We are (Still) Abusing our Elderly

Imagine the scene: a man in a chair, emaciated almost beyond recognition, his head listing at the end of a neck too weak to support it; his body bears the signs of septic shock -- he has been wallowing in his own filth -- his skin discolored, his breathing labored; this fellow, formerly “hale and healthy” at the age of seventy-five, has choked on his food and developed aspiration pneumonia. This is not a concentration camp memoir, nor is it the opening scene from some gritty work of dystopian fiction. It comes from the first lines of a major investigative report by the Associated Press late last year, into the isolation and neglect to which we have subjected our elderly, especially those we have consigned to nursing homes. During the pandemic year, elderly persons in nursing homes perished by the thousands in excess of statistical normality. Some of them died of Covid-19. The AP, however, also found that a massive number of residents who didn’t have Covid nevertheless died of “failure to thrive.” Their report estimated that for every two Covd-19 victims in long-term care, another resident died prematurely. Residents with dementia fared very badly. People with dementia rarely do well when they do not have regular interaction with family, friends, staff, and fellow residents. They tend rapidly to decline when they are in isolation -- programmed or merely effective -- and they have filled the rolls of “excess deaths” during the pandemic. “There’s something going on,” said Dr. Robert Anderson when he saw the numbers, “and it needs to be sorted out.” Dr. Anderson is chief of mortality statistics at the US Centers for Disease Control, and he’s right. It doesn’t take anything close to genius-level analytical ability or a supercomputer to crunch the numbers and see that isolation during the pandemic was a major contributing factor to these horrific outcomes. We’ve been willing to put up with this because we thought that isolation was saving lives -- of the elderly and others at risk in the general population -- but now, vaccines are turning the tide. In Israel, for instance -- which has some of the highest vaccination rates in the world -- they recently had a day with zero Covid deaths, the first time that happened in ten months. In the US, over 80 percent of those over 65 years-old have received at least one vaccine shot. This is a stunning achievement in a country with our very large population. With more and more of their family members also getting vaccinated as well, you would think that we would start seeing seniors being moved out of isolation and back into active relationships with their vaccinated family members. That it is not what is happening. The Hastings Center -- perhaps the most important bioethics center in the United States -- explains that isolating these vulnerable populations requires a “robust ethical justification” and makes clear that this kind of isolation is still infuriatingly common:

People living in nursing homes are not being permitted the same level of freedom and choice as their fellow Americans. Due to spread in the community, it is commonplace for nursing homes to identify asymptomatic cases through routine testing of staff. With each positive test the nursing homes must suspend visitation for a period of time and place affected units in isolation for at least 14 days. In New York, where routine testing is conducted twice weekly, these cases arise frequently. In an excess of caution, health authorities sometimes require the facility to confine not only residents of affected units, but all residents to their rooms every time a positive case is identified.

In this situation, an 85-year-old resident with dementia -- who is fully vaccinated and asymptomatic -- is often still required to be isolated in her room after an asymptomatic member of her nursing home staff tests positive. She is not allowed “to visit a neighbor or participate in a music program with other nursing homes residents,” much less her family and friends, even if they are also fully vaccinated. The Hastings Center report notes that the CDC offers safe visitation and socialization guidelines for this population outside of a nursing home—but this guidance is in “stark contrast” to the Center for Medicare and Medicaid Services guidance for the very same population living in nursing homes. The Center describes the “significant disparity” as “problematic and unjust.” I’ll go even further: it is abuse -- straight-up-no-chaser -- and there is no longer even so much as a gossamer justification for it, given the efficacy of the vaccines and the vulnerable of these populations to isolation. The Hastings Center uses utilitarian language to describe what is going on here -- claiming that it is “doing more harm than good.” But that is far too weak a description. What is going on here is a dramatic violation of the fundamental human rights of those who have been most vulnerable during the pandemic. Deciding that seniors who are fully vaccinated must still remain isolated constitutes that kind of abuse which violates fundamental human rights. That is, it violates the fundamental right of these human beings to associate with other human beings. That is, the kind of association which makes life livable in the first place: for we are social creatures made to exist in relationship with others. In fact, the abuse is so transparent that I believe one is forced to wonder whether the populations in nursing homes are being treated the same as other kinds of human beings. In a new book coming out this July, I argue that our current secularized culture -- which only values human beings who also happen to be fully rational and self-aware creatures -- cannot count human beings with dementia as full persons. Half of all nursing home residents have dementia. That means our current cultural climate is one in which half the people living in nursing homes don't really even count as people. If nothing is done to reclaim the idea that human beings have value because of their being made in the image and likeness of God, the next population to fall will be human beings with dementia living in nursing homes. When I set out writing, I thought that idea was a warning about where we were headed eventually. Given the abusive practices with which we continue to attack human beings with dementia -- even if they are fully vaccinated -- means that my book is more descriptive than predictive. We are, right now, apparently willing to look the other way on abuse of elderly people because we really don’t believe it is abuse of people who are “like us.” Our abandonment of the notion of human equality founded on participation in the divine image is already too much to bear. It has only begun to make itself felt in its effects.