Dear FRONTLINE,

Hallelujah. I've been working as a communications strategist since 1992 with various public, private, and non-profit agencies and businesses to help create a glimmer of recognition in the American public of the urgent need to consider the issues you explored in Living Old. Good title. Something called "Issues of Aging" wouldn't have grabbed people in what my father called "the kishkes" -- Yiddish for "the gut."

The challenge grows month by month. When I began working in 1992 as Director of Marketing for the then-leading edge program, the New York State Partnership for Long-Term Care, it seemed that if one merely shelled out the admittedly hefty bucks for a good long-term care insurance policy, one could ensure the care one would need when the ADLs failed. Now, I know that's not necessarily true. The money may be there, but the care may not. Your program pointed out that there may not be enough geriatricians to treat aged Boomers. Even now there aren't enough caregivers.

Clearly educational emphases need to change; families need to enact for their children the importance of including and caring for older relatives, volunteering to help shut-ins; as Rabbi Zalman Schachter-Shalomi, in his "From Age-ing to Sage-ing," points out, older women and men past their perceved productive stage in life need to see themselves as vital resources of wisdom and familial strength for society; and it's likely that we will have to buy fewer toys and invest in programs and personal options that will transform the world we spin around ourselves through our choices on every level into a world where people come first.

Congratulations on a fine program and thank you for this opportunity for us to to sit in a cyber-circle and share our ideas.

Leiah Bowden
Schenectady, New York

Dear FRONTLINE,

This program pulls back the curtain on living to extreme old age in our society. Thank you for showing this. I was struck by the comment of Dr. WILLIAM COCH, Family Physician: "probably at least once a week, and sometimes every day, people say, you know, "If I ever get like that, take me out behind the barn because I don't want to live that way."

How has it happened in our society that when an extremely medically fragile,extremely elderly patient who is clearly in the process of dying wants a peaceful and speedy death the only thought is to 'be taken behind the barn'?

We must empower mentally competent terminally ill patients with the ability to ask their physician for medications the patient could self administer to bring about a speedy, peaceful death, in bed,at home, surrounded by loved ones, at the time of the patient's choosing. This is an option in the State of Oregon under that state's Death with Dignity Act. As Dr. Muller recognized, "Many doctors in their practice are confronted with situations where patients are really in desperate need. And they say, "Look. When this happens, ... Will you help me to do it when the time comes?"

... I would clearly want to be given that option. If I were terminally ill or I had a progressive illness, a degenerative progressive illness that was going to gradually take away all of my function, I would want to be able to opt out. I want that control. And I don't know whether I'd ever use it, but I definitely would want it. "The experience in Oregon shows that many patients who obtain the medications to hasten death do not consume them, but are comforted to have that option if their dying process becomes intolerable to them. Patients in every state should have this choice. Please do a program on the experience in Oregon, so that all your viewers can consider that experience and whether such a law in their own state would be a good policy.In the meantime, please add a link to the Compassion & Choices website to your resources page, as we are a national non profit organization which advocates for protecting and expanding the rights of the terminally ill. www.compassionandchoices.org. Thank you.

Kathryn L. Tucker, JDDirector of Legal AffairsCompassion & Choices

kathryn tucker
Portland, or

Dear FRONTLINE,

As a long term care professional for over 30 years, I want to thank you for the professional yet sensitive manner you handled a challenging topic for Americans. Most would agree that having the ability and resources to care for an aging loved one is the preferred path to graceful aging. However, as your experts pointed out, family circumstances, availablity of care givers, physical needs, housing settings, and other health factors do create challenges to making this pathway a viable option for all families.

Caring for individuals in a congregate setting can provide a high quality of life and secure good health outcomes for the individual. The challenge we face as a society is a declining number of caregivers, both formal and informal, and finding the means to fund growing care needs, in a time of pressure on government funding sources. Certianly the current long term care system is not meeting current needs, nor will it meet the needs of aging boomers. Hopefully, your program will stimulate a serious discussion of this pending tidal wave of elderly on society.

Steven Chies
Minneapolis, MN

Dear FRONTLINE,

I am employed as a manager at an Independent Living Facility, which houses those supposedly able to care for themselves, as we provide all meals, housekeeping, transportation, activities, and hopefully, a loving atmosphere. Some live alone, some with a spouse, and others have caretakers to help daily. I see the fragile lives daily.

This has been a real awakening for me, as now I fear my own destiny. I know I have some control, but possibly little control as I age. Families have such busy lives these days. As I see it, the health care costs will skyrocket over the years, and who will be there to pay to keep us all alive for a very long time?

This is all very frightening. Every time I am called upon to answer an inhouse emergency call, I look and say, I can and will possibly replace that person in the years to come, and this definitely brings my compassion into a very clear prospective. Also, let's never forget that the family members are aging also and have their own share of health issues. We will all get there one at a time, some better, some worse. What is the answer?

Wilma Stoeckle
Pittsburgh, PA

Dear FRONTLINE,

Excellent program. I've been the sole caregiver for my mother for the past 6 years. She's now 84. We receive some outside help, but for 24/7/365, it's all me.

I feel it's a tremendous honor to be providing this for her, and I'm grateful to be able to have her at home. While I know her wishes, at age 49 I'm now beginning to think about what I would want done for myself. I think that's the overriding message of this program. Elder care is an individual decision. The more information that is put in writing ahead of time, the greater the chances that your wishes will be honored. Every person is unique in this. At the very least, get a medical power of attorney and a living will put in place for yourself now.

The breaking point between quality of life and quantity of life has been reached. How long we live isn't the issue now as much as how well we can live. Elder care is a dire crisis looming on the horizon. Our generation can take charge, in a large way, by simply expressing our wishes now before the decisions are taken away from us.

Muffett van Beethoven
Montrose, Colorado

FRONTLINE's producers respond:

There are other personal stories of caring for a loved elder in the PERSONAL STORIES section of this discussion area. Just click on the link.

Dear FRONTLINE,

Whether or not one wishes to burden one's family is something that people can and do decide in advance, as they write their Living Wills and discuss their wishes with their Proxies. I disagree with Dr. Kass. I believe that one can hold consistent beliefs and values for over one's life time. For example, if I had end-stage dementia, knowing that for what it would cost to keep me alive for a year, 4000 African children under the age of 5 could be protected from dying from Malaria with insect nets -- I would prefer to hasten my dying. As one physician colleague put it, "I want to be remembered for how I lived, not how I died." I personally and professionally see no point in prolonged unnecessary pain and suffering if there is no hope for improvement. So also do about 70% of the population.Along with the strong recommendation that all who are diagnosed with a terminal illness should seriously consider hospice, there is a paucity of knowledge that all should know in one area: There is no need to wait for a catastrophic illness for death to occur with the demented. And the laws of states need not change for people to avoid prolonged pain and suffering. The legal and peaceful alternative is to refuse all food and fluid. Observing those who died this way, hospice nurses rated their dying 8 out of a maximum of 9 for being peaceful. Good mouth care will decrease thirst and metabolic products naturally decrease hunger. It is the CONVENTIONAL way to die, that existed for all time, except the last 50 year. Any competent person can refuse any treatment. And competent people can designate Proxies to refuse any treatment on their behalf in the future; that is, if they have created written documents that were diligently crafted to be strategic to discourage or overcome challenges from others. (See www.BestGoodbye.com, where the book, The Best Way to Say Goodbye (2007, but available now in preprint edition) is described.)

Stanley Terman, PhD, MD, Psychiatrist, andExecutive Director, Caring Advocates, a non-profit organizationwhose goal is to plan and to honor end-of-life decisions www.CaringAdvocates.orgCarlsbad (San Diego), California

Carlsbad (San Diego), California

Dear FRONTLINE,

I work as an ICU nurse in a major hospital. I watch family after family ignore the person's wishes on those who are acutely ill, with dementia or other decreased abilities to understand what is happening, agree to major surgeries. They insert trach's and feeding tubes with the written wishes held in their hands that expressly ask to not have these things happen.

When you are 98 years old you will not come back from major brain surgery and the resulting long stays in the ICU. So few families are able to to just let their loved ones go. When they are faced with brain blood flow studies that show only brain stem activity, knowing the person will never recover from, they will still keep them alive on vents. I can say this as a Christian because it must be said....we are the worst because we believe G-d will do a miracle and the loved one will magically get up and walk out.

In 30 years of nursing I have never seen a traumatic brain injury/surgery with dire prognosis "get up and take your bed and walk"! Please love your family member enough to just let them go in peace. They trusted you to follow their wishes.

Connie James
San Antonio, Texas

Dear FRONTLINE,

I thought the more interesting question the program raised was what care for the elderly will look like in 20 or 30 years. While the notion of a "natural death" has blurred, it seemed to me that many of the featured individuals still relied on some notion of one's time to go. At some point ones time to go may entirely become a relic of the past - and so the question becomes whether mere survival is enough to constitute a life.

Though I hope to live a long life, I also feel as though my heartbeat would mean little if it did not provide for the capacity to have a meaningful existence in the world.

Alex Medearis
Palo Alto, CA

Dear FRONTLINE,

Well Done! BUT... this same issue was at the forefront of my gerontological training in 1972, and NOTHING has been done about it. Now I'm 73 and faced with children and neighbors who may not respect my wishes for no resuscitation, no feeding tube, no breathing apparatus if/when something happens to me.I really look forward to the afterlife journey - I've worked hard - and find life here painful due to arthritis and diminished mobility. I do not want to live beyond some level of comfort. BUT, try to find a doctor or anyone younger really willing to discuss this issue, much less any official police respecting such desires... Frankly, it frightens me.

WHY are there still no medical schools willing to discuss this issue in depth, and ready and willing to make policy recommendations to Medicare, the Congress, etc.?

Jane Kelly
Monroe, WA

Dear FRONTLINE,

I think Leon Kass makes a good point in the film. He states that we are on the threshold of the 1st mass geriatric society. People may gain a decade of longevity of good health but this is often followed by up to a decade of bad health, chronic disease and loss of function. It raises a serious question for family and caregivers. How do we decide when a loved one has had enough? Treatments like feeding tubes and respirators can extend life, but should they be used when someone has a terminal illness and is in the end stages of a disease like cancer or Alzheimer's. What do you think?For premedical students and physicians-in-training, please continue the conversation at the American Medical Students Association Geriatrics Website: http://amsageriatrics.proboards55.com

Jeremy Berger
Sacramento, California

Dear FRONTLINE,

When one reaches life's door of no return, they should have the choice of opting out without it being a crime. In many cases it is the selfishness of the children and family that keep the elderly alive for prolonged periods as well as the medical community and the pharmaceutical industry profiting from elderly patients.

Where it is good to make discoveries in science and medicine for the benefit of mankind, it is not good to rob an individual of a death with dignity.

Dennis Heinz
Spokane, Washington

Dear FRONTLINE,

As a health care worker trained in all aspects of geriatric and D.D.D. (nursing homes, hospitals, retirement living and in-home care) I must say that to be able as a family to keep your loved one in their (or your) home is the best.

I have seen firsthand the de-humanizing affect of "Mass health care" in a facility setting, no matter how nice you make the room, how nice the dining hall is or how personable the staff is. It is still a "Nursing Home" and the stigma attatched to that classification will probably never pass from people's minds. I will say, also, that the implementation of patient rights is the best thing to come out of the health care industry, EVER.

Kristen LePoidevin
Kennewick, Wash.

Dear FRONTLINE,

I am 81, with DNA on both sides of the family that suggests I'll still be around past 90. (Father lived to be 94, mother lived to be 89, uncle lived to be 102.) I take no medication, am not overweight, take a 3-mile walk at least 3 times a week, don't smoke or drink, etc. My wife is 6 years younger and has a normal and active kind of retired life despite having a carotid artery clamped off 20 years ago because of an inoperable brain aneurisym.

However...Living Old was a reminder that no one is immortal. In our case, with only one 53-year-old unmarried daughter, our future is definitely a retirement home. We've been checking them out for the last 4 or 5 years, including a facility where my 87-year-old brother and his wife have been living for the past year. (Visited the couple on site for several days recently, and wasn't fazed by all the walkers at meals.)

Bottom line: I fell that Living Old was very sensitively produced and especially pertinent for 50ish children faced with aging and frail parents.

However...I believe that the costs of living old should have been a part of the presentation, though not a major part. This has to be on the mind of both the elderly and their children as they face declining future mental and physical health. And it must be faced as a major part of U.S. debate on future funding, both private and Federal.

My wife and I live in a large affluent planned community of 3000 plus with no more than 10% to 15% retiree residents. Most of the retirees in the community are 70 or younger, with no memory or understanding of the Depression years before WWII. Their spending habits reflect this and they have raised children who are piling up debt in credit cards and paying incredible interest on unpaid balances. So the coming crisis in caring for the elderly is being heightened by growing national and personal indebtedness. That's why I feel that some attention should have been paid in the program to this coming sociological train wreck, beyond the personal problem of how mature children have to cope with their declining parents.

Anyway, thanks for a sensitive and thought-provoking presentation. And, of course, thanks to PBS for presenting a documentary that commercial TV wouldn't touch with a ten-foot pole.

Clyde Hostetter
Mesa, Arizona

Dear FRONTLINE,

It is important to have the dilemma families face, but the central issue, that has only seems to be somewhat touched on is Medicare and what to do about it. Perhaps, as unorthodox is this sounds, after a certain point, age or conditionwise, in order to get Medicare to pay for treatment, a doctor (or doctors) would have to certify it would have medical benefit; e.g. there was a reasonable chance the patient would get better. At the same time do what one of the doctors (forget which) proposed and that was have Medicare pay for lesser treatments, or treatments for someone who wasn't going to get better comfortable.

Louis Lieb
Laramie , WY

Dear FRONTLINE,

As adult children of aging parents and raising our own children, we are often refered to as the sandwich generation. As the last of the babyboomers are now in their forties they are also working full time jobs and trying to run the household. Those who have raised children understand the highs and lows of the emotional roller coaster ride you experience raising your children. Their successes and their failures all have an impact on your emotions.

Caring for aging parents also takes you through many changes and it to is an emotional roller coaster ride. Raising our own children helps you to appreciate what your parents sacraficed and did for you while you were a child.

I feel I owe it to my Mom to ensure she has the best of care as she ages (my father has previously passed). In my heart I would want to step up to the plate and promise to be her caregiver until her death but I am scared that if she suffers from sever dementia I may not be able to cope. I have experienced grandparents who suffered from severe dementia and it was very difficult to care for them. I beleive that many adult children do want to care for their aging parents but in order to do so they may need social programs to help them get through these stages of their parents aging lives. Assistance financially would be necessary so that you could stay home and give the 24 hour care, something similar to maternity leave were the adult child is granted leave from work to care for their aging parents and collect a percentage of their normal wage through employment insurnace.

Also every caregiver needs a break. Someone needs to care about the caregiver or that caregiver will burn out both physically and emotionally. If these were available to adult children than I think many of us would do our best to care for our parents until death do us part.

Donna Mc Donald
Regina, Canada