When life becomes one room

Inspecting aged care 'homes' and picturing my own mother as an occupant feels alien and eerie. I can see her lost and ghostlike wandering the corridors confused as to which of the identical rooms is hers. Or guided by a compassionate staff member to her facsimile of the last room of everyone. When familiar cues of home are lost, impairment worsens. My own mind wanders. Are these single rooms with their hospital bed and small allowance of personal display, the best that life can offer in the last days, or years, of those graced with longevity?

A nagging existential fear of many is extreme isolation; the common companion of the aged. Symbolized in the occasional grotesque news story

of the lonely person found deceased after days or months or years.

The alarm sounded by someone who has been alerted by the strange odour of decomposition, the accumulation of unpaid bills. Later featured in the nightly news with reporter microphone in hand interviewing shocked neighbours. How aghast we all are, and how could this happen in this day and age? The talkback shows asking whatever happened to family and to good neighbours?

What a terrible ending for a life.

Juxtapose this against the sterility of sameness, in the well administered aged care facility: No perished body will go unnoticed for more than a minute, no one is alone if lonely: but where souls and spirit may silently disappear.

We had several inspections to make. Most are Jewish facilities and I see more [electric] Chanukah Menorah candles in one afternoon than I have seen for years- being a lapsed Jewess, external to the flock. Where would I go when my time came? But like most I have avoided any thought of my own decline and have hoped instead to go on forever, or until I stopped dead - in my tracks. Like many I have been able to imagine that untimely diagnosis of cancer or another tragic illness; but not of the slow thinning of personhood and sinking into the fogginess of dementia and immobility. Among the many realities

younger and able (now extended to the fifties and even sixties) do not wish to face is the process of decline and older age. Perhaps that is why our new mostly "middle aged" government with its marathon running Prime Minister has scrapped the Advisory Panel on Positive Aging that was just six months shy of completing its report.

The collateral damage of the expanded life span, is the increase in dementia and disablement.The number of people with dementia estimated by the World Health Organisation as 35.6 million and is expected to double by 2030. In Australia over 320,000 and one in four Australians over 85 have been diagnosed ; but it can claim much younger minds and bodies.

But for now, I have kept eluded the grim reaper of the disability that aging brings.

Of the places we inspect, we are in agreement that the first is the winner. The Psychologist, who interviews us, is in touch with the sadness confusion and ambivalence that attach to a decision to "place a loved one in care" as they term this process. She is aware of the trauma of holocaust-impacted families, and also of the decline, confusion and loss of displacement for the parent. This is home but it is not a home she tells us. However we do all that we can to create a homelike caring environment. There are courtyard gardens, activities , music, a hair salon and manicurist, Even a café.

The second best home is a little more upmarket with Skype and tracking facilities but less homely. Our guide explains the concept of aging in place. As the person declines they may still remain in the same room but receive extra care. I had thought this meant remaining at home as long as possible.

But in this instance its more like a place at the same table. "Residents do get territorial about their dining place ", we are told. Our guide is frank likable and sympathetic, but also businesslike. I nearly fall off the chair when she tells us about the bond.

How can people who lack resources afford this cost? The deposit eventually returns to the estate but for many it must mean that family homes have to be sold. I glaze over when she explains how deals may be struck for payment of a partial deposit

Both nursing homes are pleasant if hotel like. Welcome to the Hotel California, such a lovely place. But its temporary air is ominous. After all, in the metaphorical twilight home, it is futile; to 'try to find the passage back to the place you were before'. So although 'you can check out any time you like, you can never really leave'.

This 'hotel' has long carpeted corridors with closed doors and names or smiling elderly faces to aid recognition. In that way it reminds me of kindergarten coat hooks with symbols and pictures that children can latch onto. Sonja has a rose .David has a car.

I call in on my aunt Hanni with her smiling picture on the wall beside her door. She seems to recognise me as though it is no way odd, that I have suddenly turned up after an absence of thirty years. I ask her if she likes it here. Its just a room one room , where I wait. Its very boring here but I am waiting till God decides what he wants to do with me. She laughs impishly. Remembering my father she offers to summon him up to talk to me. She remembers her husband less charitably. Saying she doesn't talk to him anymore.

People with dementia often seek a home they can't retrieve or reclaim, and people that they cannot recognise. As we walk around the corridors a woman calls to me "come here" she shouts stretching out her arms ."Come here' Later I say. "I will come later' Another hovers concerned at the information desk, the self appointed assistant cruising behind her walking frame. The human bell that you don't have to ring ,for attention. Can I help you, she inquires? She has lovely deep dark eyes, and calls to the manager. "These people need help". It is touching and melancholic.

I have heard that in dementia people become more like themselves, and I can see this emerging in my elderly relatives. Unlike novelist Patrick White's observation of the achievement of sameness as the faces smudge with time.

The third establishment we unanimously agree to flee. It has that unmistakeable old folk's home aura and scent suggestive of incontinence. The vast open dining room is as comfortless and empty as a cold old dance hall.

When I get back to the relative 'richness' of my mother's apartment, surrounded by her old photos and her tapestries ,and her accumulated bric a brac, the contrast is powerful. Most elderly people prefer to retain as much independence and to remain at home as long as possible. So could there be other ways to support them in this? Would this be the true meaning of aging in place? If we honour the principals of respect and dignity, then right to choose becomes paramount. Choice is so important at every level , even when it comes to the events of daily life. It is tempting to take over all aspects of the aged person's life, as though they are now a child, intending it to be for his or her own good. Research shows improved outcomes in states of mind and reduction of depression with humanising approaches to aged care.

The person is still there somewhere, despite not being able to remember your name, or what he ate for breakfast.