>> NARRATOR: Tonight on Frontline, Americans 85 and older are now the fastest growing segment of the population.
>> I remember being repulsed by wrinkles and gray hair.
And now they're just a part of life.
>> NARRATOR: Medical advances have enabled us to live longer, but not always better.
>> Another bypass surgery.
Another transplant.
Nobody's bothered to think about what the repercussions are of trying to keep people alive longer and longer with such a limited ability to function.
>> It's an economic, as well as a human, demand on strapped, middle aged and middle class families.
>> They're still caring for their children when they're also caring for mom and dad.
>> NARRATOR: But this is really a story about confronting the inevitable.
>> I keep trying to fix things, and even though my head says I can't, your heart... your heart wants to fix everything.
>> NARRATOR: And coming face to face with our own hopes and fears about "Living Old."
>> I like life.
I like it.
But that is not up to me.
It's not up to me.
>> I'm Estelle Strongin.
I was born on May 30th, 1911, which, if my arithmetic still serves me, makes me 94 and a half.
All right, so who else has it?
Who else has it?
I'm what was once called a stockbroker.
Okay, buy 500 each.
Today we have the rather elegant title of Financial Advisor.
Buy 500 HOLX for 82836.
And I still, even though I'm 94, I still have ambitions, and one of them is to do the job well.
I know we're chasing it, but they missed it, so, we're going to chase it.
I was never one of the people to be horrified as the decades passed.
Except I have to admit that 90 was a little intimidating.
I thought 90 meant "the end."
And I'm a little surprised that it hasn't.
>> I'm 99 years old.
I'll be 100 in two and a half months.
>> How's that feel to almost be 100?
>> It's the same as 99.
>> Never, never, never did I think I'd live so long.
I couldn't even think about ever living so long.
>> I'm a little frightened.
I don't know anybody who was 100.
Is there a change?
Is there change?
Yes.
>> We're on the threshold of the first ever mass geriatric society.
And it is in many respects, really, a wonderful time to be old because people are not only living longer, but they're living healthier into their 70s, 80s, in some cases even into their 90s.
That's the good news.
The bad news is the price that many people are going to be paying for this extra decade of healthy longevity is up to another decade of anything but healthy longevity.
In fact, more and more people are living long enough to suffer from the as yet incurable diseases of body and mind.
>> I think the biggest issue facing the population of patients is loss of function.
You begin to learn that not everyone has cancer, not everyone has Alzheimer's or Parkinson's, but almost everyone loses function.
(groans) And by "function" I mean it could be something as simple as slowly worsening vision or really bad arthritis in one knee that makes it harder to get around.
>> People want to live longer, but they want to live longer in the self that they have at that moment.
And so if there was a way that we could keep you in your 40-year-old body until you were 100 and then you dropped dead, that would be a major medical advance.
But unfortunately, as time goes on, these chronic diseases take a toll on the body.
>> I don't think that any of the lessons of gradual loss of one's bodily powers really are preparation for some of these long-term conditions of enfeeblement and frailty.
One should just simply tell the truth.
No one wishes that for oneself or for one's loved ones.
The question is, it's here.
If it's not going to go away, how can we still make something out of it?
(phone ringing) >> I'm going to make you an appointment, okay?
>> Okay, I'm going around here... >> Over the next 30 years, the number of people over the age of 65 will actually double to the point that they're about 20% of our population, about 70 million people.
>> Ms. Schiller?
>> Yes, ma'am.
>> Come with me, please.
>> Years ago people died of pneumonia and flu and tuberculosis-- infectious diseases-- and we've become much better at treating these sorts of things.
And now people are dying of their chronic diseases, things like high blood pressure, hypertension, heart failure, stroke, diabetes.
These are all things that require management over time.
>> Now we're dealing with older folks who have multiple chronic illnesses but are still kind of able to maintain their status quo.
But any little something's going to tip them over.
>> Hi, McCallowitz.
>> You know, it's that frailty where anything happens on top of it, you expose all the underlying disease and disorder that was kind of masked by the other systems that were compensating for it.
>> Our system is set up to really treat acute diseases.
Our system is set up to treat with procedures, and it's not set up to treat chronic diseases and to take time to figure out what's going on.
>> Where do you want me to go?
Here?
>> I want you to have a seat right over here.
Often times you can't get to the heart of the problem until 15 minutes into your conversation.
And with the way health care is today, you may only have 15 minutes for your entire visit.
Just a little bit more.
>> I have a terrible-- with the urine... >> You have terrible what?
>> With the urine.
>> Yes, what's happening with the urine?
>> I don't know, I make wet.
>> Okay.
>> I no can hold.
>> You can't hold it in?
>> No.
>> How long has this been going on for?
>> For a while.
>> Like a few months or just a couple of weeks?
>> Few months.
>> Months, okay.
Does it happen every day?
>> Yeah.
>> Yeah, let me close the door.
>> One more, I want this... You see, I forgot.
You see, I forgot... >> That's okay, that's all right, take your time.
It'll come up, it'll come up.
Don't worry.
Don't forget to use your cane.
The number of geriatricians right now that are in a training program for geriatrics, in a two-year program, the number that are in their second year, that started this year, is about 50.
You know, so it's nothing.
You know, it's really nothing.
So one out of five people are going to be older adults, and there's not really anyone trained to care for them.
(bell dings) >> NARRATOR: With fewer doctors now available to care for the rising number of elderly, many worry we're on the verge of a national crisis in care.
>> Nobody's bothered to think about what the repercussions are of trying to keep people alive longer and longer.
Another bypass surgery.
Another transplant.
Without anyone worrying about how do you get them physical therapy?
Will they ever walk again?
Can they swallow their food?
It's not a very thoughtful way, I think, of providing health care.
Medicine has changed, I think, appropriately in terms of the technology that's become available, and the fact that we can diagnose people and we can treat them and we can cure them in some instances.
The problem, I think, is that the pendulum swung too far and so the focus over time became predominately diagnose, treat, cure.
Good morning, how are you?
Dr. Janowitz?
Even when there's nothing "medical" to do, you still need to be there for someone.
>> NARRATOR: As more and more people are becoming too frail to leave their homes, many doctors are once again making house calls.
>> Good morning.
Early today, huh?
>> NARRATOR: David Muller, one of the founders of Mount Sinai's visiting doctors, provides medical care to a growing number of the city's homebound elderly.
>> ...going to write him some notes, I can at least say good morning.
>> My name is Dr. Muller... >> NARRATOR: For the past three years, Henry Janowitz has been wheelchair bound.
A former physician, he is now nearly deaf and has severe arthritis.
>> Okay.
>> Yeah?
How about your knees?
Pain?
Here?
Here?
>> No.
>> No, only here.
Each of us, whether we're in the baby boomer generation or not, has parents.
And we watch our parents get a little bit older.
And if even if they're relatively healthy and functional, you sort of see the slowdown and you anticipate.
You try to plan ahead for being able to be around and care for them, and at the same time you've got a family of your own, and kids, and a job, and career aspirations.
And so it's an unavoidable part of life.
And I haven't figured it out for myself either, as far as my parents are concerned.
I'd like to believe that, you know, I'll be there and be available for them, whatever they need and whenever they need it, but I don't know if that's really going to be the case.
>> What are their expectations of you, do you know?
Have you had those conversations?
>> We've had the beginnings of those conversations, probably mostly because of the work that I do.
I think their expectations are very typical and very traditional: none, zero.
They don't have any expectations that they'll move in with us.
They don't have any expectations that we'll have to do anything extra for them.
They don't want to be a burden.
They'd like to stay independent.
>> NARRATOR: Dr. Janowitz is a widower, and his daughters live too far away to be involved in his daily care.
So he pays $150,000 a year for the 24-hour help that he now needs to stay home.
>> The level of home care has gone up, because we have so many medical procedures now, and interventions, that we didn't have before.
Often there are, you know, really complex things going on that have to be done in the home.
Hi, good morning.
So it's become much more complex.
It's not just taking blood pressure and filling up the medicine box.
How are you doing?
How's she doing today?
>> All right.
She's awake.
>> That's good.
Hi, Mrs. Enoch.
How you doing?
>> I'm doing okay.
>> I'm Lillian the nurse.
>> Yes.
>> I came to check your blood pressure and do your dressing on your leg.
>> All right.
>> All right.
>> I've just got to lift your leg a little, Mrs. Enoch, okay?
>> Our goal is to make whatever time the person has left be the best and most comfortable that it can be because a lot of these things have been going on for years and years and years and they're never going to go away.
And everybody has the fantasy of dying, you know, by just going to sleep and everything... you know, not feeling anything, and everything's great.
You just don't wake up.
But it doesn't always happen that way.
Sometimes people live a long time with serious, serious problems.
>> Ready?
(whirring) >> Okay, baby.
(speaking Spanish) Okay, chiquito?
>> NARRATOR: Nearly two years ago, Antero Pallaroso was sent home from the hospital with a tracheotomy and a feeding tube.
But even with the help of two home aides paid for by Medicaid, his daughter, Carmen, still quit her job to care for him.
>> You have very good technique.
Just like a hospital.
Better than a hospital.
>> Yes, only this... you see?
>> Well the care that she gives him is really expert care.
I mean, she hasn't had medical training, but she's learned everything about his care, to the nth degree.
So she knows how to take care of all of the equipment that he has.
She knows how to feed him.
She knows how to take care of his skin, how to take care of his trachea.
Time for food.
But think about it.
I mean, it's a one-to-one, caregiver-patient relationship, 24 hours a day, seven days a week.
You can't get that in any institution.
He just never would have been taken care of that way.
(wheezing) >> Que papito, que?
(wheezing, garbled speech) Okay, Papito, no problemo.
Tu puedo dormir.
You can sleep, okay, baby?
Huh?
Tranquilo.
>> Okay.
Some people feel that their kids are their ace in the hole; they'll take care of them.
It's not always the case.
I don't have kids, for instance.
(speaking foreign language) I really seriously have to think about what's going to happen to me when I get older.
And it's not... it's kind of a scary-- scary question.
I think we all want to postpone it.
I know I do.
I don't really want to think about it right now.
But I'm faced with it every day, because I see it in my work.
Ms. Chanes?
Hi.
>> America is still a country which believes that the people who should care for the elderly are members of their own family.
But that is now an increasingly difficult task for families.
People are having fewer children.
Families are smaller, less stable, geographically spread out, and the time of caregiving has gone from months before death to years and, in some cases, up to a decade or more where people simply are living longer, in conditions that are deeply needy.
One study-- a very, very telling study-- shows that only those people who have three or more daughters or daughters-in-law have a better than 50% chance of not finishing their life in a nursing home or an institution.
>> A policeman tells us how to go.
>> ♪ Oh, when you're smiling ♪ ♪ the whole world smiles with you ♪ ♪ When you're laughing... ♪ >> What people like us need is-- isn't... >> I wrote to the maharaja and I printed it up in the page so they will see it out.
You don't have to worry.
I don't have to-- they don't even know it's me.
I just didn't give them my name.
I gave them my other name.
>> ...when you have it, you don't get it.
>> Even though I'm a nurse, I never imagined that I would be in a nursing home as a patient.
Came in with a fractured hip and been here seven years now.
No sense in crying over spilled milk.
Just take things as they come.
>> Are you frightened of what's ahead?
>> No, I'm not afraid.
I don't want to live forever.
I hate to...
I don't know.
I hate to leave my daughter, that's all.
She's 72 now, but she's doing all right.
>> That's all I wish for you.
(indistinct chatter) >> NARRATOR: Nearly 60% of those who live past 85 will go into a nursing home.
And if they stay longer than six months, the vast majority will never leave.
>> One person I visit on a regular basis in the nursing home calls it just "the waiting room."
And she views it as, "this is where we all come to wait to die."
And, you know, in some perspective, she's right.
I mean, that's what happens, you know?
Other folks...
I've seen people who thrive there.
I've had patients that were at home and then went to a nursing home, and they're much better off.
The socialization, you know, the participating in groups, having all these people around for meals, is tremendous.
And they live off of it and thrive from it.
So it's not always, you know, a downturn for some people.
>> Why did I leave my home?
Because I was lonely.
When I reached 95, 96, it was a little hard.
So I had a friend here.
So she said, "Come over, Clara, come over."
It was all right.
She was on the seventh floor.
When I came I said, "Look, you're not alone here.
"They not friends, they don't know how to be friends.
"But they people.
They people."
And I have my-- I get beautiful magazines.
I get U.S. News World Report, that for 50 years we have in our home.
So I have the magazines, I have the newspaper.
And they people, they are people.
Now, should we increase the taxes or cutting the government program such as food stamps... Food stamps, Medicaid, housing?
The hardest time is I miss-- I miss my old friends.
And I miss my home.
And I say, "Look, you can't have everything," so I try to be happy.
>> I don't know if growing old is easier here.
In some ways I think it's more difficult.
It think it's a lot harder in some ways to keep your independence here.
So you're much more dependent upon families.
Giving up independence is the worst.
It is what everybody fears.
It's what I fear.
You have the cane in your left hand.
And you move your cane forward and your right foot forward and then your left foot.
>> NARRATOR: Dr. Bill Coch opened his practice in upstate New York over 30 years ago.
He's one of a few family physicians left in the area, and he sees thousands of elderly patients every year.
(knocking) >> It's the doctor.
So, where's mother?
>> She's in here in her chair.
>> Okay.
We still have lots of three-generation households, four-generation households.
It's rare that people will give up and want to put somebody in a nursing home at the first sign of trouble.
Most people will go through a long period of trying to take care of them in their own home, or in the family home, or even extended families.
>> Yeah, it's Dr. Coch.
How are you?
I'm happy to come out and see you here.
(indistinct speech) Having a family really drives everything.
I think it really gives people a reason to be better.
It's really what their life is about, often, at the end of life, when their career is gone.
It's what's important to them.
(indistinct chatter) >> I'm trying to think and think, and think, so that you won't forget it again.
Do you hear me?
Can't you do it?
Can't you do it?
>> Do what?
>> What you were going to say... you were going to say, "Merry Christmas, Merry Christmas to you."
>> NARRATOR: Chester and Rosemary Haak, married for 68 years, now share a room in a nursing home.
Both in their 90s, he has advanced Parkinson's and she's been diagnosed with Alzheimer's.
>> All right for you.
You never do the right thing right and the wrong thing wrong.
Why do you do things like that?
>> I don't know.
>> Because you can't see?
>> For Chase who?
>> Can you imagine not being in the same room with Mrs. Haak, or would you... >> No, I can't imagine it.
I can't imagine it.
>> Because he's different.
Because he's different.
>> Let's try to stand up, okay?
Ready, on the count of three... one, two, three.
Put your hands on the walker.
Right here, where we usually hold.
Right here.
Okay?
>> Yes.
>> Maybe just walk over to the bed.
>> Oh, I'll walk over... >> NARRATOR: The Haaks came into the nursing home three years ago so that Mr. Haak could recover from a hospitalization.
But because of his wife's worsening dementia, they were never able to leave.
>> Don't you know something good when you see it?
Then lay down.
>> We took Dad in, and Dr. Coch sat down and was very kind but very frank, and explained that they would not be able to go back home.
>> He'll be coming back.
>> I don't think anyone wants their parent or a loved one to have to be in an institution.
No matter where it is, no matter how nice, no matter how great the staff is, it's still an institution.
And as a child, I always feel like I can make them just a tad bit more comfortable.
I know their desires.
I know their needs.
They don't have to tell me.
So I've worried about everything, even the linens, the pillows, the heat in the room, the view, the food.
But most of all that I've let them down by having to make the decisions we've made.
>> Well, that isn't perfect.
How are you going to make that perfect?
>> With my mother it's been a slow process, but the last few months seem, for whatever reason, things have escalated.
It's difficult some days when I'm not sure if she doesn't eat because perhaps she's forgotten how to use her utensils.
Or does she not know how to swallow?
>> What do you remember?
>> I don't know.
>> I remember... >> I keep trying to fix things, and even though my head says I can't, your heart-- your heart wants to fix everything.
>> That's good.
>> Hey, Sleeping Beauty, if Lucky comes in to sing to you, will you wake up again?
>> Yes, I will.
>> You will?
All right, I'm going to get Lucky.
Even with my nursing background and caring for elderly and terminally ill, nothing has prepared me for taking on the role of caring for my mother.
Okay, this edge.
All right, now...
Okay?
You want your glasses on?
>> Hi, Norma.
You waiting for lunch?
It's a little early to wait for lunch.
>> I'm not waiting for lunch.
>> You're just sitting here doing word puzzles.
(women singing) Oh, that's okay.
Oh, I thought there was a band in here.
>> ♪ Mr. Sandman, bring me a dream ♪ ♪ ♪ ♪ Mr. Sandman, bring me a dream ♪ ♪ make him the cutest that I've ever seen ♪ ♪ Give him the word that I'm not a rover ♪ ♪ Then tell him that his lonesome nights are over ♪ ♪ Sandman, I'm so alone ♪ ♪ don't have nobody to call my own ♪ Good morning, Hayla, aren't you going to sing with us?
♪ Mr. Sandman, bring me a dream ♪ Needs a little louder back here.
Just a little bit.
Can you turn that up an inch?
♪ Mr. Sandman... ♪ >> When you're young, you want to live forever.
You want to at least live to be old.
But many people don't want to live forever when they're old.
In fact that's their fear.
I will tell patients that I think that it's time to stop curative treatments-- whether they go into hospice or not-- and just focus on function and comfort.
Often that's what a person needs, is somebody who knows them, who has an idea of who they are, of what their goals are, and all the other things that have impacted on their illness, to tell them what to do, be that an individual or family and they would give up a certain amount of years at the end to have a good death.
(knocking) Hi, Wayne.
I'm going to turn the television off, if that's okay.
(dog barking) So tell me how things are going.
(coughs) >> Not good.
>> Not good?
>> No.
I'm exhausted all the time.
I... don't feel really sick.
Temperature, I haven't had any.
>> No temperature?
>> No.
>> You got quite a cough.
>> Yeah.
Yeah, it's... it's loose, but I don't really bring anything up.
>> You don't?
>> No.
>> He takes the oxycodone twice a day.
And yesterday I started the morphine.
The coughing... After he was diagnosed with lung cancer-- that was just a few months ago-- Dr. Coch said, "I don't want to do anything invasive."
And he said, "Wayne, I don't believe that you would come through a lot of these tests that have to be."
And Wayne accepted that.
And I did, too.
I think that none of us want to see him suffer much more.
He's been a very sick man.
Really for the last year it's been quite bad.
>> He had that infection... >> And he wanted to be home so badly and we wanted him home.
>> Do you have anything you want to talk with me about before I check you out?
>> No, you said something about a year.
I don't know whether I'll go a year or not.
>> You mean I told you, you had a year.
>> Yeah.
>> Yeah.
Did we bet on that?
>> I'm not going to bet with you anymore, you never pay off.
>> Yeah, I know.
Well, your time is limited and how long it is, I don't know.
>> No one knows.
>> No, but it could be short.
I mean, it could be weeks, or... it could be weeks.
I mean it could... you know, we don't know.
>> Well... well.
>> Well, let me check you here.
(coughs) Are you holding up all right?
>> Yes, I get tired, but that's... you know, I expect that I would.
Here's the morphine.
>> It'll be kind of tough on Lois, probably.
You know.
But... Yeah, it's...
It's... ...kind of hard to think about it.
You know, why think about it, really?
>> NARRATOR: Two weeks later, Wayne Elliott would die, as he wanted, at home.
>> You know, most people say they want to die at home, but most people die in the hospital.
I mean, that's not what happens.
(radio chatter) Every day you see someone in the hospital, you have to ask yourself: Why does this person still have to be in the hospital?
There's lots of problems with confusion, disorientation, falls, and infections.
I just wanted to follow up on one thing that we talked about.
With medicines, with IVs, with tests, with all sorts of things.
And sometimes, you know, you order a test because it's easy, because it's there, but then you kind of opened up Pandora's box, and now you found something you weren't looking for.
And oh, boy, now what am I going to do about it?
Well, you do another test.
And then you do another test.
And then you say, "Well, in order to figure it out, I actually need to go stick a needle in your bone now and take out some stuff."
And then, okay, well, and you start getting into trouble.
>> After I had that terrible surgery.
>> Okay, good, so you do remember the surgery.
>> Yeah, and I shouldn't have had that.
>> You don't think so?
>> No.
>> Why not?
>> People don't have cloth surgery.
I call it cloth surgery.
>> What's cloth surgery?
>> Pulling cloth out of your nose and out of your ears, out of your throat and stuff like that.
Zig-zawing cloth through your body.
I don't like that.
>> Do you remember what the surgery was for?
>> NARRATOR: Georgia Days was in the early stages of dementia when doctors removed a cancerous tumor.
But the hospitalization made her dementia worse, and now Dr. Farber is concerned about her recovery.
>> So, we took it out.
And that was a few weeks ago.
But now it looks like, you know, you're having trouble really still eating and putting some weight back on.
>> Because I haven't been eating.
>> Yeah.
Do you know about the procedure that we want to do tomorrow?
>> No, and I ain't too tickled about being cut on again.
>> I know, I know, that's what I wanted to talk with you about.
This is a small incision and they put a tube in from the outside and then we can give you all the medicines, all the nutrition, the food, the vitamins, the minerals, the water.
>> I don't know.
What did you say the name of it?
>> Its called a feeding tube.
>> Feeding tube.
>> Right there, right about there.
>> And they're going to put a hole in me and put the tube in?
>> Right there.
A small hole, but yeah, a hole right there.
>> Oh, boy.
>> Decision-making is a big issue for older adults.
And deciding upon a course of treatment is a big ordeal.
Someone who gets diagnosed with a cancer when they're older, it's a real question of, well, wait, do we want to do the standard of care, which is surgery and then chemo?
Or is that really not what's best in this case?
Are they really too sick, and dying from other things, and it wouldn't be in their best interest to even go through a surgery like that.
Hi, Mrs. Fuller.
It's Dr. Farber calling.
I just came from seeing your mom.
And I talk with her about stuff, including the procedure, which is scheduled for tomorrow, okay?
I know you wanted to know.
It's scheduled for tomorrow... >> NARRATOR: The feeding tube would help Georgia Days regain her strength, but the cancer had already spread, so she would be moved to hospice care.
>> When the choice needs to be made, whether it's the patient making it or the patient's family, the kinds of decisions they have to make sometimes are completely unexpected.
I had a patient with severe, severe Parkinson's disease.
And one of the manifestations of his Parkinson's was that he could no longer swallow.
So I had this long conversation, over the course of weeks, with his family.
And basically what I tried to help them understand is, his body can't sustain life anymore.
He can't swallow food.
So if we choose not to feed him, he'll die from his Parkinson's disease.
If we choose to put a feeding tube into him, he won't die now.
We'll have to wait for a medical catastrophe.
It'll have to be an enormous infected bedsore.
It'll have to be a stroke.
It'll have to be overwhelming urinary infection, aspiration pneumonia.
It's what I tried to term a "medical catastrophe," because we've actually caused it to happen.
We've let the person live long enough that the only way for them to die-- because we didn't let them die from their natural illness-- is some medicalized catastrophe.
And some families accept that.
It's very hard to do, because they're letting someone die.
And lots of families can't.
They cannot accept that.
When something happens that ends life, that's okay.
But until that happens, they need to do everything they can to sustain someone.
>> Who's ready to lost somebody from the family, especially their mother?
I'm not ready.
I don't know.
I know it will be one day.
But... >> NARRATOR: For the past year, Dr. Farber has been working with Lucia Paunescu to keep her mother, Maria, out of a hospital and at home.
>> Hi.
Hi, Mrs. Paunescu.
Oh, she's sleeping?
Okay.
>> NARRATOR: Now 96, Maria is slowly deteriorating from chronic heart and vascular disease.
>> How's mama?
Da?
Okay.
>> Just tell her I'm here.
It's Dr. Farber.
Hi.
Good.
You have a very nice smile.
Will you tell her?
>> (speaks Romanian) >> She know she never recover.
Few days ago, she was very, very, very sad, and she look at me after she had a lot of pain, and the pain calm down after the medication.
And when I ask her, "What do you feel?
Do you feel better?"
She say, "Yes."
She look at me and she say, "You try to cure me, but you never can do that again."
I give her everything what I have, but I don't know what to do.
And that is the hardest part, because I don't like her to suffer.
>> What about when she moves the leg?
>> (speaks Romanian) Yeah.
>> It hurts, right?
She's very limited.
You know she has really severe arthritis in a lot of her joints, including the hips, and at this point she's getting contractures.
>> She said the pain, what she have, she can't breathe anymore, from the pain.
>> Her mother's getting sicker overall.
And we've been spending a lot of time talking about what to do when her time comes and how it's very clear she doesn't want her to go to the hospital, she doesn't want someone to call 911, so she filled out one of these "do not resuscitate" orders at home to put on the fridge.
But it's very hard for her to kind of picture and accept the fact that she is so old and frail and not going to be around forever.
>> The bright lines that used to guide us when death was swift-- technology didn't get in the way-- those lines have become blurred by lots of things.
Loving families begin to wonder, "Is it love or is it cruelty "to treat this pneumonia in my father, "who is suffering from cancer, "and has begun to lose his appreciation of all of those things that made his life worth living?"
Lots of us now want to spare our children those kinds of burdens.
One hears it said over and over again, "I do not want to be a burden to my loved ones."
And people write living wills and make other kinds of arrangements, precisely hoping to spare the burden, not only of care, but even of decision-making about what should be done with us when we get to be old, and infirm, and incapable of deciding for ourselves.
But the fact of the matter is that it's really impossible to describe all of those circumstances that one is going to face.
And for most of the decisions of long-term care, you can't write those things.
>> Morning.
Every day I meet a friend, an acquaintance, a relative who's caring for their parents and making these difficult decisions that no child wants to make.
>> Isn't that your parking spot?
>> Yes, I don't know.
>> And every day there is a decision, even if it's a little decision like, "Well, do they need an antibiotic?"
You know, my parents do have a living will, and a healthcare proxy, but when push comes to shove, are you not going to fix that fractured hip?
Are you not going to fix those fractured ribs?
Are you going to allow your father to choke?
Or are you going to make sure that he doesn't have popcorn and things of that nature?
>> Are you ready?
>> I never had anticipated being in this position, nor having my parents in the situation they're in.
>> Good job.
Get up.
Come on, tuck your bottom under.
There you go.
>> Our daily struggle is to continue to try to assist them in having a purpose in life, because there's no question that in many aspects they've lost the quality of life.
>> Don't put it out too far.
Right foot.
>> Right foot.
>> Push through those hands.
Good.
Walker.
>> Okay, good.
Walker.
Right foot.
Oh, get that left foot right up there.
There you go.
>> Do you think you could find an X-ray for me?
>> We sure can.
>> 27463.
>> A lot of what I am-- and I think a lot of people-- is what we do.
And if you can't do anything, then, what are you?
To me, being unable to drive a car, to make music, to think clearly, is just...
I don't want to have anything to do with it.
I mean, probably at least once a week, and sometimes every day, people say, you know, "If I ever get like that, "take me out behind the barn, because I don't want to live that way."
Many doctors, in their practice, are confronted with situations where patients are really in desperate need.
And they say, "Look, when this happens, "I want to be very clear, I don't want you to prolong my life."
Or "I want you to make something available for me that will, "you know, help me to be more comfortable, end it when I want to."
Or even sometimes, you know, "Will you help me to do it when the time comes?"
Because of these experiences, I've had these discussions with my wife, too about my own end, and she and I are at polar opposites in terms of what our expectations are.
I mean, I would clearly want to be given that option.
If I were terminally ill or I had a progressive illness-- a degenerative progressive illness that was going to gradually take away all of my function-- I would want to be able to opt out.
I want that control.
And I don't know whether I'd ever use it, but I definitely would want it.
And to her, that's... it's just inconceivable that someone could think like that.
Life is life.
>> My son, who has power of attorney in case anything happens to me, asked me to sign a paper that would authorize termination in case of hopeless-looking condition.
And I said, "No, I'm not signing that."
There are a lot of cases where doctors have said this patient has three months to live and they've lived 30 years.
I don't think that medicine knows everything perfectly, and that while there's life, there's hope.
And it's part of my general optimism, I guess, and confidence that if it were that hopeless, my heart would intervene and say, "The end," and I'm willing to let it go at that.
>> Why do you think so many people are prepared to sign, though?
>> Because they don't want to see their children suffer.
And I said to them, "I don't care.
Suffer."
(laughs) >> How long would you like to live, Mrs. Singer?
>> What, honey?
>> How long would you like to live?
>> Never question it, I never thought of it.
I don't want to think of it.
I like life.
I like life.
It's the sun, it's the air, it's the work, it's the books.
I like it.
But that is not up to me.
It's not up to me.
>> It's, I think, simply not true that we can know in advance how we ourselves will feel about many of these things once we find ourselves not 45 and fit, but 75 and viewing life with a different lens.
I'm trying to accept the coming limitations with a certain amount of grace.
I have this perverse occupational interest to see whether, having thought about it all this time, I can age better rather than worse, and be a kind of decent example to my children and to my grandchildren.
It's not simply in my control.
It's a time of life that interests me a lot.
>> Hi, Mrs. Goff.
How you doing?
>> NARRATOR: For the first time in history, those 85 and older are the fastest growing segment of the population.
>> Hi, Luella.
>> NARRATOR: And within 25 years there will be over 70 million elderly living in America.
>> I'll be back next week.
All right?
>> We haven't even begun to contemplate what this means socially, in terms of the meaning of having all these years stacked up at the end of life.
It's a lot easier for the country to think about the economic aspects.
We've not yet begun to face up to what this means in human terms.
>> Next time on Frontline... >> ♪ I got the world on a string ♪ >> Americans with credit cards: 185 million.
Interest and fees paid to the credit card companies: $101 billion.
Big banks holding all the cards: priceless.
Some things money and power can buy.
For everything else you want to know about credit cards, there's Frontline.
>>To order Frontline's "Living Old" on videocassette or DVD, call PBS home video at 1-800-Play-PBS.