Honoring the Elderly

COVID-19 has killed nearly 150,000 Americans, and about half of them were residents of nursing homes and other long-term care facilities. In misguided attempts to save space in hospitals for younger people, a handful of Democratic governors—with New York Governor Andrew Cuomo in the lead—sent elderly COVID-positive patients to nursing homes, creating wildfires of infection and death. These fires quickly spread, as the underpaid staff at nursing homes often work multiple jobs in multiple facilities.

If the pandemic has a silver lining, it is that it has forced us to reexamine how our culture treats the elderly. It has forced us to reconsider shuttling our relatives off to facilities to die alone, apart from their families. Even before the pandemic, nursing homes were woefully underfunded and understaffed, and many residents died because of despair or neglect. This is not how we honor our elders. It is essential to rethink how we treat the elderly in our society. Sen. Robert Casey Jr. (D-PA), ranking member on the Senate’s Special Committee on Aging, has introduced legislation proposing that Medicaid (or another established funding mechanism) receive resources to fund in-home care of the elderly. This would mean funding for nurses or other care aides who visit their patients at home or even reside in the home. Democrats, usually comfortable with this kind of spending, support his proposal. But many pro-life and pro-family groups also support it.

This is because they recognize that we need a cultural shift to in-home care rather than nursing home care. Many of the elderly want this. And many families do as well—at least when they can get the right help. It’s easy to understand why the elderly want it. Our throwaway culture tends to downplay the emotional costs of nursing homes, but consider the trauma of being pulled out of one’s home and relationships and thrust into an unfamiliar institution full of strangers. Staying at home means home-cooked meals. It means seeing children, grandchildren, great-grandchildren, and other family members far more often. It means familiar surroundings and comfort.

Pro-family conservatives ought to be doing all they can to keep these generations connected to one another, not least by encouraging families to take responsibility for their elderly relatives rather than sending them to institutions. Such practices also help strengthen local community bonds by making space for neighbors, churches, and other local groups to help out.

Pro-life conservatives also ought to support in-home care because nursing homes have become corridors of death. Death comes more quickly in isolation. And the elderly are often neglected in nursing homes—not least because most facilities are understaffed—which also hastens death.

Of course, most families simply don’t have the training and resources necessary to care for loved ones as they age, particularly if they develop disabilities. Families with means can hire the specialized care needed (this should be a cultural expectation), but families without such means require help from the community and government.

Although pro-family conservatives support this kind of legislation, more libertarian-leaning Republicans may consider it fiscally irresponsible to spend federal dollars on this kind of care—particularly at a time when national debt levels are climbing. But in-home care would actually save the government money. A report on the “money follows the person” program documents this. And this explainer on the report notes the bottom line: “Home- and community-based services are not only the preference of most people, they are also cost-effective. On average, for every one person residing in a nursing home, Medicaid—the largest public payer of long-term services and supports (LTSS)—can fund three individuals receiving community-based long-term care.”

This is just common sense. By funding care at home, the government can avoid many overhead and other costs associated with nursing homes: general administration, HR, cleaning, massive amounts of laundry, utilities, kitchen staff, and more. Furthermore, nursing homes were closing all over the country even before the pandemic—and COVID has kicked that trend into another gear, especially as families move to keep loved ones at home. That means that monies spent on nursing homes in the recent past are now available for other uses, like in-home care.

For working-class Americans who desperately want to get back to work, staying at home to care for a loved one full-time can be devastating for their family’s bottom line. It can also be devastating for the country’s bottom line. Funding for in-home care would not only save money on care itself, it would free family members to do their jobs and help get the economy moving again.

As Republicans think about the kind of spending they can support during the “Phase IV” pandemic relief bill negotiations over the next several days, they ought to support Democrats moving to use federal money to help families honor their elders by caring for them at home. This initiative is pro-family, pro-life, and fiscally responsible. It is one important way, especially in this cultural moment, to “honor thy father and mother.” 

Charles C. Camosy is associate professor of theology at Fordham University and author of Too Expensive to Treat?—Finitude, Tragedy, and the Neonatal ICU.

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