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A TGB READER STORY: Structure in a Time of Pandemic

Are Old People Lives Worth Less Than Young People's Lives?

We, all of us, are witness to something that up until now seemed an historical event safely tucked away in the Middle Ages or, at least, a hundred years ago.

No more than two months ago, few if any of us could have guessed we would see so many succumb to the coronavirus in so short a period of time that morgues and funeral homes would need to store the dead in refrigerated trucks.

Even in our largest cities, there is silence in the streets. We who can lock ourselves in our homes rarely leave nowadays and never get closer than six feet to another person.

Front-line workers take their lives in their hands to care for the sick and dying. Others perform essential services for the rest of us. Both do so while living as separate as possible from their families for fear of passing the virus to loved ones.

It is fear that drives us now. We live in a state of suspended animation with no end date. Does anyone here believe that the numerous U.S. states “opening” their economies now will result in anything but spikes in infections and deaths?

Old people account for more of the dead than any other age group.

On Saturday, The New York Times reported that one-third of all COVID-19 deaths have occurred in long-term care facilities:

”At least 25,600 residents and workers have died from the coronavirus at nursing homes and other long-term care facilities for older adults in the United States, according to a New York Times database. The virus so far has infected more than 143,000 at some 7,500 facilities.”

The Washington Post reports that the number of elder deaths from the virus may be even higher:

”It’s become clear that nursing homes are particularly deadly incubators: Fifteen states reported (as of Friday) that more than half of their covid-19 fatalities were associated with long-term-care facilities.

“Meanwhile, the World Health Organization says that as many as 50 percent of all deaths in Europe have occurred in such places.”

There has been more than a little ageism in the discussion of who lives and who dies in this pandemic. In March,

”Texas Lt. Gov. Dan Patrick set off a firestorm of criticism after he suggested Monday that he and other older Americans should be willing to sacrifice their lives for the sake of the economy, which he said was in mortal jeopardy because of shutdowns related to the coronavirus pandemic,” reported the Washington Post.

“'Let’s get back to living,' Patrick (R) said. 'Let’s be smart about it. And those of us who are 70-plus, we’ll take care of ourselves, but don’t sacrifice the country.'”

Just over a week ago, Ken Turnage II was ousted as chairman of Antioch, California's city council when he posted this to Facebook:

”'In my opinion we need to adapt a Herd Mentality. A herd gathers it ranks, it allows the sick, the old, the injured to meet its natural course in nature," reported NBC News.

“As for homeless people, he added that the virus would 'fix what is a significant burden on our society and resources that can be used.'”

Those two are not alone. Calls for sacrifice of elders and the disabled has become relatively commonplace in relation to the pandemic but reporter Nina A. Kohn, in that same Washington Post story wrote a strong counter-narrative on Friday.

Acknowledging that old people are particularly susceptible to the virus, she points out a long-standing inequality that contributes to the large number of elder deaths:

”They’re also dying because of a more entrenched epidemic: the devaluation of older lives.

“Ageism is evident in how we talk about victims from different generations, in the shameful conditions in many nursing homes and even — explicitly — in the formulas some states and health-care systems have developed for determining which desperately ill people get care if there’s a shortage of medical resources.”

Pointing out specifics about how nursing homes are woefully understaffed and under-regulated, while childcare centers that violate state rules routinely have their licenses revoked and facilities closed, Kohn reports,

”Almost two-thirds of the approximately 15,600 nursing homes in the United States have been cited for violating rules on preventing infections since 2017, according to a Kaiser Health News analysis of state inspection results.”

When fines are imposed, Kohn writes, they are low enough to be considered the price of doing business. Further, says Kohn,

”Ageism is most explicit in official policies governing whose lives should be saved if equipment or medical staff become scarce during the pandemic...states and health-care systems have plans for such situations.

“All prioritize patients who are likely to benefit from treatment over those who are unlikely to benefit, but many also rate them based on age — with younger patients getting the nod.

“Louisiana, for example, has long advised hospitals to employ a triage system for disasters that deprioritizes anyone age 65 or older. In April, Pennsylvania issued interim guidance that directs hospitals to rank patients based on broad 'life stages': age 12 to 40, age 41 to 60, age 61 to 75, older than 75.”

Ms. Kohn concludes and I agree:

”Inequalities rooted in ageism have caused the coronavirus to spread, and many policy responses take for granted that older lives are worth less than younger ones. These moral blind spots compromise the fight against the pandemic and diminish us all.”

Which brings us back to today's headline: Are Old People's Lives Worth Less Than Young People's Lives? What do you think?

This is an important story rarely so well and thoughtfully reported as Nina A. Kohn has done. You can read it in full at the Washington Post.

Comments

This is far more complicated a question that it might seem. It is inevitable that we are all going to die. That is a certainty of life on this planet so both life and death must be respected. I certainly think more about the fact of my death more now in my 70's than I ever did even a few years ago.
However, a facile answer might be that the only life worth respect in that still in the womb.

The Swiss ICU Pandemic guidelines, leave it to the Swiss to pre-plan, do not rank people by age or disability. It's solely based on short-term prognosis with or without intensive treatment and specifically says not to use medium or long term life expectancy. If your commorbities mean you wouldn't survive, then sure, take it into account but none of this toss the 75 year old for the 60 year old, for the 50 year old etc. The fact that it seems most other countries quickly came up with such ranking systems, unquestioningly too, is quite interesting. It shows that ageism really is "to the bone."

Dystopian ideas now resurrected, and while I was looking for the Washington Post story, I found that Jerry Stiller passed away, and how he brought together a comedy team, with Anne Mearra, and produced kids who brought us more, L'dor V'dor, generation to generation, thinking G-d will take us, and all that too. Pandemic guidelines, and the role of learning from and having leadership from whom? "After Army service, he received a bachelor’s degree in speech and drama from Syracuse University in 1950. He met Meara in New York three years later. Both were looking for work, meeting with an agent who made a pass at Meara while she sat alone in his office. When she ran out in tears, Mr. Stiller followed, invited her for a cup of coffee and offered to pay. Instead, she insisted he steal the silverware; she needed another set for her apartment.

Flatware pilfered, the couple soon married and started a family in New York, raising their two children, Ben and fellow performer Amy Stiller. When Mr. Stiller and his wife guest-hosted the daytime talk program “The Mike Douglas Show,” Ben and his sister were brought on to perform a squawking violin rendition of “Chopsticks.”

Ageism is growing. Young feel the elderly are holding them back. Sound familiar? Letting the old die is a prevalent theme in all societies. Most accumulated wealth is controlled by the elderly. Isn't it like the proverb about saving for a rainy day? Sorry, after working for 66 years I am a little short on generosity. Ageism aside, I feel I have a right to enjoy all that I worked for, even if I can't go to a movie and a nice dinner. B

The idea that the old should give way for the young is pretty much incorporated in human existence. No argument here. But the utter inhumanity of saying old people should die for THE ECONOMY is a window into a person who lacks a soul. What's really outrageous is that they feel it's normal to say these things out loud.

Some journalist should compare their comments about sacrificing the old with their statements on protecting the unborn. Maybe we should start referring to the aged as fetus'.

I've been sequestered in my tiny assisted living quarters for nearly 60 days. And, while it certainly is a hardship I know I have to do it to keep me safe. The draconian measures they have taken are evidently working because as of today none of our residents have died while in the facility.
Unfortunately, eight residents have succumbed to the virus in a nearby hospital while being treated for other illnesses. A tragedy many of us will have to deal with, alone. This is why I'm very afraid of getting ill right now knowing, if I leave here, I might never come back. This is what many older Americans are facing today. Something is going on in our hospitals in regards to the care and treatment of seniors and it's not good.

I'm afraid that in modern western society it has always been that way. When things were good the veneer of denial of that fact was thicker...veneer nevertheless. The thing is, what are we going to DO about it?
Jackie M

Oh lovely, another addition to the "let's get depressed" list along with "don't go out, you'll die," and the extra 20 lbs added even with regular treadmill sessions.

I would love to think that there is anything we can do about anti-old but until everyone over the age of 70 is a millionaire, no one is going to pay attention to us.

And so, life goes on! Take care, stay safe, don't despair.
o/

Ventilators were not given to Covid19 patients in Italy who were 65+. Sweden seems unconcerned that the majority of their Covid19 deaths take place in nursing homes (they use a different term for nursing home & I don't remember it.) In the U.S., 30% of Covid19 deaths were nursing home residents. Barring Italy, I think the nursing home death rate shows very poor infection control.

I am a longtime zoo volunteer. In response to the man from Texas, African dogs, a highly social mammal, takes care of their sick and elderly by bringing them food.

If it’s a choice between the lives of children and my life, they win, hands down! I’ve had a great life while they’re just beginning. I don’t mean to say I’m giving up, far from it. I’m relatively healthy at 75 and hope to stay that way for the foreseeable future. In the event of life threatening illness, though, I’m all right with dying with dignity. But that’s just me; others for sure feel differently. Understand though, I would like the decision to be mine.

Ooops. Not the man from TX. The man from CA.

Up until about two weeks ago here in Florida I believed the alarming number of unreported COVID deaths among Seniors was simply accepted as collateral damage. It's not collateral damage - more of an intentional coverup aided by a gross ineptitude and incompetence. This sophisticated society is way beyond a Stone aged mentality where we took those old folks out into woods and left them on a flat rock!

All along the number of deaths in LTC and nursing homes have been concealed - as have those deaths in state prisons.

Why is this happening? Not reporting the accurate numbers keeps the more favorable statistics politically correct. Who or what benefits? Your guess is as good as mine.

If we can't dazzle these idiotic leaders with our brilliance and wisdom, I strongly suggest everyone, in lieu of being led out to that flat rock in the woods - we instead go vote - and vote often!

My life means as much to me as it ever did. Yours probably does too. There may come a day when I choose to lay that life down, but not today.

In the meantime, perhaps we can help build a sense of community with those around us. This could be more beneficial than merely dying.

I suspect that Odette is right -- it is our resources, or those that others share with us, that primarily protect our ability to survive, regardless of our age. Obviously the focus of this blog is on what happens to us as we age, but the fact is that there are many more people of all ages dying all the time due simply to lack of resources. Same as it ever was.

And please don't take my comments as a sign of despair. I put native plants in the ground to support the pollinators and birds, expecting that their numbers may be increased or at least sustained by this activity, and engage in other activities in hope that the environment and nature may be restored and rescued. I have overseen the care of my chronically ill husband over the course of 40 years regardless of the fact that he will never be a "productive" contributor to society again, as far as working goes. But America's -- indeed most of the world's -- emphasis on increased "productivity," consumption and elevating our lifestyles beyond that which is needed to reasonably maintain safety and health and insure future generations ability to do the same is out of whack and has been for several decades at least. It's interesting that the last great pandemic that took so many lives was also during a time when the discrepancy between the richest and poorest in America was similar to what it is today, and was soon followed by the greatest blow the American economy has ever experienced. Perhaps the U.S. will emerge from this time more successfully than it did in the 20th century and we will have learned something and will successfully apply it; I hope so, but that remains to be seen.

Triage decisions are complex. If it comes down to which of two patients gets limited resources, they'll go to the patient with the best chance of surviving, and that may or may not be the younger of the two. In an emergency situation, care goes first to the most critically injured (again, not necessarily the youngest). I'm certainly not going to step aside for one of those crazy demonstrators demanding a reopening and no masks.

I've long thought a nursing home is the last place I'd want to "live," and this pandemic has convinced me of that like nothing before.

I am not surprised, Ronni, that Dan Patrick of Texas said that older Americans should be sacrificed for the economy. Many others I bet think the same inwardly.

Having lived in this country a long time I came to think that the US stigmatizes older people; they certainly are a devalued group in the society. This could be because this is a youth-centrist culture where efforts to stay young is a billion dollar industry. The younger generation is afraid of growing old because of all the stereotypes. When you are afraid of something you want it to go away. Often the older people are shown as mentally or physically impaired, decrepit, helpless, old fashioned, and cognitively incompetent. There are few pictures of older happy Americans living joyful and productive lives independently. Although the symbolic and nurturing “grandma” who bakes cookies and play with the young ones is better perceived, she is still thought as unable to use a computer keyboard without help… So it is an easy step to think that old people can be sacrificed or placed in nursing homes with underpaid staff and little oversight.

Culture is very slow to change. I don’t think the US youth worshiping culture will change in my lifetime; ageism and all its ugly ramifications are here to stay.

I'm with Janet L. (I absolutely support death with dignity!), Cathy J., Susan R. and Yellowstone.

Thank you for this conversation on age discrimination. It made me take inventory of the ways I contribute to the idea that as an older person I am not worth as much as I used to be. For example, I have used self deprecating humor about my memory lapses and eyesight and hearing. I have tolerated and even smiled at remarks about my love relationship being cute. I have grown more quiet in conversations with younger people. I have made fun of how slow I am to understand how to use my laptop and cell phone and tv remote. Until I read the comment about the Swiss method of determining who gets healthcare first, I accepted as necessary and right that I would be at the end of the line for a ventilator. I have honored and respected old people since I was a young child, but am beginning to see I have fallen short in extending that respect to myself.

The WH is very much into pitting groups of people against other groups lately. State against state. Liberals vs Republicans.
Young vs old. Poor vs wealthy.
They thrive on the chaos.

No one talks much about the shared air of nursing homes and apartment dwellings and how the microbes move from one apt, condo or room to another. That’s probably one of the reasons NYC has been struck so hard.

Anyway, yeah, if it comes down to me at 72 and a 20 yr old being forced to give up on life, spare the 20 yr old please. However I don’t see these sort of situations popping up too often. If ever.

The throwing out of seniors into the void is simply more propaganda meant to create chaos and turn us all against one another.
Trump wants chaos in order to better to create a dictatorship.

Thoughts---
In the olden days, old people lived with family.
If a flu came along, the old probably died and it was considered natural and right that the strong survived.

Today, we notice the deaths more because the old are housed in one place and it comes to them more easily and more rapidly once the flu gets into the facility. (This is not to excuse the knowedge of the care homes inadequate care in most care homes.)

I would love to hear a debate on the question Ronnie presented to know if the amount of deaths acceptability and number of deaths would be different if one was living with family?

Sorry if this is confusing as the subject is so complicated and my mind goes in to many directions.

Money is so much a part of the answer and another topic for debate. Money is probably the answer to all this. Somebody on this site said "If it can be fixed with money, it is an expense."

A lot of these deaths were poor people with chronic conditions, not the wealthy.

I am so grateful that I am outta there,

Few old persons check themselves in to a nursing home; it is an option when independent living, assisted living, or home care cannot provide the level of care needed. So, nearly all patients in nursing homes are not well enough to lead the activism needed for reform.

Are we who are old but living independently going to make some noise now? Will the middle-aged children?

If one has a week immune system, one is a sitting duck for infection. I am not sure the public realize how difficult infection control is in any institution. Nursing homes need to do a better job, absolutely, but it is a tough problem, Covid or not.

Oh this might be a futuristic curveball, or maybe it's already happening. Consider the AI programmer who is programming AI logic for something like, let's say driverless cars where two cars are on a serious unavoidable accident/collision course and the AI programs (which are communicating with each other) have to determine which car has the more "valuable" occupants so it can programmatically alter what happens in the collision in an attempt to save lives. When you write programs you have to include logic for as many things that can go wrong as you can think of. These systems run at speeds of millions of instructions per second. How will the programmer code the value of the occupants?

To answer your question, "No, older people's lives are not worth less than the lives of younger people." Perhaps some who tout so loudly they're the defenders of human life while trying to force their beliefs on others seem to have among them leaders they support who make an exception for older people.

There can be numerous factors that come into play when someone becomes a patient with illness of any kind. Age is only one factor with numerous others that may appropriately enter into any decision about how to proceed with the individual's care. Setting up criteria with age a major influencing factor on which a decision is based is a simplistic "cookie cutter" approach which I strongly oppose in all of health care whether it be for surgery, rehabilitating therapy or other care. It's often based on stereotyping individuals. Circumstances that require triage care also should be administered on assessment of each individual whatever the age.

As for institutional living, most such places may stay within the regulations to which they are required to adhere but likely meet the least demanding criteria level -- that's probably less costly for them. My observation, even among some of the best multi-levels of long term care living arrangements, is these regulations allow them to have inadequate RN staffing, also instead replacing some RNs with a lower qualified nursing level. CNAs numbers are inadequate, too. Complicating matters is the fact of a shortage of trained nurses and aides at all levels which is partially why standards were lowered years ago to begin with.

The quality of care in settings for those depending on supplemental government program assistance can experience even less needed care and attention due to low reimbursement rates to the institution and providers.

Infectious diseases have presented challenges in all those settings and hospitals as I recall when various viruses began to surface years ago -- MRSA, VRE, Norovirus to name a few. Then hospital patients were sometimes unexpectedly transferred to various institutional settings that could be unprepared, especially in the beginning for a new virus. Viruses are infections that should not be taken lightly at any age and we older folks are especially vulnerable.

The idea of the older giving their lives for the younger (or for that matter anybody giving their lives for another) has to be their choice and not forced on them by another. You don’t get to be reckless (by not doing everything possible to prevent infecting another)
just because It’s too much trouble and you think the other person is expendable.

Using that criteria why should we spend any resources to care for people who are sufficiently handicapped as to not add value to society? People who are disabled to the point where they can’t hold a job. They are just a drain on society- money that could be much better spent in more productive places.

Also - just in case it has not registered yet... by saying that we must open up even though there will be more deaths (vs saying we will open up with plans with a goal of “no more deaths”) they have just said this... “It is ok for a manufacturer to decide that a product defect that may cause death is ok to not fix if it’s not economically advantageous to them to do so.”

Obviously some level of mortality can be economically justified. So no more “wrongful death” suits in these cases.

Basically they have just made the case that we don’t have to be responsible for each other.

SO true, Bob. That's exactly what the wannabe Emperor of Trumpistan espouses. With him, his reptilian associate Stephen Miller and the rest of his circle of sycophants, it's ALL about the money and stomping on "the Other" (which is anyone not part of their crowd).

My kidneys are failing and I am not doing diyalisis..The nephrologist let me know I was not going to get a kidney at 70 almost 71..His nurse who schedules everything now acknowleges I can physician assisted you know what..She said it as much when I spoke with her this past tuesday..I asked about the drugs knowing full well how expensive and difficult they were to get, she said I could get that in washington state and oregon..Our insurance in this hmo we had excellent insurance..geez, one would think professionals would speak to patients better..My husband is devastated and so is my only child who wants to give me her kidney and my hubs also, but to tell the truth I am tired and not in any pain and watched my mom suffer with cancer all thru her with no insurance and no help, I keep thinking I will drift away peacefully..It is afterall my own life isn't it..I read your blog and to tell admire your guts and determination but I don't feel the way you do and just want some rest and if it permanent than that is my feeling, why doesn't the medical establish listen to what the patient really wants..just my opinion...

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