老有所“依”

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 excellent5)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.

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.

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.

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院。而那個地方將會是你除了醫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炎，在連續跌倒過幾次之后，她別無選擇，只能離開之前的公寓大樓住到療養院。通常狀況下，都是孩子們把老人送去療養院，但是這位老奶奶的情況卻是她自己決定住進療養院。“一周之內我摔倒了兩次，我告訴女兒我不再適合住在家里了。”她說。

她是一個月前住進療養院的。這家療養院是她自己挑的，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。

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。“我知道我不能做我之前做的事情了，”她說，“但這里讓人感覺像個醫院，而不是家。……