Squeeze on Nursing Homes

Daily Observer

May 31, 1974

Simon Quentin Lapius was preparing for bed, not an ordinary ritual. First he located the sherry to be sure there would be enough for him at bedside, to sip until its soporific effects induced slumber. Next, the porcelain potty he recently bought and stowed under the bed, “to avoid the long cold dark walk to the bathroom at 3 a.m., Harry,” he informed me. Finally, and this was new, a pair of hot water bottles, filled to the brim with what looked like pure steam as it came from the faucet.

“What’s the trouble, Simon? Backache? Ear ache?”

“Not in the least, Harry. Just a simple bed warmer. You have heard, no doubt, that we must turn our thermostats down to freezing temperatures at hour of sleep. A suggestion of the president. I must admit being somewhat taken aback by the fuel shortage. You know Harry,” he lowered his voice so as not to be overheard in the empty apartment, “the average family governs its life and plans its future with more care and wisdom than our government does. And the very same government wants to tell us how to run medical affairs. It should be the other way around. After all, the medical profession has a long history of success.”

I didn’t want to get started on that monologue because it was so late, so I changed the subject. “And the hot water bottles will keep you warm through the night?”

“Harry, they are an absolute delight. Beneath a heavy quilt they will retain warmth till morning. They are warm and soft. I think they could replace bundling.”

“Why two?”

“One is for my feet,” he said, as if that answered the question. “Besides, my joints have been aching lately, and I am preparing techniques to take me into my dotage. I would much rather be self-sufficient at home than ensconced in one of those convalescent centers.”

“You are not that old.”

“No, but I am getting there.”

“What have you against convalescent centers?”

“Nothing really, except for the food, the care, and the expense.”

“Come on, Simon, you know they are not that bad. We have many patients at convalescent centers.”

“True, but things may get worse. The government is now asking doctors to justify visits to Medicaid patients if more than one visit a month is made, and the insurers and Medicare administrators are following suit. This has the effect of cutting back on a service that should actually be increasing. After all, there is no end to the care that one can give to the elderly. As a matter of fact, with increasing age there is increasing dependency, and increasing need for medical, nursing, dietary and physiotherapy services. When finally bedridden, patients must be watched carefully as not to develop bedsores. Yet the government won’t pay for soft mattresses. Have you noticed that the diets are more scanty? That in part is because there is no cost of living adjustment for the nursing homes when food prices suddenly rise. I certainly don’t want to be subjected to those indignities. I don’t want the government, or any other agency, deciding how much care I need. That is what my doctor should decide. No sirree, I want to die in my own bed.”

“If you keep gulping that shooting sherry, the chances are good that you will. Anyway, the government doesn’t say that a patient can’t have all the medical care s/he wants, it just says that it won’t pay for all of it.”

“But of course that’s unfair. After all, when Medicare was instituted, the stage was set for people to live longer, and the implication was that the tab for the catastrophe of prolonged illness in the elderly would be picked up by the government. Now they are finding out just how expensive good care really is, and are pulling back.”

“Well, it is expensive, Simon. As you said, there’s no limit to how much one can do to make another person comfortable.”

“Society will set a limit. As a matter of fact, with the moral fences that guarded the sanctity of life, utterly destroyed in the abortion debate, euthanasia will be next on the agenda.”

“Do you think it will really come to that?”

“It did in Nazi Germany.”

“Whoa, Simon. Come off it. That’s not fair. We can’t compare our society to Nazi Germany.” I was getting annoyed. I suspect Lapius was a little tipsy.

“We will become more like them the more we compromise our ethical barriers concerning the sanctity of life. As ethical barriers fall, what once seemed extreme, becomes commonplace. It certainly seems paradoxical that the same factions that urge the abolition of capital punishment because they want to protect society from taking a life, urge abortion and the consideration of euthanasia.”

Lapius wasn’t tipsy at all. Although he looked ridiculous in his nightgown, nightcap and clutching the hot water bottles. But he was deadly serious.

“To what do you ascribe this paradox, Simon?” I asked.

“To the God-is-dead syndrome.”

“But you were never a religious man.”

“True, but I always felt comfortable in the thought that most of us were obeying the law of a higher authority. Without a higher authority everyman must be his own judge, and I am not sure we all have that much wisdom.”

“Certainly you don’t want to stay stuck in a rut. After all, if nothing changes, there will be no progress. You are not against progress, are you?”

“No. But I would surely like to know what progress is. Everybody defends their concept of progress. Good night. I’m going to bed.”

“That’s progress,” I said under my breath.