Annotated Bibliography Assignment

[MUSIC PLAYING] GOOD EVENING, EVERYBODY.

EVERYBODY'S CARDS CLEARED.

LET'S PLAY BINGO, HERE WE GO, FOR $0.50 A GAME.

G48.

G-4-8.

G49.

VERY RARE THAT HAPPENS, ONE NUMBER AFTER THE OTHER.

O65.

O-6-5.

B2.

B2.

WE HAVE A WINNER, BINGO!

BINGO, WE HAVE A WINNER.

CONGRATULATIONS.

THANK YOU.

THIS IS NOT AN ASSISTED LIVING FACILITY.

THIS IS A NURSING HOME.

AND THERE REALLY IS A DIFFERENCE IN TERMS OF THE HELP THAT PEOPLE NEED HERE.

A VERY HIGH PROPORTION OF OUR PATIENTS NEED ASSISTANCE WITH VERY BASIC ACTIVITIES OF DAILY LIVING-- HELP GETTING ON THE TOILET, HELP BATHING THEMSELVES, SOMETIMES HELP FEEDING THEMSELVES.

AND SO THE INSTITUTION IS HERE TO HELP PEOPLE WITH THOSE NEEDS.

BUT WHAT MAKES IT DIFFERENT THAN OTHER NURSING HOMES IS WHAT IT IS ABLE TO OFFER ON TOP

OF THAT.

IT'S ABLE TO OFFER A LIVING ENVIRONMENT, SO THAT YOU'RE NOT HERE TO DIE, YOU'RE HERE TO HAVE AS GOOD A QUALITY OF LIFE DURING THE REMAINING TIME THAT YOU HAVE AS POSSIBLE.

AND SO TO FOSTER THAT, WE HAVE ACTIVITIES.

THERE'S SO MANY PROGRAMS THAT ARE OFFERED HERE.

I JUST WAS OVERWHELMED WITH WHAT IS OFFERED.

I CALL BINGO.

THAT'S ON THE LIGHTER SIDE, OF COURSE, BUT IT'S FUN, AND THAT KEEPS ME BUSY.

I'M ALSO VERY MUCH INVOLVED AND VERY MUCH LIKE ATTENDING THE PSALMS, SONGS, AND STORY WRITING.

IN THIS GROUP, WE READ A PSALM OUT OF THE BIBLE, AND WE INTERPRET WHAT OUR FEELINGS ARE.

AND FROM THAT POINT, WE WRITE A SONG.

I'M DOING PAINTING HERE, WHICH IS OFFERED TO ME, WHICH I AM LEARNING.

I'VE NEVER HELD A BRUSH IN MY HAND BEFORE.

AND THEY SAID YOU DON'T HAVE TO KNOW.

AND THEY SAY THAT I'M DOING NICELY.

AND I DO ENJOY IT VERY, VERY MUCH.

I'VE ALWAYS DONE A LITTLE ARTWORK, DRAWING LOGOS AND THINGS.

WHEN I CAME HERE, THE ART FACILITY HERE, THE ROOM HERE, IS ABSOLUTELY FANTASTIC.

IT'S JUST WONDERFUL THERAPY.

AND SO I DECIDED I HAD NOTHING ELSE TO DO THE REST OF MY LIFE, BE A GREAT THING FOR ME TO START TO DO SOME PAINTING, WHICH I HAD NEVER DONE BEFORE.

THIS IS ABSOLUTELY MARVELOUS HERE, BECAUSE THE DEPARTMENT IS SO GREAT.

YOU COULD COME AND GO AS YOU PLEASE.

THIS IS MY LIFE NOW, AND I'M HAVING A LOT OF FUN.

THERE IS A MISCONCEPTION THAT PEOPLE COME TO NURSING HOMES JUST TO DIE.

I'VE BEEN BLESSED TO SEE WHERE RESIDENTS COME HERE AND GROW AND DEVELOP AS INDIVIDUALS, THAT THERE'S A REAL SENSE OF COMMUNITY.

AT ANY GIVEN TIME AT THE JEWISH HOME, WE HAVE WRITERS, PEOPLE WHO HAVE WRITTEN SONGS, POETS, ARTISTS.

AND THEY WORK WITH THE OTHER RESIDENTS.

THEY HELP DRAW THOSE RESIDENTS OUT.

THEY HELP THEM DEVELOP HIDDEN TALENTS.

AND SO WHEN PEOPLE COME TO NURSING HOMES, SPECIFICALLY THE JEWISH HOME, THEY CONTINUE TO GROW AND DEVELOP AS INDIVIDUALS, AND THEY CONTRIBUTE TO THE SENSE OF COMMUNITY THAT EXISTS HERE AT THE HOME.

I'LL BE 92 IN THREE MONTHS.

AND I'VE BEEN HERE 12 YEARS.

AND IT'S A GREAT, GREAT SENIOR FACILITY, I THINK PROBABLY THE FINEST SENIOR FACILITY IN THE UNITED STATES-- PROBABLY THE WORLD.

AND YOU HAVE TO BE VERY FORTUNATE TO GET HERE.

SO I LOVE MY LIFE HERE.

NARRATOR: NOT ALL NURSING HOMES OFFER THE QUALITY OF CARE OR THE RICH ARRAY OF PROGRAMS SAN FRANCISCO'S JEWISH HOME PROVIDES ITS 400-PLUS RESIDENTS.

IN LARGE PART, THE BIGGEST CHALLENGE FOR MOST SUCH FACILITIES IS FINANCIAL.

ATTRACTING AND RETAINING QUALITY STAFF MEMBERS AND CREATING AN ENVIRONMENT THAT IS BOTH STIMULATING AND NURTURING IS EXPENSIVE.

FIRST STEP AT IMPROVING CARE FOR PEOPLE WHO NEED THIS TYPE OF CARE IS TO PROVIDE ADEQUATE RESOURCES, ENOUGH MONEY FOR FOOD, ENOUGH MONEY FOR NURSING, TO PAY ADEQUATE SALARIES TO STAFF SO THAT THEY DON'T QUIT AND NEED TO BE REPLACED SO FREQUENTLY.

ON A SECONDARY LEVEL, I THINK ONE REASON THAT WE PROVIDE BETTER CARE THAN MOST OTHER FACILITIES IS OUR MEDICAL STAFF.

I USED TO RUN THE TRAINING PROGRAM IN GERIATRIC MEDICINE AT THE UNIVERSITY, AND I HIRED MY GRADUATES.

SO OUR MEDICAL STAFF ARE TRAINED GERIATRICIANS.

THAT'S REALLY UNUSUAL.

SO THAT THE TENSION THAT INDIVIDUAL PEOPLE GET HERE EARLY IN THE COURSE OF AN ILLNESS IS WONDERFUL.

NARRATOR: AT THE JEWISH HOME AND ELSEWHERE, MEETING THE NEEDS OF AMERICA'S GROWING POPULATION OF ELDERLY ADULTS IS A CHALLENGE THAT BECOMES MORE PRESSING EVERY DAY.

THIS IS DUE AT LEAST IN PART TO WHAT SOME HAVE CALLED "THE LONGEVITY REVOLUTION." WELL, THE LONGEVITY REVOLUTION REFERS TO THE FACT THAT LIFE EXPECTANCY, THAT IS THE AVERAGE LENGTH OF LIFE FOR AMERICAN CITIZENS, HAS NEARLY DOUBLED SINCE 1900.

IN 1900, THE AVERAGE LIFE EXPECTANCY WAS RIGHT AT 47 YEARS.

CURRENTLY, LIFE EXPECTANCY IS ABOUT 78 YEARS FOR MALES, AND ABOUT 82 YEARS FOR FEMALES.

THAT'S A TREMENDOUS INCREASE, JUST AN INCREDIBLE INCREASE.

PERSONALLY, I THINK THAT'S THE PROBABLY GREATEST ACCOMPLISHMENT OF THE 20TH CENTURY.

NARRATOR: WHILE THE NUMBER OF ELDERLY AMERICANS HAS RISEN STEADILY OVER THE PAST CENTURY, THERE'S SOME DISAGREEMENT ABOUT WHETHER THE QUALITY OF THEIR LATER YEARS HAS KEPT PACE WITH THE QUANTITY.

QUALITY OF LIFE CAN BE A DIFFICULT ISSUE TO ASSESS.

THERE ARE OBJECTIVE INDICATORS OF QUALITY OF LIFE.

ARE PEOPLE HEALTHIER, ARE PEOPLE RICHER, ARE PEOPLE LESS ISOLATED?

ON ALL OF THOSE KINDS OF OBJECTIVE INDICATORS, TODAY'S OLDER POPULATION IS SUBSTANTIALLY BETTER OFF THAN THAT 30 TO 50 YEARS AGO.

MEDICARE CAME INTO BEING IN THE MIDDLE 1960S, AND WAS A TREMENDOUS BOON TO THE ECONOMIC STABILITY OF OLDER ADULTS-- NOT JUST THEIR HEALTH SERVICES, BUT THEIR ECONOMIC STABILITY IN TERMS OF NOT BEING BANKRUPTED BY OUT-OF-POCKET HEALTH CARE COSTS.

THE CURRENT OLDER POPULATION ARE THE PARENTS OF THE BABY BOOMERS, SO THEY'RE NOT ISOLATED.

I THINK OUR HEALTH HAS IMPROVED.

OUR NUTRITION HAS IMPROVED.

AND SO A PERSON WHO IS 75 TODAY MIGHT LOOK LIKE SOMEONE WHO WAS 65 20 YEARS, 30 YEARS AGO.

AND IN THE MIDWEST WE ASK PEOPLE, WHAT WOULD YOU SAY WAS THE BEGINNING OF OLD AGE?

WHEN DOES SOMEBODY BECOME OLD?

AND ALMOST TO A PERSON THEY SAID 75.

NOW 40, 50 YEARS AGO, I THINK THAT WOULD HAVE BEEN 65 OR MAYBE EARLIER.

THERE ARE PLENTY OF PEOPLE WHO ARE IN THEIR 70S AND YET DON'T CONSIDER THEMSELVES YET TO BE OLD.

SO IT'S CLEAR THAT OLD AGE IS A TIME THAT BEGINS SOMEWHAT LATER THAN IT USED TO.

AND OF COURSE, PEOPLE ARE LIVING MUCH LONGER THAN THEY USED TO.

ANY GENERALIZATIONS ABOUT OLD AGE TODAY ARE DIFFICULT TO MAKE, BECAUSE THERE ARE SIMPLY TOO MANY DIFFERENCES AMONG PEOPLE OF THAT AGE GROUP.

MANY PEOPLE ARE ACTIVE IN THEIR JOBS RIGHT INTO THEIR 70S OR EVEN THEIR 80S.

THE FASTEST-GROWING GROUP IN OUR POPULATION ARE THE 85-PLUSERS, WHICH IS A REMARKABLE THOUGHT IF YOU THINK ABOUT IT.

AND IN FACT, THERE'S A GROUP OF THEM WHO ARE CERTAIN TO LIVE TO 100 BECAUSE THEY STAY ACTIVE, THEY STAY INVOLVED, AND AGAIN, THEIR HEALTH IS GOOD.

NARRATOR: WHILE THERE ARE MORE ELDERLY PEOPLE IN THE US NOW THAN ANY TIME IN THE PAST, AND MORE OF THEM ARE LIVING ACTIVE, FULL LIVES, LONG-HELD STEREOTYPES ABOUT SENIORS REMAINED LARGELY UNCHANGED.

COMMON STEREOTYPES OF THE ELDERLY ARE VERY DIFFICULT TO COMBAT, BECAUSE THERE IS, IN FACT, AS IS TRUE, I THINK, OF ALL STEREOTYPES, A KERNEL OF TRUTH IN THEM.

ONE OF THE BEST WAYS I KNOW OF MAKING SENSE OF STEREOTYPES, WHERE THEY'RE WRONG AND WHERE THEY'RE RIGHT, IS THE DISTINCTION BETWEEN WHAT WE CALL THE YOUNG-OLD AND THE OLD-OLD.

OLD AGE NOW, IF ONE USES THE CONVENTIONAL DEFINING POINT OF AGE 65, IS A VERY LONG PERIOD OF TIME.

IT'S OFTEN 30 YEARS OR MORE.

AND REALLY, THOSE 30 YEARS ENCOMPASS A LOT OF CHANGE, DEVELOPMENT, GROWTH, DECLINE, AND SO FORTH.

STEREOTYPES OF THE ELDERLY AS POOR, LONELY, POOR HEALTH, ISOLATED HAVE VERY LITTLE TRUTH IN GENERAL.

BUT THEY CERTAINLY HAVE VIRTUALLY NO TRUTH FOR THE YOUNG-OLD, THAT IS, PEOPLE WE MIGHT ARBITRARILY DEFINE AS AGE 65 TO 80.

AND THE STEREOTYPES ARE VERY DAMAGING, BECAUSE THEY KEEP US FROM RECOGNIZING THAT THESE PEOPLE ARE PRODUCTIVE.

NARRATOR: STEREOTYPES AND MISCONCEPTIONS ABOUT THE ELDERLY ARE MORE PROBLEMATIC IN THE US THAN IN MANY OTHER SOCIETIES, WHERE OLDER ADULTS ARE NOT ONLY VALUED, BUT REVERED.

SOME SOCIETIES HAVE LONG PUT AN EMPHASIS AND A PREMIUM ON RESPECT FOR THE ELDERLY.

AND A CLASSIC EXAMPLE WOULD BE CHINA, WITH ITS CONFUCIAN TRADITION OF AUTHORITY AND

HIERARCHY.

IN SOME SOCIETIES A SENIOR IS REVERED AS A STOREHOUSE OF KNOWLEDGE AND WISDOM, AND ALSO AS A CHILDCARE PROVIDER AND PASSER OF TRADITIONS TO THE GRANDCHILDREN AND GREAT GRANDCHILDREN.

IN SOME SOCIETIES, THE SENIORS ACTUALLY RUN THE SOCIETIES.

ONE HAS ALWAYS HEARD OF THE ELDERS IN AFRICA WHO COME TOGETHER TO MAKE DECISIONS ABOUT THE COMMUNITY, AND ARE HIGHLY RESPECTED, AND THEIR OPINIONS ARE SOUGHT AFTER.

IN TRADITIONAL SOCIETIES, AGRARIAN SOCIETIES, PRE-INDUSTRIAL SOCIETIES, THE OLDEST PEOPLE ARE TYPICALLY THOSE WITH THE GREATEST AMOUNT OF POWER, OFTEN THE GREATEST AMOUNT OF WEALTH, AND THE GREATEST AMOUNT OF SOCIAL PRESTIGE.

THE TERM THAT THOSE SOCIETIES USE IS "ELDERS." AN ELDER IS A TERM THAT HAS A POSITIVE CONNOTATION.

NARRATOR: SOME SOCIOLOGISTS CONTEND THAT CROSS-CULTURAL DIFFERENCES IN THE TREATMENT OF THE ELDERLY ARE DIRECTLY RELATED TO WHETHER A SOCIETY PLACES MORE VALUE ON THE INDIVIDUAL OR ON THE COMMON GOOD.

AND THAT BASICALLY BREAKS DOWN TO WESTERN SOCIETIES VERSUS EASTERN SOCIETIES SUCH AS THE JAPANESE, THE CHINESE, AND SO FORTH.

THE MAJOR UNDERLYING IDEOLOGY OF THOSE CULTURES IS THAT THEY ARE COLLECTIVISTIC CULTURES, THAT THE COLLECTIVITY IS WHAT IS IMPORTANT, THAT AS AN INDIVIDUAL IN THAT SOCIETY I WOULD SUPPRESS MY PERSONAL DESIRES AND WISHES FOR THE GREATER GOOD OF THE COLLECTIVITY.

ADULT CHILDREN HERE OFTEN SAY-- THEY REALLY OFTEN GRAPPLE WITH THE QUESTION OF, HOW MUCH DO I OWE MY PARENTS?

TO WHAT EXTENT SHOULD I REALLY PUT MY LIFE ON HOLD IN ORDER TO CARE FOR THEM?

THOSE QUESTIONS SIMPLY TEND NOT TO COME UP IN THE COLLECTIVISTIC CULTURES.

THAT'S NOT A QUESTION.

YOU DO IT.

AND THAT WILL BE DONE FOR YOU IN TURN.

WELL, IN THOSE FAR EASTERN COUNTRIES, THE OLDEST SON IS REQUIRED TO TAKE CARE OF HIS PARENTS UNTIL THEY DIE.

THERE'S NO SUCH THING AS A NURSING HOME OR A VERY, VERY FEW NURSING HOMES IN KOREA.

WE AREN'T HONORING OUR ELDERS IN THIS COUNTRY.

NARRATOR: WHILE THERE ARE CULTURAL DIFFERENCES IN THE WAY THE ELDERLY ARE PERCEIVED AND TREATED FROM ONE SOCIETY TO THE NEXT, THERE ARE CERTAIN CHANGES THAT TAKE PLACE AS PEOPLE AGE NO MATTER WHERE THE LIVE, CHANGES THAT PRESENT SOME VERY DEFINITE CHALLENGES.

WITHOUT QUESTION, POOR HEALTH IS THE BIGGEST CHALLENGE ANY PEOPLE FACE AS THEY AGE.

THE COMMON DISEASES IN THE ELDERLY ARE SOME OF WHAT ARE CALLED NEURODEGENERATIVE DISEASES.

THESE ARE DISEASES THAT AFFECT THE NERVOUS SYSTEM, LIKE ALZHEIMER'S DISEASE, LIKE STROKES, LIKE PARKINSON'S DISEASE.

SO THESE ARE MORE COMMON IN THE ELDERLY THAN IN YOUNGER PEOPLE.

HEART DISEASE, PARTICULARLY THINGS LIKE CONGESTIVE HEART FAILURE, WHERE THE HEART PUMP ISN'T WORKING VERY EFFECTIVELY, ALSO BECOMES MORE COMMON.

NARRATOR: ONE SERIOUS AND ALL-TOO-COMMON CONDITION THAT SPECIFICALLY TARGETS THE ELDERLY IS OSTEOPOROSIS.

OSTEOPOROSIS IS A BONE DISEASE, THE MOST PREVALENT BONE DISEASE IN THE UNITED STATES, THAT CAN AFFECT ALL THE BONES IN YOUR BODY EXCEPT YOUR SKULL.

AND IT LITERALLY MEANS "POROUS OR THIN BONE." AND WHAT HAPPENS IS THAT BONE IS A VERY ACTIVE TISSUE.

WE DON'T THINK OF IT THAT WAY.

WE THINK OF IT AS STRONG.

BUT IN FACT, IT'S BEING REPLACED AND REPLENISHED ALL THE TIME.

EVERY SEVEN YEARS YOUR ENTIRE SKELETON IS REPLACED.

WHEN ONE DEVELOPS OSTEOPOROSIS, THE CELLS THAT TAKE AWAY OLD BONE ARE WORKING FASTER THAN THE CELLS THAT ARE BUILDING NEW BONE.

AND AS A RESULT, WE HAVE A LOSS OF BONE THAT GOES ON.

THE LOSS OF BONE ITSELF IS NOT THE PROBLEM.

THE FRACTURES THAT OCCUR FROM THAT LOSS OF BONE ARE A PROBLEM.

NARRATOR: AND, IN FACT, IT'S A PROBLEM THAT'S MORE WIDESPREAD THAN IS GENERALLY UNDERSTOOD BY MOST MEMBERS OF THE PUBLIC, WHO OFTEN ASSUME THAT ONLY CAUCASIAN WOMEN ARE AT RISK.

JUST ABOUT EVERYBODY IN THE UNITED STATES WHO'S OVER THE AGE OF 21 IS AT SOME RISK OF OSTEOPOROSIS.

IT IS A MYTH THAT THIS IS AN OLD WHITE WOMEN'S DISEASE.

ONE IN FIVE PEOPLE WITH OSTEOPOROSIS IS MALE, FOR EXAMPLE.

AND AFRICAN AMERICANS, LATINOS, ASIANS ARE ALL AT SUBSTANTIAL RISK OF THIS DISEASE.

SO IT'S SOMETHING WE'RE TRYING TO ENLIGHTEN PEOPLE ABOUT AND HAVE THEM RECOGNIZE THAT THIS IS A TERRIBLY DEBILITATING DISEASE.

NARRATOR: WHILE PHYSICAL AILMENTS DO PRESENT CHALLENGES TO THE ELDERLY, IN MANY CASES THERE ARE WAYS TO ELIMINATE OR GREATLY REDUCE THE SEVERITY OF MANY SUCH AILMENTS, INCLUDING OSTEOPOROSIS.

THE PRESENCE OF CALCIUM AND VITAMIN D IS CRITICAL.

AND EVERYBODY NEEDS TO BE GETTING SOMEWHERE BETWEEN 1,200 AND 1,500 MILLIGRAMS OF CALCIUM.

MOST OF US DON'T.

THE SECOND THING IS EXERCISE, WEIGHT-BEARING EXERCISE AND STRENGTH TRAINING EXERCISE.

AND I KNOW WHEN I SAY WEIGHT-BEARING TO AUDIENCES, THEY HAVE THIS VISION OF THIS HEAVY SET OF WEIGHTS THAT PEOPLE HAVE TO LIFT ABOVE THEIR HEADS, BUT IN FACT, WALKING IS THE VERY BEST WEIGHT-BEARING EXERCISE THAT YOU CAN DO.

AND THEN MEDICATION, WHEN APPROPRIATE.

NARRATOR: ALONG WITH THE PHYSICAL CHANGES THAT COME WITH AGING, THERE ARE SOMETIMES ACCOMPANYING EMOTIONAL ISSUES THAT ALSO PRESENT PROBLEMS. IN MANY CASES, FOR EXAMPLE, OLDER ADULTS ARE TROUBLED BY A GRADUAL LOSS OF INDEPENDENCE.

AS WE GROW OLDER WE'RE NO LONGER ABLE TO DRIVE.

SOMETIMES WE'RE NO LONGER ABLE TO BE FUNCTIONAL, GO OUT AND DO OUR SHOPPING AND TAKE CARE OF OURSELVES.

THAT'S EMBARRASSING.

THAT'S HUMILIATING, IN ADDITION TO BEING A PROBLEM THAT WE HAVE TO SOLVE WITH MONEY, WHICH IS NOT SOMETHING MANY OLDER PEOPLE HAVE.

I THINK THE MAJOR CHALLENGES AT THE INDIVIDUAL LEVEL FOR OLDER ADULTS ARE, IN FACT, HEALTH AND ECONOMICS.

THE GREATEST FEAR AND WORRY OF OLDER ADULTS IS THAT THEIR MONEY WILL NOT LAST FOR THEIR LIFETIME, AND THAT THEY WILL BECOME ECONOMICALLY DEPENDENT, PERHAPS PHYSICALLY DEPENDENT AS WELL, BUT ECONOMICALLY DEPENDENT.

NARRATOR: ONE OF THE MOST PRESSING CONCERNS OF OLDER ADULTS IS WHETHER OR NOT THEY'LL BE ABLE TO AFFORD THE CARE AND ASSISTANCE THAT MAY BECOME NECESSARY AS THEY AGE.

BUT IN MANY CASES, THEIR ANXIETY EXTENDS BEYOND SIMPLY MONEY.

I DON'T KNOW ANYONE WHO WANTS TO SPEND THEIR LAST DAYS IN ONE OF THOSE HOMES.

I THINK IT'S A REAL PANICKY FEAR FOR PEOPLE TO THINK THAT'S WHAT'S WAITING FOR THEM.

ON THE OTHER HAND, THE OLD SYSTEM WAS TO HAVE THE FAMILY DO IT.

BUT GUESS WHO THAT WAS?

IT WASN'T THE FAMILY, IT WAS THE WOMEN DOING IT.

SO IT WAS A WOMAN MAYBE HAVING A BIT OF A JOB, FEEDING HER KIDS, TAKING CARE OF HER RELATIVES AND HIS RELATIVES.

SO THE OLD SYSTEM WASN'T THAT GREAT, EITHER.

FAMILIES CONTINUE TO PLAY A VERY CRITICAL ROLE IN THE CARE OF DISABLED OLDER PEOPLE.

AT THE SAME TIME, WE HAVE A NUMBER OF PROGRAMS WHICH ALSO ASSIST FAMILIES, FROM MEDICARE, MEDICAID, VARIOUS SOCIAL SERVICES, SENIOR CENTERS, HOME HEALTH CARE AGENCIES, AND THE LIKE.

PERHAPS THE DIFFICULTY IS WE HAVE TOO MANY PROGRAMS THAT ASSIST OLDER PEOPLE.

WE HAVE A BALKINIZATION OF SERVICES THAT ARE DIFFICULT TO ACCESS AND DIFFICULT TO COORDINATE, EACH WITH THEIR OWN ELIGIBILITY AND BENEFIT CRITERIA.

AND SO WE HAVEN'T FIGURED OUT HOW TO HAVE A SEAMLESS SERVICE THAT HELPS LINK FAMILIES AND COMMUNITIES AND THE BROADER SOCIETY TOGETHER, ALL IN PROVIDING A COORDINATED SUPPORT OF AN OLDER INDIVIDUAL WHO'S IN NEED OF HELP.

NARRATOR: IN THE CASE OF THE JEWISH HOME AND ITS RESIDENTS, THAT CRITICALLY IMPORTANT COORDINATED SUPPORT IS PROVIDED, PIECED TOGETHER FROM A VARIETY OF SOURCES.

85% OF THE RESIDENTS HERE DON'T HAVE THE MONEY TO PAY FOR CARE.

SO THEY ARE UNDER OUR STATE'S MEDICAID PROGRAM.

IN CALIFORNIA THEY CALL IT MEDI-CAL.

AND THE AMOUNT OF MONEY THAT MEDI-CAL PAYS IS BETWEEN $10,000 AND $12,000 A YEAR LESS THAN WHAT IT COSTS.

AND SINCE IT COSTS MORE MONEY TO PROVIDE THE CARE THAN WE GET FROM THE STATE, WE NEED TO MAKE THAT DIFFERENCE UP IN CHARITABLE DONATIONS.

THE JEWISH HOME OF SAN FRANCISCO IS REALLY UNIQUE, AND IS IN A VERY FORTUNATE POSITION TO HAVE THE LEVEL OF COMMUNITY SUPPORT, PHILANTHROPIC SUPPORT, THAT ALLOWS IT TO PROVIDE

THE DIVERSITY OF PROGRAMS, IT ALLOWS IT TO PROVIDE A LEVEL OF CARE AND STAFFING THAT IS UNSURPASSED IN MOST OTHER NURSING HOMES.

IF WE WERE TO ONLY RELY ON THE LEVEL OF GOVERNMENT SUBSIDIZATION OR REIMBURSEMENT, WE WOULD NOT BE IN A POSITION TO PROVIDE THE KINDS OF PROGRAMS AND SERVICES AND FACILITIES THAT WE ARE ABLE TO OFFER TO OUR COMMUNITY.

NARRATOR: BUT EVEN WITH ALL THE RESOURCES AVAILABLE HERE, INCLUDING A DEDICATED AND NURTURING STAFF, RESIDENTS OF THE JEWISH HOME, LIKE AGING ADULTS EVERYWHERE, MUST COPE WITH A VARIETY OF DIFFICULT ISSUES.

AMONG THE MOST CHALLENGING IS THE REALITY THAT THEIR LIVES ARE COMING TO A CLOSE.

AMERICAN SOCIETY IS NOT A SOCIETY THAT LIKES TO CONFRONT DEATH.

COMPARED TO OTHER CULTURES, FOR EXAMPLE, WE EXHIBIT HIGHER LEVELS OF DEATH ANXIETY, OF WANTING NOT TO TALK ABOUT IT, EITHER IN GENERAL, IN TERMS OF PUBLIC DIALOGUE, OR PERSONALLY, IN TERMS OF OUR OWN PERSONAL HOPES, FEARS, WISHES.

THE FACT THAT WE HAVE THIS EXPECTATION THAT PHYSICIANS CAN CURE ANYTHING IS ALSO A PROBLEM.

SO WE SEE PEOPLE BRINGING IN 95- AND 100-YEAR-OLD PATIENTS WHO'VE BEEN DEMENTED FOR YEARS, WHO HAVE KIDNEY FAILURE AND WHATEVER ELSE, AND THEY WANT THEM DIALYSED AND KEPT ALIVE, BECAUSE THAT'S IMPORTANT.

TO ME, QUALITY OF LIFE IS REALLY THE ENTIRE MESSAGE.

AND IF YOU WANT TO SUSTAIN LIFE, YOU SHOULD BE SURE IT'S A QUALITY THAT PEOPLE WILL WANT TO LIVE WITH.

A LOT OF THE MONEY THAT WE SPEND ON THE ELDERLY, ESPECIALLY WITH FANCY TESTS AND PROCEDURES THAT OCCUR IN THE LAST YEAR OR TWO OF LIFE, WOULDN'T HAPPEN IF WE SPENT MORE TIME TALKING TO PEOPLE AND UNDERSTANDING THEIR VALUES AND WHAT THEY WANT.

WE WASTE A LOT OF MONEY DOING THINGS THAT PEOPLE DIDN'T WANT DONE ANYWAY.

NARRATOR: AT SOME POINT, WHETHER LAST-MINUTE MEDICAL INTERVENTION HAS BEEN BROUGHT TO BEAR OR NOT, THE INEVITABILITY OF DEATH BECOMES UNDENIABLE.

IDEALLY, DECISIONS HAVE ALREADY BEEN MADE ABOUT WHAT TO DO ONCE THIS POINT IS REACHED.

THE REAL ISSUE IS BEING STIMULATED TO TALK ABOUT THIS WITH YOUR PHYSICIAN AND GET SOME SENSE OF THE THINGS YOU SHOULD BE THINKING ABOUT, THE KINDS OF CHOICES THAT MIGHT ARISE, AND THEN BEING ABLE TO TALK WITH A SPOUSE OR YOUR CHILDREN AND SO FORTH ABOUT THAT, SO THAT-- IT'LL NEVER BE EASY FOR THEM, BUT THAT IT WOULD BE EASIER IF THEY HAVE SOME SENSE OF WHAT YOUR WISHES WERE AND THEY HAD TALKED IT THROUGH.

AND I THINK IT IS IMPORTANT WHILE YOU'RE MENTALLY WITH IT AND YOUNGER TO SIT DOWN ADVANCE DIRECTIVES OF WHAT YOU DO NOT WANT AND WHAT YOU DO WANT DONE WITH YOURSELF IF YOU SHOULD BE INCAPACITATED.

AND ALSO SET UP A DURABLE POWER OF ATTORNEY WITH PEOPLE, NOT ONLY WHO ARE RELATIVES, BUT PEOPLE WHO HAVE LIKE MINDS AS YOURSELF.

I'VE SEEN SITUATIONS WHERE THE SENIOR OBVIOUSLY HAD CERTAIN WISHES, AND THE PERSON WHO HAD DURABLE POWER OF ATTORNEY HAD ETHICAL, RELIGIOUS, AND MORAL DIFFERENCES WITH WHAT THAT PERSON WANTED.

AND THAT'S A VERY DIFFICULT SITUATION.

SO IN ADDITION TO HAVING FAIRLY DEFINED ADVANCE DIRECTIVES, I THINK HAVING YOUR DURABLE POWER OF HEALTH CARE IN THE HANDS OF SOMEONE WHO KNOWS EXACTLY WHERE YOU'RE AT, I THINK IS EXTREMELY IMPORTANT.

PEOPLE AREN'T GOING TO LIVE FOREVER.

AND PEOPLE WANT TO HAVE DIGNITY WHEN THEY DIE.

AND SOMETIMES PUTTING SOMEONE IN INTENSIVE CARE UNIT FOR A PERIOD OF TIME, WITH TUBES IN THEM, IS NOT WHAT THEY HAD IN MIND.

I THINK THAT IN THE UNITED STATES WE HAVE THE FIRM BELIEF THAT WE SHOULD HAVE ACCESS TO THE VERY BEST SERVICES WHEN WE SHOULD WANT THEM.

AND I THINK IT'S A RELATIVELY NEW RECOGNITION THAT PERHAPS PEOPLE MIGHT NOT WANT TO HAVE THE ULTIMATE MEASURE APPLIED TO SAVE THEM IN THEIR LAST DAYS.

NARRATOR: UNFORTUNATELY, HOWEVER, IN SOME CASES, THE DYING PERSON'S WISHES ARE

IGNORED.

IN MANY SITUATIONS, IN HOSPITALS, IF A PHYSICIAN IS DEALING WITH A PATIENT AND THERE IS A LIVING WILL, AND THE LIVING WILL CLEARLY SPELLS OUT THIS PATIENT WOULD LIKE TREATMENT TO BE STOPPED AT THIS POINT, BUT THE SURVIVING FAMILY MEMBERS DISAGREE AND URGE THE PHYSICIAN TO CONTINUE TREATMENT, IN ALMOST EVERY CASE THE PHYSICIAN CONTINUES THE TREATMENT.

THIS IS CONTRARY COMPLETELY, OF COURSE, TO THE IDEA OF PATIENT AUTONOMY, TO THE IDEA OF AN ADVANCE DIRECTIVE.

PHYSICIANS WOULD SAY THAT THEY ARE TRYING TO DO THE COMPASSIONATE THING HERE, BY TENDING TO THE WISHES AND DESIRES OF SURVIVING FAMILY MEMBERS.

IT'S CLEAR THEY'RE PROBABLY ALSO CONCERNED ABOUT LAWSUITS.

THE DYING PATIENT IS NOT GOING TO FILE A LAWSUIT.

THE SURVIVING FAMILY MEMBERS MIGHT.

NARRATOR: EVEN WHEN THERE ARE NO DISPUTES ABOUT HOW A PERSON'S LIFE SHOULD END, THERE'S NO WAY TO MINIMIZE THE FACT THAT DEATH IS NOT SOMETHING MOST PEOPLE LOOK FORWARD TO.

BUT THE EXPERIENCE OF GROWING OLDER IS NONETHELESS OFTEN A RICH AND REWARDING TIME OF LIFE, OR AT LEAST IT CAN BE.

SOMETIMES WHEN PEOPLE LOOK AT OLDER ADULTS, THEY CAN'T GET PAST THE WRINKLES AND THE GRAY HAIR.

ONE THING THAT'S A VERY, VERY IMPORTANT TO KEEP IN MIND IS THAT IN SPITE OF THEIR PHYSICAL APPEARANCE, AND IN SPITE OF THEIR CHRONOLOGICAL AGE, OLDER PEOPLE FEEL LIKE THEY'RE YOUNGER PEOPLE.

THEY'RE US.

MOST OF THE CITIES IN NORTH AMERICA PUT FLUORIDE IN THEIR WATER TO HELP KIDS' TEETH.

I WOULD LOVE TO BE ABLE TO PUT SOMETHING IN THE WATER THAT WOULD MAKE PEOPLE RECOGNIZE THAT OUR OLDER ADULTS ARE THE BEST NATURAL RESOURCE WE HAVE. I THINK IF WE

CAN ENABLE MORE OLDER PEOPLE WHO ARE HEALTHY TO STAY IN THEIR JOBS, TO BE ACTIVE AND PARTICIPATING MEMBERS OF COMMUNITIES, CHURCHES, SCHOOL SYSTEMS, ET CETERA, AND IF WE CAN TEACH THE KIDS ABOUT HOW WONDERFUL GRANDPARENTS AND GREAT-GRANDPARENTS CAN BE, WE CAN MAKE A CHANGE HERE.

[MUSIC PLAYING] NARRATOR: "THE WAY WE LIVE" IS A 22-PART SERIES ABOUT SOCIOLOGY.

FOR INFORMATION ON THIS PROGRAM AND ACCOMPANYING MATERIALS, CALL 1-800-576-2988, OR VISIT US ONLINE.