Aeon magazine, a new favorite of mine, specializes in medium to long written and audio pieces that defy multitasking by the reader or listener and demand attention and occasionally a re-read to make sure I got the point.

Such was the piece by poet Donald Hall, in which he called old age “a ceremony of losses.”

It’s part of a video series, shot at his home and done at almost slow-motion speed with long pauses and sparse dialogue. A few minutes into it, I get that this is intentional: his life is slow, disjointed, disorderly and, for Hall, absolutely dependent on the assistance of four women contributing to his daily wellbeing.

After the N Y Times piece on a sort of “anti-assisted living” theme made news a few weeks ago, the two pieces taken together struck me as a brilliant but coincidental unification of the range of lifestyles in old age.

Health care has adopted a hospitality focus and not a moment too soon. The arrogance of the practitioners and barriers to humanism like the large plexiglass window between “us and them” when we check in were not-so-subtle reminders about who’s whom in the practitioner-patient relationship.

As it was becoming apparent that the artificial barriers and class distinctions no longer work, people in geriatrics, especially, were moving away from the disease model and into the patients-as-people era.

It wasn’t news to Dr. William Osler (the “Father of American Medicine”) at Johns Hopkins over 100 years ago that it was better to know the person than to know the disease if a physician wanted to do the best work.

Fast forward more than a century and we find assisted living in its various forms facing an identity crisis: the medical model, which is focused on the delivery of geriatric health care “24/7” and the social model which attracts customers with beautiful accommodations and delivers minimal health care along the lines of other amenities like linen changes, vacuuming, restaurant dining and activities which are more diversional than therapeutic.

 

In this model, sometimes as an afterthought, a floor or a wing of the four or five story building will have a designated “memory care unit.”

If that is a reference to providing special care to people with Alzheimer’s disease and related disorders, then it strikes me like a hospital calling its intensive care unit the “short of breath” unit, so as not to worry patients that they have actual illnesses.

The Times article touched some raw nerves in the industry by pointing out the innuendo that if old people live pretty lives in pretty surroundings, then they won’t get old and frail and sick (and certainly not die).

In their brochures, two photoshopped elders riding bicycles without helmets is a sure sign that the pitch will be for pretty lives evermore.

But that’s not how life plays out. The Greatest Generation can afford pretty lives, but they can’t avoid the wear and tear of gravity, too much sun, red meat, butter, alcohol, tobacco and genetics.

The Fields are all about health care and happen to be in beautiful settings where building upkeep is expensive and labor intensive which require special geriatric training.

As I surf around the internet looking at the way assisted living facilities present themselves, I see a subtle sleight of hand and a bit of bait and switch. The “pretty ever after” is appealing to the children shopping for their parents. If your mother stays young and pretty, then so must you…

Just wear a helmet and don’t fall off you bike.