心靈美文_老有所“依” Rethinking Old Age
文字難度：★★☆
At some point in life, you can’t live on your own anymore. We don’t like thinking about it, but after retirement age, about half of us eventually move into a nursing home, usually around age 80. It remains your most likely final address outside of a hospital.
To the extent that there is much public discussion about this phase of life, it’s about getting more control over our deaths (with living wills and the like). But we don’t much talk about getting more control over our lives in such places. It’s as if we’ve given up on the idea. And that’s a problem.
This week, I visited a woman who just moved into a nursing home. She is 89 years old with 1)congestive heart failure, disabling arthritis, and after a series of falls, little choice but to leave her 2)condominium. Usually, it’s the children who push for a change, but in this case, she was the one who did. ‘‘I fell twice in one week, and I told my daughter I don’t 3)belong at home anymore,’’ she said.
She moved in a month ago. She picked the 4)facility herself. It has excellent 5)ratings, friendly staff, and her daughter lives nearby. She’s glad to be in a safe place—if there’s anything a decent nursing home is built for, it is safety. But she is struggling.
人生到了一定時候,你就再也不能照顧自己了。我們不愿去想這些事情,但是過了退休年齡以后,通常在80歲左右,我們中大約一半的人最終會搬進療養(yǎng)院。而那個地方將會是你除了醫(yī)院之外的最有可能的命終歸宿。
提到大眾對這一人生階段的討論,大多圍繞著應如何更好地應對掌控死亡這一問題(比如說生前立遺囑之類的)。但我們很少談論到怎樣更好地掌控自己在療養(yǎng)院里的生活。好像我們已經完全不去想了。而這正是問題所在。
這周,我拜訪了一位女士,她剛剛住進了一家療養(yǎng)院。老人家已經89歲了,并且有充血性心力衰竭和導致她行動不便的關節(jié)炎,在連續(xù)跌倒過幾次之后,她別無選擇,只能離開之前的公寓大樓住到療養(yǎng)院。通常狀況下,都是孩子們把老人送去療養(yǎng)院,但是這位老奶奶的情況卻是她自己決定住進療養(yǎng)院?！耙恢苤畠任宜さ沽藘纱?我告訴女兒我不再適合住在家里了?！彼f。
她是一個月前住進療養(yǎng)院的。這家療養(yǎng)院是她自己挑的,其聲譽好,工作人員友善,而且女兒就住在那附近。她很高興 自己能待在一個安全的地方——如果說一家像樣的療養(yǎng)院是為了某個目的而建造的話,那就是安全。不過,老人家適應起來還是掙扎了一番的。
The trouble is—and it’s a possibility we’ve mostly ignored for the very old—she expects more from life than safety. ‘‘I know I can’t do what I used to,’’ she said, ‘‘but this feels like a hospital, not a home.’’ And that is in fact the near-universal reality.
Nursing home priorities are matters like avoiding 6)bedsores and maintaining weight—important goals, but they are means, not 7)ends. She left an 8)airy apartment she furnished herself for a small 9)beige hospital-like room with a stranger for a roommate. Her belongings were 10)stripped down to what she could fit into the one cupboard and shelf they gave her. Basic matters, like when she goes to bed, wakes up, dresses, and eats were put under the rigid schedule of institutional life. Her main activities have become 11)bingo, movies, and other forms of group entertainment. Is it any wonder most people dread nursing homes?
The things she misses most, she told me, are her friendships, her privacy, and the purpose in her days. She’s not alone. Surveys of nursing home residents reveal chronic boredom, loneliness, and lack of meaning—results not fundamentally different from prisoners, actually.
Certainly, nursing homes have come a long way from the 12)firetrap warehouses they used to be. But it seems we’ve settled on a belief that a life of worth and 13)engagement is not possible once you lose independence.
問題是——這也可能是對老人我們通常會忽略的地方——她期望從生活中得到更多而不只是安全感?！拔抑牢也荒茏鑫抑白龅氖虑榱?”她說,“但這里讓人感覺像個醫(yī)院,而不是家?！笔聦嵣?這幾乎是很普遍的情況。
療養(yǎng)院擺在首位的大事無非是讓老人家避免褥瘡和維持體重等——都是些重要指標,但這些只是途徑而非目的。老人家離開自己裝飾布置,通風透氣的公寓,來到一間米色調、像醫(yī)院病房一樣的小房間,還要和一個陌生人做室友。她只能攜帶一些有限的生活用品,而且是要能夠放進療養(yǎng)院提供給她的一個壁櫥和架子里的。一些基本的生活問題,比如睡覺、起床、穿衣和吃飯時間都被嚴格制度化,得按章進行。她的主要活動變成了玩賓果游戲、看電影和其他形式的群體娛樂。這樣的療養(yǎng)院生活怎么會不令大多數人心生恐懼呢?
老人家告訴我,她最懷念的是她的友誼、隱私和她每一天的目標計劃。她并不是一個特例。據調查顯示,居住在療養(yǎng)院里的老人們會長期感到厭倦無聊、孤獨寂寞和缺乏生活目標——實際上,這些調查結果顯示的與囚犯們的感受沒什么根本區(qū)別。
當然,療養(yǎng)院從過去那種充滿火災隱患的倉庫式建筑發(fā)展到今天這種狀況已經是很大的一個轉變了。但我們似乎早就篤定了一種觀念——一旦生活不能自理,想過有價值有保證的生活就是不可能的了。
There has been, however, a small band of 14)renegades who disagree. They’ve created alternatives with names like the Green House Project, the Pioneer Network, and the Eden Alternative—all aiming to replace institutions for the disabled elderly with genuine homes. Bill Thomas, for example, is a 15)geriatrician who calls himself a ‘‘nursing home abolitionist’’ and built the first Green Houses in 16)Tupelo, 17)Miss. These are houses for no more than 10 residents, equipped with a kitchen and living room at its center, not a nurse’s station, and personal furnishings. The bedrooms are private. Residents help one another with cooking and other work as they are able. Staff members provide not just nursing care but also mentoring for engaging in daily life, even for 18)Alzheimer’s patients. And the homes meet all federal safety guidelines and work within state-19)reimbursement levels. They have been a great success. Dr. Thomas is now building Green Houses in every state in the country with funds from 20)the Robert Wood Johnson Foundation. Such experiments, however, represent only a tiny fraction of the 18,000 nursing homes nationwide.
‘‘The No. 1 problem I see,’’ Dr. Thomas told me, ‘‘is that people believe what we have in old age is as good as we can expect.’’ As a result, families don’t press nursing homes with hard questions like, ‘‘How do you plan to change in the next year?’’ But we should, if we want to hope for something more than safety in our old age.
‘‘This is my 21)last hurrah,’’ the woman I met said. ‘‘This room is where I’ll die. But it won’t be anytime soon.’’ And indeed, physically she’s done well. All she needs now is a life worth living for.
不過,有一小群“叛逆者”不同意上述觀點。他們提出了諸如“綠園計劃”、“先鋒網絡”和“伊甸園他選”等替代 物——所有這些計劃都志在用真正的老人之家來取代那些向不能生活自理的老人提供幫助的機構。例如,老年醫(yī)學專家比爾·托馬斯,自稱是“療養(yǎng)院廢除主義者”,就在美國密西西比州的圖珀洛市建立了第一所“綠園”。這些房子里的住客不超過10人,房內配備了廚房,房子中央是客廳而不是看護工作臺,還配備了私人家具。臥室是私人的。住客互相幫忙一起烹飪以及分擔其他一些他們能做的事情?？醋o人員不僅要提供看護,還要指導他們如何過好日常生活,甚至包括指導患早老性癡呆病的住客。這些房間全都符合聯邦政府的安全指引,而且其費用標準也沒超出國家福利資助范圍。
他們取得了巨大的成功。依靠羅伯特·伍德·約翰遜基金會的資金支持,托馬斯醫(yī)生現在正在美國的各個州建立“綠園”。然而,類似“綠園”這樣的試點在全國范圍內的18000所療養(yǎng)院中所占的比例微乎其微。
“我覺得,最大的問題是大家都覺得現在提供給老人的服務已經不錯了?！?托馬斯醫(yī)生告訴我說。結果,人們就不會向療養(yǎng)院施壓,提出諸如“你們打算下一年做些什么改變?”之類的難題。但是如果我們想要期待自己年老時可以得到一些除了安全感之外的東西,那我們就應當提出那些問題。
“這是我最后的努力,”我探訪的老奶奶說,“這個房間將是我離開人世的地方。但是這還得有一段很長的時間?！贝_實,她的身體狀況還很好?，F在她所需要的是一種過得有意思有盼頭的生活。
