Creeping Normalcy…in a retirement community

I have not posted to the series “Diary From a Social Distance” in many months. The novelty, even of a pandemic, and the insights it might offer each of us, have gradually faded into the background of daily life, no matter how restricted. I offer this poem, written over the course of the summer and early fall, as a final post in this series. An historic US election will take place in less than a month and, regardless of the result, will, perhaps, give birth to a new series of posts under the umbrella of “respect.”

Creeping Normalcy

Normalcy is creeping back into our lives.

It is hard to resist.

All my resolutions to live

By the lessons learned during

These past months of pandemic,

Are donning fresh feathers and

Getting ready to fly out the window.

Sick of “social distancing” guidelines,

An impromptu cocktail hour

Has sprung up on the patio.

Technically, chairs should be

Six feet apart and masks should be donned,

But even without a tape measure, I can

See that the chairs are nudging closer.

And masks are dangling from one ear

Or bundled beneath the chin.

A nose peeps out, to catch a breath

Or lips to speak a word unmuffled by a covering.

Others have dispensed with masks all together.

After all, how can you consume a cocktail

With your lips held prisoner by a mask?

The staff, hoping I suppose to set good examples,

Wear their masks avidly and sit at great distances

For their lunch breaks on the patio.

At the beginning of this long ordeal,

When I would step outside my door in early morn,

To begin my daily round,

I would be shocked by the quiet – the absence

Of traffic humming in the distance.

Now, not only do I hear it at

Rush hour, but when I drive to some “essential” errand

I notice a “normal” number of cars on the road. 

In pandemic’s early months, the streets were quite deserted.

Though I have not dined in a restaurant,

But only ordered take out,

Or shopped in any store,

Except a pharmacy or a supermarket,

I felt emboldened by the warm weather

To meet friends outdoors and walk

Among the budding trees,

Six feet apart, of course,

En-masked for sure.

Now that nearly seven months have passed,

And we are reminded frequently that not one single

COVID case has plagued our retiree sheltered lives,

We feel a sense of invulnerability.

We think, why not eat inside at the “Dolphin”

Shop with crowds at Walmart,

Go to church, a wedding, or a funeral.

Let those who live in congregate housing

And those who live in cottages co-mingle, we implore,

To do jumping jacks and yoga,

Play bridge and ping pong,

Meditate and talk!

But no, the risk is still too great

Until we vaccinate.

The prime concern as winter comes,

And holidays are round the bend

Is contact with our families.

We’ve seen them “en plein air,”

So to speak, in summer months.

Cold gradually prevents that luxury now.

The staff is searching for a way

For us to see those we love in cold and snow.

A special room, a special shield,

Hygienic cleansing, no touching please!

Enormous effort, expensive too.

Reminding some of TV scenes

Of prisoners on either side of

Touch-proof glass

With hands outstretched, and eyes engaged.

What seems acceptable and normal now

A year ago

Would have been unthinkable.

This normalcy has crept upon us

Each day, each week, each month.

So now, the temptation is oh-so-keen

To abandon caution,

Let down our guard.

But no! En garde! My friends.

A little more patience and sacrifice

Is required of us still.

Our strength and ingenuity will help us

In this battle against virus and the flu.

Get your shot, wash your hands,

Wear your mask, stay six feet apart.

We will prevail!

And though the virus spreads and kills,

We’ll do our part on our small front

To end this Plague, and stem this Tide

Of loss and grief,

Inhumanity, and vicious Pride.

Moriah Freeman

October 10, 2020

Walking Meditation

About six weeks before the COVID-19 pandemic forced us to practice social distancing, a small group of residents at my retirement community began a weekly meditation session. The activity fell under the umbrella of “Health and Wellness,” and the meditation we practiced was purely “secular.” Each week the same core group of meditators gathered for half an hour of sitting (or lying down) in silence and stillness, focusing on our breathing and relaxing our bodies.

Proof that we found it helpful lay in the fact that we kept coming back. Some of us were new to meditation, and others had practiced for years, but meditation is an “equalizer.” We are all beginning again, each time we sit in silence.

In early March, the decree came down from on high (the management) that we must not gather indoors in groups of any size, we must stay six feet apart at all times and, eventually, wear face masks. The cottagers were told not to come to the main building where the apartment dwellers live. So, reluctantly our little band of meditators “disbanded.”

Before “social distancing” became the rule of thumb, I invited the group to try walking meditation. But while we could gather indoors, there was not much interest in it. Then, as hints of spring began to appear in the world around us, as we became tired of long days inside, I asked again if anyone would like to join me outside for a meditative walk. This time it appealed.

We gather on the open patio behind the main building. Fortunately, two paved paths lead off in opposite directions from this central point, bordering the large triangle of lawn on which we play croquet in the summer. The paved walkways are safer for those of us who are unsteady on our feet, and those who use canes or walkers.

We begin at 1:15 p.m. each fine day (but not during rainy weather.) The small masked gathering of five or six seniors stands quietly in a large circle with the appropriate distance between each. A singing bowl chimes three times, and we start off at a snail’s pace, down the left walkway and back to the patio, down the right walkway and back to the patio. We again gather in a circle, hear three more chimes, and end by bowing to each other and offering the greeting “Namaste,” “the light in me honors the light in you.”

Such a simple practice, but one that we find meaningful and helpful during this stressful and tumultuous time. Focusing on the breath as we walk gently on the earth awakens us to the present – to what we see, smell, and hear, to the warmth of the sun and the touch of the breeze on our faces. We thank each other at the end of the walk. At first, the “thank-you’s” were accompanied by smiling lips, but now, we see only smiling eyes above our face masks.

I don’t know what my fellow meditators experience during our daily ritual.  For me, it is a welcome break in the middle of each day.  My days are not exactly “busy” anymore, but they’re still full and purposeful. Our walking feels like an anchor that holds me secure amid all the uncertainty around me. I take deep breaths and allow my “self” to sink into my body. As my mind quiets and my body awakens, my senses are heightened. I see more clearly and hear more acutely. My brain stops whirling like a dervish, and my time-conditioned mind drops into the timelessness of “now.”

The enormous pine tree in front of me waves in the breeze with a “whishing” sound. The birds chirp, and so does a brave little chipmunk who is determined to warn us away from his territory. We notice first the crocuses, then the daffodils, and eventually tulips leaves and tiny red buds on trees that will soon flower in glory. I totter along, wondering at how unbalanced I feel when I walk slowly. I hear the gentle scuff of feet behind me. I disengage from planning. I stop analyzing and dissecting the circumstances of my life. Someone told me that other community members look down at us from their apartment windows. I wonder what makes them stay inside. We are an open invitation to a simple and mindful pause in the middle of the day.

No matter how slowly we walk, the meditation ends too soon for me. I ask myself, again, to carry this slow “nowness” into the rest of my day.

What sustaining rituals have you created during the Coronavirus pandemic? What new practices are your anchors at this time of worry, fear, political confusion, isolation, loss, unemployment, poverty, sickness, and death? If you have found some inner peace and reassurance during this time, can you carry it forward into the future? Can you join it to the various awakenings experienced by many others in this unprecedented situation? Might it be a “change-agent” for your life after COVID-19 is vanquished?

So might it be.

Coping Tips

For some time, I’ve been meaning to share my friend Carolyn’s blog with my readers. Carolyn is a writer, mother, and philosopher. She publishes twice a week, or more, and I am amazed by her creative, resourceful and wise approach to every situation. She has wonderful tips for navigating all areas of life. AND she will make you smile and laugh! Thank you, Carolyn. I always find something in your posts to stimulate reflection.

Some Sense of Normal

Behind the Scenes: Respecting those who serve you

[I am breaking into my series on “Executive Assistants and Respect” to post an article on another group of service people – wait staff in dining establishments; a topic that is now of great interest to me.]

Almost three years after my retirement from Harvard, my work life took an unexpected turn.  I began waiting tables in the dining room of the retirement community where I live.

Our dining room is chronically short staffed for a variety of entirely understandable reasons.  The work is physically hard, and the pay is relatively low.  We offer staff a generous yearly bonus but no tips.  For these reasons, the job attracts mostly young people – high school and college students for whom this may be their first work experience.  We feel very grateful for them and for the more mature wait staff who have been serving steadily and faithfully for many years.  However, the lives of teenagers and those in their early twenties are constantly changing, and their studies must take priority, so they often need to move on to other important things.  The staff turns over rapidly and hiring and training new staff takes a great deal of time, effort, and patience.  The head of dining services and the dining room manager are always between a rock and a hard place.  They want to offer the residents the highest quality service – an excellent dining experience – but they find that difficult to do with a shortage of wait staff.

When the head of dining services described this situation at a resident meeting this past fall, I immediately wondered if I, at the age of 65, could do anything to help solve the dilemma.  I was completely aware of my time constraints and physical limitations, but I spoke with the dining services director anyway, offering my assistance in any form that might work for both of us.

A month later I started waiting tables on Tuesday and Thursday evenings.  The other residents and the kitchen and wait staff are very supportive and patient, and after two months of learning the ropes, I am beginning to relax and enjoy the work.

I have learned more than I could have imagined about what goes on behind the scenes in the kitchen and what wait staff do.  My respect for those who do this work has grown enormously.

Shifts for wait staff during the evening meal are four hours long.  On very busy days or days when the dining room is short-staffed, they can stretch to four and a half or even five hours.  Some staff work two shifts a day, a full eight-hour workday.

For the first hour, the staff members prepare for the meal.  Wait staff check tables to make sure the settings are complete, prepare condiments, make the coffee, fill water pitchers, set up the service stations, prepare fruit cups, cut and plate desserts, restock the ice cream freezer and make sure dressing and beverage dispensers are full.  They prepare the order slips for the tables they have been assigned and make a note of the starch and vegetables being offered and special appetizers and desserts for the day. They also prepare trays for room service, deliver them and, if there is any time left, fold napkins. Ten minutes before the meal begins, the chefs brief the waitstaff on the menu, and there is an opportunity for reminders and questions.  If short staffed, and table service is not feasible, the wait staff help to set up a buffet.

Once the meal begins, wait staff are in constant motion for two full hours. On most evenings the waiter is assigned three to five tables of various seating capacity.  The timed arrival of diners makes it possible for one wait person to serve as many as 16 people during the meal.  They offer beverages, take orders, deliver appetizers, entrees, desserts, coffee and tea, clear tables between courses, and reset tables when guests have departed.  There is no separate “bussing” staff, so wait people do it all.

Once the meal is over, around 7:00 or 7:30, wait staff are assigned “closing” tasks.  Covering unused salads, desserts, and condiments, restocking supplies and linens, washing the coffeemaker and pots, wiping trays and carts, picking up room service trays, and disassembling the buffet table.

The dining services director and dining room manager supervise the entire four-hour shift and pitch in when necessary to make sure service is smooth and timely.  It is, indeed, a well-oiled machine and teamwork at its very best.  Staff members look out for one another and help when they see a need.  They do this with good humor, respect, and appreciation for everyone’s contribution.  Current staff welcome new members with open arms.  He or she will make everyone’s work easier.  All are open to learning from and encouraging one another.

Even more “behind the scenes” are the chefs and their assistants.  The kitchen is busy and well organized.  The chefs are proud of the food they prepare and serve, and they help the wait staff to provide the best service.

While all of this is specific to the dining room in my retirement community, it provides a window into restaurant and foodservice venues everywhere.  Our residents and dining room clientele are appreciative and respectful of the staff who serve them, but I wonder how many know what goes on behind the scenes to deliver the meals they enjoy daily.

So, the next time you are dining out at a restaurant or frequenting our dining room and service seems a little slow, or a wait person forgets an item you have requested, or you are facing yet another buffet on a night when staff is short, please remember that the folks who are serving respect you. They are doing their best and are worthy of your respect too.





Motorcyclists and Respect


[Photo Credit: Pixabay Free Downloads]

Many years ago, when I lived in a suburb of Boston, I called the local police in the middle of the night because neighbors were partying with blaring music and loud shouting.  I said to the officer who answered that I wanted to report a “disturbance of the peace.”  “A what?” he asked.  “A lot of noise,” I translated.  This story has been told at my expense in many circles to illustrate the old-fashioned “turns of phrase” I sometimes use.  (Just as an aside, I have also been teased mercilessly because I once said, “so-and-so had a baby out of wedlock.”)

This post is about motorcycle noise, so, in a manner of speaking, it’s about disturbing the peace.

Let me say up front that I love motorcycles.  A highly polished black and silver Harley Davidson is a thing of beauty.  Riding with an experienced cyclist can feel exciting and freeing.  So, I’m not prejudiced against motorcycles or cyclists.  I know a couple who have taken cross-country motorcycle trips as seniors and I admire their sense of adventure, their courage, and their style!

Loud motorcycle noise, however, is definitely a “disturbance of the peace” in my book.  When I lived in Massachusetts one of my greatest joys was sitting on our screened porch on a warm summer evening with a glass of wine and a book, or engaging in quiet conversation there with friends.  I was livid when our peace and our conversation would be interrupted by the deafening roar of a motorcyclist racing up a nearby street, revving his engine to the maximum.  Often, as I was falling asleep at around ten p.m., I was incensed to be awakened by the same cacophony – inconvenient for me, but even more so for the neighboring parents of small children whose interrupted sleep would make them cranky the next morning.

Early on, shortly after we built the porch, I called the town police to report the disruptive motorcycle noise.  They indicated little interest but said they would “look into it.”  The noise continued, multiple times daily.  Next, I dropped in at the police station and expressed my concern.  The duty officer behind the glass wall said that it would be impossible for the police to catch such a cyclist in the act of making the noise because by the time they arrived on the scene he would have sped on his way.  I suggested that just parking a cruiser in the vicinity for half an hour on a summer’s evening would enable them to catch the culprit.  They suggested I call the next time the disturbance occurred.  I gave up and the roar of engines continued.

Several years later, after my retirement, I finally had the time to think about a more effective approach to the problem of excessive engine noise in my neighborhood.  I asked the candidates running for town council to suggest solutions (hinting that the one who provided a successful result might get my vote.) Their answers ranged from presenting the issue at a town council meeting to organizing a petition with my neighbors.  I chose, instead, to write to the town’s police chief.  He responded, after some delay, by saying that he would raise it at his next staff meeting to see if his duty officers could suggest solutions.  He did not report back to me the results of this consultation and the noise continued.  Finally, I moved away before having the opportunity to approach the town council or to organize my neighbors.

What is the point of this story-telling?

I am presumptuous to speculate on the reasons why cyclists loudly rev their engines, but I will do so anyway.  Is it the thrill of accelerating quickly?  I wouldn’t want to put brakes on the thrilling activities of others, but it seems that a muffler might mitigate the consequences for those nearby. Is it selective defiance of the restraints of society?  Which of society’s restraints would the cyclist want to be enforced for his or her own comfort and peace? Is it a deliberate attempt to ruin his or her hearing?  Or is it simply a “f— you” attitude?

Whatever the explanation, at its roots, loud motorcycle noise demonstrates lack of respect for those nearby – a lack of interest in or care for how the cyclist’s behavior affects those in the vicinity.

This post completes my “pet peeves” series:  disrespectful bicyclists, dog owners, and motorcycle noise perpetrators.  Respect arises from, among other things, thoughtful reflection on how my behavior may affect the lives of others – it’s the good old “golden rule” principle.  Do I want to be endangered, limited or even just interrupted by others?  Does exercising my so-called rights or liberties harm or inconvenience my neighbors?  These are “old-fashioned” questions like the phrase “disturbance of the peace,” but perhaps it’s time to revive them.

Dog Ownership and Respect

A year ago, I adopted a dog from a shelter called “Save a Dog” in Sudbury, Massachusetts.  I had longed to own a dog for many years but had always felt it would not be fair to the dog since I worked long hours, far from home and could not give it the company, exercise and care it would need.  A year and a half after I retired, I decided it was time for the great dog-parent experiment.  Admittedly, I was not as prepared as I should have been, having no clear idea how much time, energy, patience and money it would involve.  When I fell in love with the first puppy I met, I didn’t listen to advice about looking for an older, lower-energy dog “at my age.”

However, a year later and much water under the bridge (as well as many nights of wanting to tear out my hair in frustration), I now have a beautiful, happy, and relatively well behaved 18-month-old Paperanian (Papillon/Pomeranian mix), named Digby.  I have learned not only a great deal about dogs in the last year, but also about dog ownership and dog owners.

One of the saddest lessons I’ve learned is how unwelcome dogs are in most public places. Signs abound in stores, hospitals, malls, hotels, tourist sites, restaurants (of course), parks, campuses and even on wooded trails. I had no idea that a well-behaved dog and a responsible owner would find so many barriers to enjoying ordinary daily life together.  Occasionally I would see a water bowl outside a store and I would think, “Oh, this place must be dog friendly!”  Yes, but outside only.

I can, of course, understand why dogs (except for service animals) are not allowed in restaurants, and hospitals. I’m guessing that issues of allergies, hygiene and fear cause these bans.  But I find it harder to understand why dogs are not allowed in outdoor venues, hotels, malls, or large stores.

However, as I looked around more carefully in my neighborhood, populated by quite a few dogs, I began to understand why dogs have, in large part, been banished to their own homes and yards and to dog parks.  I walked the neighborhood with my pup, pockets stuffed with “dog waste” bags, and noticed that the streets and sidewalks were defiled everywhere with the excrement of other people’s pets.  I jokingly put words in my dog’s mouth: “Mom, why do you pick up my poop all the time when other moms don’t do so.  I must be pretty special.”  On our walks through the woods the waste would be even more pronounced in spite of abundant signs pleading with dog owners to pick up after their pets.

I also saw signs saying, “Dogs allowed on leash only,” and my heart would sing.  However, no sooner had Digby and I entered the permitted area than an off-leash dog would dash up to us, followed at a distance by its unconcerned owner.  Digby, who is smaller than many dogs, would cower behind me and I would cower behind a tough but false cheerfulness about the situation.

“Jumping up” is another problem in public places. Yes, it’s difficult to teach your dog not to jump on strangers or friends, but it can be done.  Though Digby is not perfect, he’s a lot better than he was as a younger pup.  It’s taken a lot of persistence with him, and a lot of educating of those who want to greet him, to get him to the stage where he will squirm with excitement at someone’s feet, sit upon command most of the time, and wait for his new friend to bend over and slowly and gently scratch him under the chin.

So, what is the point of all this storytelling?  Sadly, I believe the disrespectful behavior of many owners causes dogs to be unwelcome in so many settings.  If more owners would pick up after their pets, keep them leashed when required, and teach them how to behave in public, dogs would be better integrated into our society.  Wherever I go, people stare in awe at service animals (the legitimate ones) who are so calm, well mannered, and expert at their trained tasks.   No one expects such model behavior from a pet, but certain minimal behavioral norms are the entrance key to more “allowed” places for dogs.  “Pick up” means pick up; “on leash” means on leash; no jumping on people, no barking incessantly.  Again, it comes down to respecting the rules – there is a reason for them – and respecting the needs of others.

I am thrilled when a public place, like our new bank in Maine, allows us to bring our dog inside while we do business.  I’m going to be extremely careful that he is as well behaved as he can be, politely greets the staff and other customers who want to meet him, and is not a contributing factor for a “no dogs allowed” sign on the front door in the future.




Bicyclists and Respect

For many years, as I commuted from my home in a Boston suburb to Harvard University, I frequently vowed that when I retired I would write a “Letter to the Editor” expressing my frustration with the bicyclists I encountered daily on my route through Cambridge.  Their apparently superior attitude and their disrespectful actions annoyed me intensely. I did not write the letter, but as I now reflect on respect I believe this blog would be an appropriate place to voice my pet peeves.

I know several people who bike to work who are extremely cautious about safety – they wear helmets, use reflective gear, and obey all the rules of the road.  When I complain to them about disrespectful bicyclists, they agree completely. I don’t know the cyclists personally who cause my frustration, but from observing their actions I imagine their attitude to be: “I’m better than you are.  I’m getting daily exercise while you sit immobile in a gas guzzling car, your emissions damaging the atmosphere (causing climate change).  The rules of the road don’t apply to me. Safety is your responsibility.  I have no responsibility to anyone for my biking behavior.”

Sound a bit presumptuous and judgmental?  Well, here’s what has led me to these assumptions.

I’m driving along Mass Ave in Cambridge in morning traffic.  I pull up to a stop light, noticing in my right rear-view mirror that a bicyclist is approaching me from behind.  I have my right turn signal on, but I am still nervous that the cyclist will shoot out into the intersection when the light turns green and I begin to turn.   However, instead, the cyclist whizzes by on my right, nearly scraping my car, and speeds through the intersection paying no attention whatsoever to the red light.  I fume!

Or, I’m driving down Sherman street at 6 p.m. The cyclist in front of me is not wearing a helmet.  Sherman Street is very narrow, so when she wants to jump the line of traffic she swerves onto the side walk.  Drivers, including me, are very careful to stay at a safe distance behind her.  I worry about her erratic behavior. Suddenly, as we approach the stoplight at the bottom of the street, she shoots out to the left of the line of cars, passes them all, glides through the stoplight and weaves into a street on her right.  I think, “She’s an accident just waiting to happen; one that could possibly ruin her life and that of the driver who hits her unintentionally.”

Boston instituted the “Hubway” bike share program about 10 years before I retired.  1,600 bikes are available at 180 stations across Boston, Brookline, Cambridge and Somerville. The program promotes attractive motives for using its bicycles to get around town: “Save time; save money; have fun; get exercise and go green.”  Several pricing options make it convenient to use the bikes:  $8 a day; $20 a month; $99 annually. One joins, gets a ride code or key and selects a bike at any nearby station.  Sounds like a great idea, right?

I cringed when I first heard about the program and when the distinctive Hubway bikes started appearing in traffic.  For the most part Hubway riders do not wear helmets (though I have heard that some stations do make them available.) Many are inexperienced – tourists in town looking for an “up close and personal” tour of the city; professionals seeking a quick way to get across town for a meeting; someone running an errand on his lunch break.  Were they more experienced riders, they would probably have their own bicycles and helmets.  I applaud Hubway for its environmental and exercise mission, but I believe if we are going to encourage more people to bike and therefore fewer people to drive, we need to ensure that the riders are well trained in the biking rules-of-the-road and in safety precautions.  Why, for instance, is study, practice, testing and licensing required for motorists and motorcyclists, but not for bicyclists?

By the way, I should mention that I would have loved to bike to work at Harvard, but for the last 15 years I lived 20 miles away.  Commuter rail was not an option because of parking and work schedule issues.  When I lived in a nearer suburb of Boston, I took the commuter rail daily, and on weekends, rode my bike, of course, while wearing a helmet.  Once when I was on a bike trip from Cambridge to Newton, a parked driver opened her car door in front of me and I slammed into it, falling to the pavement, hitting my head, and scrapping my hands and knee.  Thank goodness for the helmet!

If a cyclist is injured or killed by a car, regardless of who is at fault, the motorist will most likely be viewed as the aggressor (even in her own eyes), since she is considered in a position of power and is therefore more responsible for her actions. The bicyclist is more physically vulnerable, surrounded only by air, while the motorist has the protection of heavy plastic or steel, glass and airbags. But motorists are vulnerable too. I recently read a New Yorker article describing how a driver’s life can be irreversibly damaged by unintentionally causing another’s injury or death.

Safety for drivers and bikers alike is ultimately about respect – respect for the law, respect for safety precautions, and respect for those who are travelling differently from you to the important places and events in their lives.  I’ve seen many “Share the Road” signs in Massachusetts.  Now that I am living in Maine, I frequently see “Bicycles May Use Full Lane” or “3-Feet to Pass” signs.  The following blog article provides an excellent summary of ways cyclists and drivers can share the road safely:

As I close this post, I recall the many avid but careful and law-abiding cyclists I have known:  a man who cycles to work daily even in the winter, using the appropriate safety gear and bicycle; riders who wait patiently behind cars in traffic until lights change; those who signal correctly when making turns; those with excellent lighting on their bikes and their persons; the mother who bikes to school each day with her children, teaching them safety and respect along the way.  I also recall the cautious drivers who wait for cyclists to pass on their right before making turns; those parked motorists who look behind before opening their doors; those who follow at a safe distance when a cyclist is using the full lane; and those who yield to oncoming traffic, slowly and carefully passing bicyclists.  Thank you all for fostering respect on the roads!

More Reflections on Dignity and Respect

[I came across the following post on a blog about the meaning of words.  It provides a relevant perspective on the meanings of dignity and respect in care-giving relationships with the elderly.]

Dignity is honorableness, a quality of the person being elevated.  Respect is a viewpoint, a quality of the person doing the elevating.

It is helpful to look at the etymology of these words, because their meanings reflect their history. Dignity it comes from the Latin noun dignus, “worth”, and is related to other valuing words such as dignitarydaintydeigndisdain, and indignation.³ Respect comes from the Latin verb respicere, literally “look back at”, and is related to other viewing words such as spectatorspectacles, and inspect.

I agree that there is considerable overlap between the two terms, dignity and respect, yet they do often be seem to be used together. One context that is fairly common and topical in the UK at the moment is in the treatment of patients – and particularly elderly patients – in hospital.

In that particular context, I tend to think of dignity as referring to the manner in which they are ‘physically’ treated or handled, e.g. handling them in a private cubicle with curtains properly drawn, treating their physical body with respect and privacy as far as possible even when having to help them dress/undress or having to help with private and/or intimate functions.

On the other side, I think of respect as ‘dignity’ for their ‘inner person’, for their wishes and desires: listening to what they want and to their preferences, and responding to them, even if you cannot meet their wishes or they are inappropriate for medical reasons – not just doing what you think is necessary and ignoring what they are saying. Give them at least a moment of time, rather than ignore them completely.

–Trevor D



Dignity and Respect


I want to take a short break from what at least one of my readers has called “depressing” reflections on nursing home conditions to dwell briefly on the suggestion that Harry Lewis made in response to my introduction many weeks ago:

Sometime you can parse the relation of respect to dignity. There is actually rather a lot of talk about DISrespect these days, so much so that the word has been turned into a verb. This thought is rather fuzzy in my mind, but it seems that people would be more likely to be treated with respect if they acted with dignity, and dignity is today considered inauthentic, like using the dessert spoon while eating the entree.

After some reading and reflection, I have come to consider dignity as an inherent quality of all human beings, what I will call “inherent dignity.”  Respect, on the other hand, is a sentiment demonstrated through certain behaviors offered in response to perceived inherent dignity.  Respect may also be earned by “worthy”, or as Harry would perhaps say, “dignified” behavior.

The notion of inherent dignity is, I think at root, a religious one.  For example, Daniel Groody writes in “Globalization, Spirituality and Justice”, p.109:

Catholic social teaching believes that human beings, created in the image and likeness of God (Genesis 1:26-27), have by their very existence an inherent value, worth, and distinction. This means that God is present in every person, regardless of his or her race, nation, sex, origin, orientation, culture, or economic standing. Catholic Social Teaching asserts that all human beings must see within every person both a reflection of God and a mirror of themselves, and must honour  and respect this dignity as a divine gift.

Apart from a creationist or religious belief, the notion that, as human beings, we share the same “essence” encourages us to believe in the worth and value of others as we believe in our own worth and value.

There is little about an elderly man or woman in a nursing home that would elicit a natural response of respect. Most are physically ravaged by age and illness, possibly scarred or handicapped, stooped, and weak; many are angry or resentful about their condition, tired, lonely, and hungry. Under these circumstances, some are incapable of acting with dignity. Whether we recognize these individuals as children of God or simply as fellow human beings, determines whether we acknowledge their inherent dignity and respond with respect.

As a society, I think we have come to value “productivity” in all its forms as the highest possible good, the most valued human quality.  Those who are not “productive” for whatever reason—age, mental or physical disability, social or financial disadvantage—are considered of less value and are regarded as less deserving of respect. This, I believe, is why we allow the oldest members of our communities to live in conditions that, when we come face to face with them, appall us and make us afraid of our own end-of-life circumstances.

If you were to ask an elderly person, faced with entering a nursing home what he or she fears most, I believe (and research has shown) that the answer would amount to the inability to make one’s own decisions or the loss of control – control of one’s body, of one’s surroundings, of one’s schedule.  It is extremely difficult to maintain a sense of personal dignity, and therefore an expectation that one deserves respect under these conditions.  Some elders do so.  They are the ones we consider dignified; the ones we admire and hope to emulate.  The ones we may respect.  But the others?

The way we treat the elderly, indeed, the way we treat all those who are more vulnerable than we imagine ourselves to be, says a great deal about who we are as a society.

For this reason, I am writing about the “depressing” conditions in nursing homes.

Nursing Homes: Money, Money, Money

When Dorothy began to consider the possibility of spending her final days in a nursing home she asked me and her son, Robert, to gather information about the cost of such care.  She hoped to leave an inheritance to her children so wanted to choose a care option that would meet her needs but not eat up all her resources. Because my friend had worked extremely hard, managed her finances carefully and lived frugally all her life, her income was above the poverty level. She had enough resources to qualify as a “private pay” patient in a nursing home, meaning that her care would not be subsidized in any way by Medicaid, the federal and state health insurance program for low income individuals.

She was convinced from the outset that care facilities in the Boston area would be more expensive than those further from the city, and of course the information we gathered confirmed that suspicion.  What was shocking, however, was not the differences in price from one location to another or the specific types of care the different facilities offered, but rather, the total monthly cost for a semi-private room, regardless of locale or care.  In and near Boston, the price per day ranged from $410-$490, or $12,300-$14,700 a month.  Further afield, in the neighboring states of Maine and Vermont, the range was $260-$333 a day, or $7,800-$9,900 a month – a difference of almost $5,000 a month for the same basic, and perhaps even marginally, better care.

Assuming that Dorothy’s physical decline was serious enough for her to qualify for admittance to a nursing home, she was looking at the possibility of spending between $93,600 and $176,000 a year for care as long as she lived.  Her modest savings that she wanted to pass on to her children would severely, and very quickly, diminish.  Her children tried to convince her that it was most important for her to get the care she needed and deserved, and that she should not be guided by thoughts of their future, but she could not put these concerns from her mind.

For the poor and destitute, the financial decision to enter a nursing facility is, perhaps, a little easier.  A nursing home will take almost the entire Social Security income of an impoverished individual and supplement that with Medicaid funding.  I do not know the prices for “Medicaid” beds in nursing homes (that’s rather difficult for a lay person to find out, and my intent here is to speak from personal experience and to focus on the situations with which I am intimately familiar), but we can assume that the state and federal governments pay significantly less per bed than private paying patients.  This means that private payers are subsidizing Medicaid patients not only through their lifelong payments to Medicare and Social Security but also through the payments they make for their own care (upwards of $176,000 a year).  This should not trouble a socialist like me, or a liberal like Dorothy, but somehow, as part of the larger eldercare picture, it does seem a little disconcerting.

When Dorothy agreed to a week of respite care in a nearby nursing facility she paid approximately $400 a day, or $2800 for seven days.  For that amount she received a bed in a semi-private room; three meals a day; assistance getting in and out of bed, bathing, dressing, and going to the toilet; medication dispensing; laundry service; a few physical therapy sessions and consultation with an admitting doctor/gerontologist.  This may not seem like an outrageous amount of money to pay for such services, but consider that the meals were meager and of very poor nutritional quality; the assistance was infrequent, always slow in coming and often performed in a grudging and brusque manner; her medication regime was uncomplicated; and she did not use the laundry service because she had been warned that unlabeled clothing would be lost.  Important information that she or her family communicated to one shift of caregivers would not be passed on or remembered by subsequent shifts.  Once she had to wait for more than an hour to be taken to the bathroom despite repeated “calls” for an aide.  “It was very painful,” she said.  In other words, she received “custodial” care*, in no way customized or responsive to her needs or wishes. Dorothy’s conclusion, at the end of her week of “respite” in a nursing home was that she had not gotten her money’s worth.

Why does it cost so much to provide this kind of custodial care? The consumer is, of course, paying not just for the care but for the “overhead” of capital expenditures, building maintenance, employee salary, training and benefits, certification costs, advertising, record maintenance, reporting, etc.  And, of course, all these expenses are higher closer to metropolitan areas.

I do not believe I would (and Dorothy might not) so much mind the expense, if it were to purchase the type of atmosphere that takes into consideration the trials of aging; an ambiance that generously dispenses kindness, attentiveness, gentleness and compassion; a tone of respect for the humanness of those of advanced age, the sick and the dying.  But that is not what one is buying when one checks into most nursing homes.

*Custodial care is non-medical assistance with the activities of daily life (such as bathing, eating, dressing, using the toilet) for someone who’s unable to fully perform those activities without help.

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