire, will the trial lawyers or bureau- crats or reporters take over the care of these old folks?

4. Euthanasia: in April,1975, the USA evacuated Saigon in a frantic,disgusting display of disorganization and myopia. Where were the expert planners from Washington, DC? Compar- isons to the 1975 evacuation of Saigon will be drawn to events in US healthcare in about 15 years. Suddenly, euthanasia will become acceptable to discuss, then a fit subject for legislation,then promoted.Read WELCOME TO THE MONKEY HOUSE, by Kurt Vonnegut.

Again,"Living Old" should be required viewing for every student in American high schools & colleges. Most of them won't accept the possibility of aging, but they must be informed about howtheir lives will probably end. Currently,few Americans seem to know what actually happens.

Robert Harrington,MD
Green Bay, WI

Dear FRONTLINE,

It's horrifying to hear that 60 percent of the old will end up in one of those nursing homes with the blaring, ubiquitous televisions and dorky sing-alongs. We can do better by making gardens and pets standard issue in nursing homes. And, pilot programs using psychedelic drugs in hospices can be expanded to include any elderly patients.

But, we really ought to be having a national conversation-as we did around Terri Schiavo-on how to provide the elderly (all of us at some point)with a way out when we're imprisoned in nonfunctioning bodies/minds. Others have broached the subject on the tv program and this forum. We have living will forms. Why can't we have a "decrepitude" clause included? This "decrepitude" clause should be signed by the elder and his/her next of kin, as well. When they all feel the elder's quality of life doesn't make life worth living, the elder should be allowed assisted suicide without criminal repercussion. Since the extremely old are the fastest-growing segment of the population, those who will pay nursing home bills-taxpayers-should want to give the elderly a way of deliverance.

sandra malone
los angeles, california

Dear FRONTLINE,

Your TV presentation last night was informative, moving, and thought-provoking. I do hope you make the web site resource material available for a long time to come. There's a lot to read and digest. Thank God for public television. Your doing a terrific job. FRONTLINE has always had superior programming. It never lets the viewers down.

New, NY

FRONTLINE's producers respond:

This web site's content - plus the full program in high quality video - will remain available for viewing and reading for years right here on FRONTLINE's site, as part of the public service mission of public broadcasting/media.

Dear FRONTLINE,

I have been a caregiver since 1985.First my aunt, followed with my mother , then and now my hubby.The one institution that failed me was a care facility .After being there for three months she died from neglect.My aunt who remained hom e until she died lived til she was ninety six.My hubby is seventy six and does so well because of the wonderful help from hospice , the aides and my self.

Care facilities have not changed much since the days of yesteryear.They have made them look a little better, but the attitude, for most, are about the same.They treat them like you would herds of cattle.If you do find a good one, it is so expensive but still does not say they get quality of care.More time and energy is spent on window dressing then on the afflicted or elderly.

The same can be said for the professionals such as nurses and doctors.The only time you will get the true facts is through the loved ones who have had experiences with doctors nurses, care facilities and hospitals.There is an attiude the prevails that our elders are like old toys .They have no use to us so we disgard them.

We need people who will do what needs to be done to see that the elders are showed love and compassion.To have their dignity as they always had.The masses need to be reminded these are the people who fought the hard battles to bring us to where we are today.Sadll nothing gets done because those who work in these facilities know they cannot come forward to tell the truth as they will be fired and black balled.The dirty little secrets they go on behind these walls .They need to have surprise visits to all facilities who care for people.Not ones that are known about ahead of time.

I have dealt with all aspects of caring for the elderly.Outside of the hospice and the aides I would rate them the lowest .What care one receives depends on how deep one's pockets are.That can also be challenged.We need someone to stand up to all those who lobby for the care facilities, the doctors.Their has to be away to hold all those who fail accountable.

edna evans
west chester, pa

Dear FRONTLINE,

LIVING OLD was a extremely moving, hard-to-watch documentary.I hope you will undertake more groundbreakers on this under-reported almost invisible topic and social conundrum.

As a increasingly arthritic but alert,"only" 74-year-old lucky enough to be a resident in a "very well physically-managed" Senior Citizens Complex known as India Brook Village, in Randolph, NJ, a mostly upscale suburban community, created and run by the Morris County Housing Authority, my reaction to your eyeopener was "WOW, this report appears to focus on New York seniors who for the most part are very well fixed financially."

There is an even more difficult story that lies underneath as your report may be just "the tip of the geriatric iceberg": What happens to Seniors who slip down from a Middle Class lifestyle when their retirement 401Ks, etc, run out or prove not to be sufficient to cover out-of-control medical expenses despite Medicare, etc,in their final years? As Hedrick Smith reported recently in a retelevised Frontline on The Truth about 401Ks, "Those final years can be rough indeed!!! How is extreme aging,handled for instance,in the Scandinavian countries, or elsewhere?

Werner Simon
Randolph, New Jersey 07869

FRONTLINE's producers respond:

FRONTLINE's report is indeed part of a wider picture that can, and should, be drawn about how aging is handled in other countries and, in particular, how the elderly fare who have no money. In developed European countries that have strong social safety networks, there's a support system generally in place for families and caregivers and the aging. In contrast, there are real gaps in America's system of financing long-term care and changes are needed. The "Where To Go" section of this site offers suggestions for how individuals can call attention to this problem.

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posted nov. 21, 2006

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