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GoetheInstitute

01/11/2006

What to do with mother?

Susanne Mayer looks at the trials involved in putting one's parents in an old age home

I could have known sooner. For example, when mother told me about her friend E. A small woman who was in the habit of trotting out of the house in the morning with a spring in her step, to lift the garage door to let her husband, a man of status, roll out into the world. Now, mother told me, E.'s hands were so stiff she had to immerse them in hot water for a quarter of an hour after getting up just to be able to move them.

I can't get rid of that image of the old lady standing at the washbasin soaking her hands. How much stoicism do you need in old age, how much patience? In my childish egotism I'd thought that question applied to me, not to mother. In fact there was no denying that mother was going downhill too. She stood less straight than she used to, her steps uncertain. That jarred with the image I had of her, for example of the upright lady standing with us in the garden in photos from our childhood.

Watching your parents grow old means noticing that you age yourself. Maybe that's why we look away for so long, sensing that their fate could become our own. A friend of the family, Mr W., scalded himself in the shower – the same shower he'd used without any difficulty for more than twenty years. He turned it up too hot, and in the shock of the pain was unable to find the cold tap to put a stop to the boiling water. Once the author of clever thoughts about the world, he was now imprisoned in the steaming hell of his own bathroom.

Bad news has a tendency to multiply. Mrs A., we heard, took a fall in her own kitchen and struggled on hands and knees to the phone in the living room. But in her panic she had forgotten the number of the neighbour she wanted to ask for help, and she was unable to stand up to reach the phone book. Broken ankle! And then Mrs H., who tumbled over into the roses she was pruning, prickly bushes planted by her husband, who died a quarter of a century ago.

What should she hold onto to regain her balance? Mrs H. had to crawl through the thorns to the garden fence where she finally found a handhold. It seemed the time had come to get mother to a safe place. But how? And where? Who will take care of things, who has time?

In a society that has spent years passionately debating the compatibility of career and parenthood – fruitlessly of course – contemplation of the compatibility of family, career and caring for the elderly has not even begun. Why should it have? You can't make society responsible for solving all your personal problems, a high-flyer of this society advised me recently, a manager of a big company. Self-help is the order of the day, he said. Now, the care of his own children he had clearly managed to delegate to his wife. It is fair to assume that certain sections of the population always get things sorted out. But the majority? Demographer Herwig Birg predicts that in coming decades the number of over-80s will grow from three to ten million. Presumably more than one third of them will be in need of care. Where will they want to live? And where will they be best looked after?

Raising questions like this with your own parents means pointing out to them that the last round is beginning. That is difficult for children because it feels unseemly. Perhaps also because the children have to take on new responsibilities. Parents, whose established role is to look after their children, probably like the exchange of roles just as little, partly because it's an admission of weakness, worse still a weakness from which they will never recover. After a long life, time can suddenly start to exert pressure. One of mother's friends has gone to live with her niece, hundreds of miles away. Mr W. has found refuge with his daughter, hours away on the train. A former colleague has disappeared from the radar, caring for her seriously ill husband. Another friend passed away unexpectedly, overnight. It was as if someone had turned the cogs inside a tightly knit group of friends and sent them hurriedly scattering in all directions. So much for the sanctified utopia of a commune for the elderly, the idea of getting together for the last stretch. Who knows what waits for each one of us there.

Ageing creeps up unawares, casting its shadow over a life, maybe even bringing it juddering to a halt. "Everything takes so long now," you start to hear. But ageing can also pull the carpet out from under your feet with a jerk. Even the last move, meant to put them out of harm's way, can badly upset an old person, and the upset may turn out to be less temporary than had been hoped.

Anyone who takes elderly relatives into their own home stands before a task whose magnitude is in no way calculable. Suddenly the elderly aunt is so confused she has to be accompanied everywhere she goes. Or the bedding has to be changed three times a night, and incidentally the linen has to be washed too. How can this kind of flexibility fit in with the accelerated rhythm of working life, with its demands of constant availability extending to a working week of at least 40 hours? A question that also arises if the parents find a place in a rest home. Even if it is the nicest place you can imagine, a sunny room, balcony, changing skies above. But you cannot simply hand your mother over. You have to take care of things. But how, several hundred kilometres away? Discussions with the doctors? Sounding out the impression the carers have. Are there problems, how could they be solved? For your parents you may have become the last link to their own biography, so many others have gone already. But how do you create connections from so far away?

There are formalities to be dealt with, bills. The state care insurance pays 1,432 euros for the highest care category, level 3. The home writes its invoices. Partial washing, manicure: 8.80 euros. Washing, toilet, assisted feeding: 29.60 euros. Excretions: 4 euros a time. The costs accumulate quickly, soon they can exceed what the care insurance will pay by 1,000 euros and more. That is what the politicians meant when they warned that the care insurance scheme was "partial coverage".

The meaning of "economy measures" becomes clear at the latest when the patient's arms and legs become so entangled in the bars of the care bed that the fragile skin tears and a protective cover is needed. But it has disappeared from the catalogue of services covered. Invoice for 290.00 euros plus VAT of 46.40 euros makes 336.40 euros. Request for reimbursement from the insurance, rejection, written objection. The hours trickle away, the time for yourself too. Now there is no leeway for any other emergency at all in your own life. Easily said.

Already today, even before the demographic problems have entered the stage of extreme acceleration, the care insurance funds are struggling with exploding costs. Staff are being ordered to rationalise the use of time. Out with the stopwatch. Could the food not be delivered more quickly? Could the smile not be sped up? How will it be when the number of gainfully employed in this Republic has shrunk by millions and millions, but society and its old people expect them to provide everything, financially and otherwise? And by no means every old person has their own children at their side to represent their interests – perhaps not always gladly but hopefully at least dutifully.

I come to visit and it is almost like the old days. She's still making jokes! We laugh. I come again and find that mother has lost all recollection of my last visit. Oh yes, the newspaper has been cancelled too, the world outside is of no interest any more. The television collecting dust, yes even that. A ghastly fright. How quickly the world can shrink to a tiny dot.

Simply to fall asleep and never wake up again, plenty of old people dream of that. Many in vain, for the line between life and death is often blurred. "Perhaps I'll be gone next time you come, and even if I'm lying there it won't be the person you know," my mother once said in a moment of great clarity.

How weak can a person become before they die? In a retirement home there are many versions to be heard. Like, he was too weak to chew, or the colon has to be cleared out now, manually. She can no longer express herself. He didn't want to drink any more. Supposedly enlightened individuals regard old people's refusal to eat and drink as a voluntary act. But what is natural when the home where a friend's mother lives serves only dry bread in the evening, with a kind of sliced sausage that the mother already detested when she was young and hungry? Is it natural to want to die under those circumstances? Or a sign of depression? Perhaps realism in the face of the choice of eating or dying.

Our society talks itself into a tizzy about how much mothering a child needs to develop healthily in the first years of life, yet is blind to the question of how much of the nutrient affection is needed to make the end of life bearable. There is someone who cares that I exist! How could that feeling be engendered in the minute-by-minute timetable of a professional care provider? There are moving examples of staff – underpaid as ever – smuggling warmth and friendship, even hilarity, into the lives of old people, as a non-billable service, so to speak. And what good fortune if, like my mother, you have a friend who comes by every day, perhaps even turns up with a bowl of strawberries, topped off with cream and that extra portion of affection without which no age of life was ever worth living. Can you organise that kind of warmth? For millions? Better not to think about it.

It is often necessary to deal with distress in these final stages. Sometimes even misery that has been repressed a whole life long, but wells up now. Also fear of that which will inevitably come. I heard about a woman who cried for help as soon as she was without the touch of another person. It has been known for a resident to press the emergency button 60 times in a night, an act of desperation simply to call another human being by, a primal cry for closeness. What does a person need at the end?

In certain luxury hotels people are employed simply to give the guest the impression that he is welcome. But old age is no holiday, at least not in a society that fills its cities with highly tax-subsidised empty office space but has hardly begun to tackle the architectural challenge of building care facilities that combine privacy and communal closeness. Certainly affection is hard to convey over the telephone. Especially when the person at the other end cannot lift the receiver, or perhaps can only babble. The rest is calculable.

With good will and one or two visits a month, each lasting about 90 minutes, how many hours together does that make? 40? 80? "The clock is ticking," my mother occasionally comments dryly. Uncertain too, whether you will be there when the end comes. The end does not always announce itself. One sign of a competent care service is a reassurance that no-one is left alone.

"Sometimes," a carer once told me, "the dying think I'm their own child, and I let them think that, even if I prefer not to tell it to the children." I read that the dying often call not for their children, but – a child again themselves – for their own mother. That would then be very similar to childbirth.

*

The article originally appeared in German in Die Zeit on October 5, 2006

Susanne Mayer, born 1952, is a journalist at Die Zeit. She is author of "Deutschland Armes Kinderland" (Germany, poor children's land), a radical plea for the re-integration of children into contemporary society.

Translation: Meredith Dale.

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