When you were younger, did you ever imagine needing a Ph.D. to understand how to pay for your prescription drugs in later life? That is about where we have arrived with the passage of the so-called “Medicare Prescription Drug, Improvement and Modernization Act of 2003.”

A recent headline “Medicare Law Befuddles Elders” aptly describes the mental condition of most among us who have paid any attention to the recent restructuring of Medicare. Except for blasting AARP for selling out our interests, I have suffered enough befuddlement myself to discourage me from writing much about the subject till now.

The very name of the new legislation rankles me. Improvement? Modernization? Both words are politically charged and hide the antisocial philosophy that lies behind the changes in Medicare. They also disguise the fact that the 700-page legislation favors drug companies at the expense of consumers.

I still hope for changes in the new law, if not ideally its complete repeal. And yet, facing reality, I believe that older Americans should take advantage of whatever help we can get now to pay for our medications. The cost of many drugs lies increasingly out of reach for so many of us that we cannot afford to pass up help.

Though the full legislation does not kick in till 2006, this is the month when Medicare Drug Discount Cards have become available, their appearance signaling the first opportunity, due in June, for some elders to save money on medication purchases.

Getting word about the new cards to older people is crucial, says CMS (Centers for Medicare and Medicaid Services), the federal agency responsible for implementing the changes. Otherwise, its administrators fear, almost three million eligible beneficiaries will fail to register and thus forfeit access to a $600 annual subsidy, plus other possible savings.

This is why more than 100 national organizations have banded together to spread the word. They include AARP, the National Council on the Aging, and Catholic Charities USA. This coalition believes that “Few low-income beneficiaries are likely to know that they should not only consider enrolling in a Medicare discount card but also continue to take advantage of existing public and private prescription savings programs.”

In a slide show, the coalition shows how the difference for some could amount to far more than the basic credit of $600 that comes with the card for many low-income people. They show a 68-year-old Louisiana woman saving $1,320 and an Idaho man $5,058, largely through taking advantage of discount programs given by the drug manufacturers.

Compared to the rules set for 2006, those for the cards seem relatively simple. However, even here most older people will need some explanation of the system before making wise choices. And, after grasping how it works, we will require further help to discern which card will serve us best.

Those considering the cards will have to ask questions: How convenient are the pharmacies where the particular card can be used? does the card cover the drugs they need? does it offer the best price for these drugs?

Fortunately, those who already belong to Massachusetts’ Prescription Advantage program do not need to sign up for the discount cards.

I recommend taking counsel from the SHINE Program, run by the state Department of Elder Affairs. SHINE operates in the Councils on Aging in Massachusetts cities and towns, with cooperation from the state home care agencies in each part of the Commonwealth. Through this program, professionals and volunteers trained in financial and other issues provide information and counseling to older people who request it, free of charge. You can reach this source of help by calling 1 800 AGE-INFO.

If you use the Internet, you can find details about the drug discount card by tapping into the Medicare web site www.Medicare.gov. Otherwise you can call a toll-free number: 1 800 MEDICARE.

AARP also has helpful information at www.aarp.org, and, by telephone, at 1 888-OUR-AARP. The latter organization also offers callers a well designed booklet (with a title in small caps): “medicare changes that could affect you.”

Again, if you have Internet access,  I strongly recommend reading what the Families USA Foundation offers at www.familiesusa.org.  It describes the discount drug card program as “very flawed” and gives reasons why it does not serve the best interests of consumers. But it also offers guidelines for choosing the discount cards.

I hope that the new program will serve elders well but fear otherwise. How can we expect much good to come from a law that prohibits the federal government from bargaining with the drug companies for lower prices?  And how can users of the discount cards be confident of savings when the companies and other agencies that sponsor these cards are allowed to make indefinitely large profits by raising prices with only one week’s notice?

All of this is further argument for getting help in finding your way through this maze of laws and rules. Again I recommend asking the SHINE counselors for assistance as the best resource.

Richard Griffin

As I lay upon my bed, my mother gently took my left arm and raised it above my head. Then she moved it down toward my side, all the while speaking to me words of encouragement. She explained how this exercise would make stronger an arm that had recently become much easier to move. At age 33 she was doing her best to help me, her first-born, get the most use of a limb damaged at birth four years previously.

Looking back some 70 years to this experience, I recognize it as my earliest memory. Even now I can feel the reassurance in my mother’s voice as she carried out doctors’ instructions to improve the use of my arm after surgery to repair my damaged muscles.

My mother, Alice Barry, grew up in Peabody, Massachusetts in a household that was formed in the Victorian period and had imbibed many values of that culture. Outwardly, she seemed to break with that regimen in her early adulthood. In the 1920s after her graduation from college, she was one of the first young women in her milieu to own a car and she sported what looked like a carefree lifestyle.

She herself used to tell me that this was the best time to have lived, the Roaring Twenties, when freedom reigned and our country was at peace. In response I would take issue with her and suggest that her being young and in good health was the reason why the times seemed so good to her; I also gently suggested that the good times were limited to people of her social class.

The older she got, the better that era looked to her because of the many problems that assailed her. The worst was the anxiety that plagued her inner life: from age 40 on, she suffered from scruples and other mental problems. I remember the crucial point at which, out of fear, she gave up driving the family car.

In mid-life, Alice also suffered life-threatening cancer. Surgery brought her through this crisis but she had to endure its effects for the rest of her life.

My mother also had external events that were difficult to cope with. The worst of these, by far, was the death of her husband, my father, when he and she were only in their middle 50s. After that catastrophe she was never the same.

Her husband’s death left her with responsibilities that she was not prepared to handle by herself. Only two of her six children were on their own at this point. Like many middle-class women of her time and place, she was not skilled in business matters and was hard pressed to deal with other major decisions suddenly thrust upon her.

 Writing about my mother from the vantage point of my current age, I am giving a different account from what I did earlier in my life. I like to think I now bring to my mother’s life a greater empathy than was possible when I was young. Age allows me to enter into the misfortunes that she suffered and the inner demons that afflicted her.

The injury that I suffered at birth must have been especially difficult for her. For her to have begun child-bearing this way probably stirred feelings of guilt and regret.

So my mother’s life was hard in many ways. However, she did have the satisfactions of seeing her children grow up healthy and reasonably successful, and she enjoyed the pleasures of her grandchildren. When she suffered physical decline, she received loving concern and help, especially from her two daughters, making her last years somewhat less anxious than the earlier years.

My mother passed on to my siblings and me a strong physical inheritance that has already assured us relatively long lives. And she gave us a set of values that have proven vital in an era marked by sudden and drastic change. Even in the midst of her many difficulties, she persevered in love for each of us and she supported us in our basic choices.

Still, I wish that she could have known more inner peace. A prime source for that might have been her religion but, unfortunately, she seems to have regarded that as more a source of obligations than of consolations. The faith which she professed throughout her life would appear to have brought her little serenity. I will always regret that she could not have known peace on mind and heart.

As Mother’s Day 2004 approaches, I thank God for my mother and appreciate the many gifts she gave me, life itself being the most precious of them. On this occasion, I like to think back and see her as I never did with my own eyes: a young, carefree woman driving her car, scarf flying in the wind, laughing with friends in the spirit of the Roaring Twenties.

Richard Griffin

Travel can sometimes have spiritual impacts that surprise us. I refer, not to religious pilgrimages where that is the whole point, but rather to the stirring up of old friendships. Visits to San Francisco and New York recently did that for me and I am the better for these encounters.

In the first meeting I spent time with an old friend (whom I will call Charley) from whom I had felt somewhat estranged. This happened, not because of any quarrel between us, but rather because of problems my friend was experiencing in his family life.

His differences with his wife affected me because my wife and I were friendly with her. Though we did not actively take sides, the rift between them spilled over. Whenever I ran into Charley in the last few years I would feel that the affection between us had been spoiled.

On this occasion, however, he freely entered into conversation with me and we had a heart to heart talk in which he shared his inner experience with me. I quickly discovered that he felt no hostility toward me: I now felt restored to the intimacy that we had enjoyed before.

Charley now lives by himself and has become spiritually reconciled to that fate. He has lost his family, at least for the foreseeable future. He finds it difficult to live alone but has found much consolation in the practice of the spiritual life. He has discovered centering prayer, an approach to contemplation that brings him comfort.

As our conversation went on, it became clear to me how Charley has undergone an inner renewal that helps him deal with the difficult history of his family life. He knows his own responsibility in that breakdown but has learned how to accept what is now. In doing so, he has had the help of a spiritual counselor who has provided sensitive and effective guidance.

I came away from this encounter with Charley feeling renewed and uplifted. Being restored to intimacy with him has heightened my appreciation of personal relationships. I now hope to stay in active touch with Charley and continue the dialogue so agreeably restarted in San Francisco.

Last weekend brought me to New York where I renewed personal contact with an old friend whom I had not seen for some 30 years. It was a pleasure to share brunch and converse with him, his wife, and his two daughters as we reviewed some of our past adventures and exchanged news about current activities.

Retired now, this friend (whom I will call Bill) lives in Manhattan and enjoys life in the big city. He has the good sense to continue working for others, in particular making his free time available to fellow educators. Bill has been blessed with enough income to fund a life style that is gracious and expansive. His wife has continued running her successful interior decoration business.

Bill is one of the many people who have redefined retirement as an opportunity to shift gears and take on new projects. He gets paid for some of his activities, such as teaching in a professional school, while he does others gratis for the benefit of those in need. Doing things for the common good makes a lot of sense to him now that he has time to spare.

That free time also enables him to contribute to the home life of his wife and himself. When she returns from her commute at the end of the day, he frequently has dinner ready for her, along with freshly bought flowers. The quality of their affection for one another is manifest, and not only in details like these.

The parents take obvious pride in their daughters, young women around 30, and relish the younger woman’s activities as an actor and playwright. The older daughter works in her mother’s business, much to the satisfaction of both of them, it would appear.

Bill did not share much with me explicitly about his spiritual life, although it seems to me clear that he has high ideals inspired by the religious tradition in which he grew up.     

The gracious hospitality that Bill and his family showed to me and my family on this occasion stirred not just our thanks but also the admiration and affection that remain at the root of our long-lasting friendship. It would be unrealistic to claim that the passage of those 30 years had changed nothing. However, the feelings that we first had for one another long ago had clearly lasted.

Two encounters, one on the west coast, the other on the east, one planned, the other accidental, brought me together with old and valued friends. I take these two meetings as a source of spiritual grace and blessing. Finding that these friends still care about me and I about them has provided me with renewed feelings of worth on both sides.

Richard Griffin

This is the story of a person who used the dreaded O word to get ahead.

During an intermission of a performance of Tchaikovsky’s Pique Dame at the Metropolitan Opera, my sister Carol joined a long line of women waiting to use what she calls “one of the woefully inadequate ladies’ rooms.” While standing there, she observed her fellow ladies-in-waiting and was struck by their patience.

Among them was a visibly pregnant young woman just behind her. My sister briefly considered offering the mother-to-be her place in line but rejected this option, realizing the gain would be slight and the woman might resent it if she thought my sister was judging her to have a disability.

As Carol neared the entrance to the ladies room and was still pondering her decision not to relinquish her place in line, another woman came from nowhere and attempted to squeeze herself into the space between my sister and the pregnant woman.

The newcomer had no obvious physical condition meriting special consideration nor did she appear to be in any kind of distress. If either had been the case or if she had simply asked to break into the line, Carol would have been glad to accommodate her.

The intruder spoke not a word, just smiled sweetly. The body language of the other women in line suggested they were reacting the way my sister was feeling, namely annoyed at the boldness and presumption of the interloper.

Given these feelings, Carol was surprised that no one else challenged the woman, so she decided to do it herself. She turned toward the woman and explained that this was a line she was breaking into. In response the woman said: “But I’m old.”

Though astonished by this reply, Carol took no more than a half-note’s time to reply: “So am I!”

Pursuing the matter, as if she were a child on an elementary school playground, the woman said: “I bet I’m older than you.”

Carol then pointed out that this was a line of waiting women, not a contest to see who was older. Intent on arrival at her destination, my sister then lost track of where the woman went.

However, she has continued to be intrigued by the incident, an instance, unprecedented in her experience, of someone appealing to a personal characteristic usually left unmentioned, if not disguised in the other direction.

How might one understand the action of the woman who determined to break protocol? Was she every Bostonian’s stereotype of the pushy New Yorker, the person who feels entitled?

Or was she too shy to confess, even among women, the pressing need that drove her to get ahead in this particular line?  What still seems unreal about the story is the blatant appeal to age. Most Americans avoid the word “old” at almost any price.

Perhaps she has experienced age discrimination in employment or in personal relationships and seized this opportunity to get some value out of her advancing years. If people are going to put her at a disadvantage because of her age, she may reason, I will use the power that I have to my own advantage.

She may be attracted to a certain mystique that has caught on with some older women. They have determined to wear purple, they say, and to become outrageous. If society is going to downgrade them, they will stand ready to avenge themselves by acting with a greater freedom than they exhibited when younger.

To the claim “I am old” coming from this woman, the other women might reasonably, if not politely, have replied “So what?” The presence of others in line who themselves looked comparably mature took away the edge in that claim.

Old age may have its privileges, but invoking it to break protocol is not one of them, at least not in my book.

I confess feeling tempted, at times, to indulge my elder status. At buffet dinners, for instance, when I am starving and everyone in line is moving so slowly, I want to elbow my way forward. But these are feelings that I have had since I was six; do I really have an excuse to indulge them now?

Need is valid; age in itself is not a reason for much of anything. Common sense allows a certain leeway to people obviously far advanced in years. By common agreement, those in their 80s, 90s, and 100s can be accorded a certain deference paid to age.

Still, there is something disedifying about an elder pushing herself ahead of others. It does not fit with the graciousness that some of us believe comes with age. We like to think ourselves above that kind of selfishness.

Surely the interloper at the Met could have said something to justify her breaking protocol. My sister Carol’s guess about the woman is this: she makes a habit of doing this just for the satisfaction she gets in exercising reverse ageism.

Richard Griffin

Two Sundays ago, the face of a friend known to me since her college days, some 35 years ago, appeared among the wedding announcements of the New York Times. Helen Cooksey was announcing her marriage to Susan Love, after their taking advantage of the short official-wedding gap opened by the Mayor of San Francisco in February. Both physicians who are based in Los Angeles and parents of a daughter now grown up, these two women obviously felt intense happiness at having their bond legally recognized.

Their joy reminded me of that felt by hundreds of other lesbian and gay couples in that place and in several other American cities. I was particularly struck by those first in line in San Francisco – Del Martin, 83, and Phyllis Lyon, 79 – who have been partners for 51 years. Such longevity in love ought to impress everyone.

A look at recent polls reveals, however, that 60 percent of Americans over age 65 oppose the legalization of gay marriage. This contrasts with a scant 23 percent of those under age 30 who stand against.  

Does this mean that a great many elders are taking a kill-joy attitude toward fellow members of our national community who have discovered a personal love that has stood many tests of time and has continued to bring them fulfillment?  Are older people hard of hearts as well as (sometimes) arteries? Is it that they are simply old, stuck in their ways, and unable to change? Or do they have something significant to bring to the debate?

In searching for answers to these questions, I have not simply talked to some of my age peers but have tried to untangle what may be part of their underlying mentality. The issues that polls never get deep enough to analyze are those that may play an important part here.

Many, if not most, of those over 65 must surely find some pleasure in what others see as good fortune for themselves. Is it not likely that others feel the way I do, namely joy at others having the benefits of being bound to others in love and fidelity?

Elders in good physical and mental health are certainly open to change. Their ability to transform behavior and attitudes has been documented sufficiently to chase this stereotype.

That a large percentage of those who oppose gay marriage do, at the same time, support civil rights and widespread benefits for those entering sexual unions attests to their openness. Endorsing civil unions represents a major transformation of mentality for many people who never heard of such arrangements until quite recently.

Still, many advocates of civil unions refuse to accept legal marriage of same- gendered people. I would point to three separate considerations that might be moving those over 65 to opt against gay marriage. If advocates wish to change elders’ views, I would suggest taking these issues seriously.

First, to people growing up in homes shaped or influenced by classical culture, the naming of things makes a difference. Older adults, even if not highly schooled, have lived their whole lives in a mental framework that values things by their names. Literature, philosophy, and theology that have had such an impact on our lives, at least indirectly, have taught us to distinguish among things that are different.

In this view of reality, the word marriage does not apply to gay unions. Marriage means the coming together in a permanent sexual bond between people of different genders. For these “classical” thinkers, another kind of union –  –  however desirable in itself –  –  requires another name.

Secondly, there are large numbers of Catholics in Massachusetts, and the teaching of their church makes gay marriage problematic. You can believe (as I do) that the Catholic Church stands in bad need of a new approach to sexuality, but it does not have one yet. Furthermore, Catholics have the sense of belonging to a worldwide church, one that is unlikely to adopt a position that runs counter to the culture of other nations.

Finally, not a few older people may feel that society is moving too fast on this issue. After all, even the well-informed may not have heard of the legalization of gay marriage as a possibility until very recent months. People need time to think about it. Those who have reached seventy or eighty know from experience that history is full of unintended consequences. A decision of this magnitude should not be taken in haste; it deserves ongoing analysis and reflection.

These oppositional views are not those of all elderly people. As we have seen, some of the couples married in San Francisco are far from young. But the views of more skeptical or conservative elders should not be seen simply as an expression of blind prejudice. If we are to proceed in amity as a society, they should be accorded the same presumption of good faith that is owed to the proponents of gay marriage.

Richard Griffin

Few experiences absorb our attention the way illness does. Yet, when you talk about it with others, even close friends, their eyes soon grow glassy and begin to rove. How can something be of such pressing interest to us and of so little to others, I often wonder?

Despite awareness of this hazard, however, I write this week about a recent bout with shingles. This I do, not on my own initiative, but in response to a suggestion from my pastor, Dennis Sheehan. He urged me to share this experience with readers so as possibly to encourage others in coping with what can be a painful ordeal.

As a person of classical bent, I never feel myself in possession of a word’s meaning unless I know its roots. In this instance, the word “shingles” refers, not to the wooden boards that provide the exterior of some houses but rather to quite a different image.

When used to name the disease, “shingles” comes from the Latin word “cingulum,” that indicates a girdle across the middle of the body. Speakers of English in the Middle Ages with their fondness for variation apparently wore away the opening letter “c” in favor of the “sh” beginning the bizarre word that we know today.

The word describes the experience aptly because shingles sufferers usually feel themselves covered in a zone of pain that stretches part way across their body. Mine, however, has been located on my forehead, just above my left eye.

Though you do not need to have lived long to get shingles, age often brings it on. What most fascinates me about it is how this virus can have been lurking in our body since childhood. Its origin is the virus that causes chicken pox that so many of us had as kids but which may have lain dormant for decades. One member of my family got shingles in her 80s, some 70 or more years after the root disease first took hold in her body.

With this disease, our nerve ends become exposed, thus making us vulnerable to oftentimes excruciating pain. What causes the virus to erupt is still not clear, though medical authorities often point to stress. If that is the trigger, you can easily understand why shingles abounds in the general population.

If shingles carry a certain advantage, it may be the disease’s power to win sympathy. Most people know two things about it: first, it is usually very painful and second, it is not life-threatening.

That frees people to express condolences with the sufferer, a benefit I have been gathering in over the last several weeks. You can tell a person about being sorry for his trouble without worrying that your words might be inadequate. You know that the sufferer will get well.

For me, the illness has brought some other benefits as well. The most important of them for me is, once more, an acute sense of the kindness of strangers. In this instance, I mean mostly members of the medical staff at the clinic run by Harvard Vanguard.

In illness, you have to trust others to respond. My constant experience is that they do. You learn to practice a reliance on others that ultimately can enrich your own life.

Almost all people with whom I had no significant contact previously, these medical staffers have reached out to me in caring and sympathetic ways. This style of applying the healing arts has upped my morale and given me the confidence of finding relief from the disease’s effects.

That these caregivers are mostly women, some people of color, makes for a medical staff much different from what I knew earlier in life. Nurses, physicians, technicians, and others bring a diversity more representative of the world at large than in the past. I welcome the changes and believe us improved by the special gifts that women bring to the healing ministry.

Entrusting myself to the care they offer brings me to face my own dependence. Contrary to the great American cultural myth that we don’t need anyone, we all depend on one another. As a lady once told the author Mary Pipher, “Honey, life ain’t nothing but strings.”

Though not life-threatening, shingles has brought me further experience of my own mysterious vulnerabilities. How complicated we continue to be, defying all simplifications of human life!

Even at the most painful times, I try to ward off the unlovely emotion of self-pity. The heroic examples of friends who are engaged in long-term struggles with death-bringing diseases such as cancer shame me into placing limits on my own narcissism.

More positively, shingles speaks to me of the value in each day. Feeling unwelcome pain on some days enhances the joy of living on other days.

In this connection, I never tire of quoting Rabbi Abraham Joseph Heschel because his sentiments reinforce my continuing experience of life: “Just to be is a blessing; just to live is holy.”

Richard Griffin

The conference speaker told about his wife providing help for an 84-year-old woman hospitalized after a heart attack. His wife still considers the older woman a member of her extended family, though she is only the mother of her first husband from whom she was divorced 34 years ago!

Such is the continuing power of family ties, suggests Vern Bengston, a professor at the University of Southern California and a researcher well known in the field of social gerontology. In March he served as one of many distinguished presenters at a Boston College conference entitled “Public Policy and Responsibility Across the Generations.”

Bengston took another example of tenacious family ties from his own experience with his mother. Over her last decade, she lived in a nursing home that took some four or five hours for him to reach by car. Yet he made it a point to make this trip every few weeks even though, in her last two years, his mother could no longer recognize him.

This California researcher also cited the changing roles of grandmothers within so-called broken families. He told of one such situation in which a grandmother is raising eleven children. Several of the parents have had trouble with the law and at least two are currently doing time in prison. This qualifies as what Bengston calls “one of the strongest examples of unplanned parenthood.”

Another extension of parenthood, admittedly less dramatic and less uncommon, is taking place now within Bengston’s own family. His adult children, among them a 31-year-old daughter, have come back home to live with their parents.

Yet a further example of continuing strong multi-generational bonds, cited by Bengston, is that 40 percent of his college students have grandparents contributing to the cost of their education. He and his wife have put aside money for their own grandchildren’s schooling.

From these examples and his research findings he concludes that the nuclear family will prove to be lasting. Twenty-five years from now it will remain vital and members will be less isolated than they are currently. He does not envisage a future conflict between generations, despite pressures that may be created by changes in Social Security.

These conclusions come as a surprise, however, in view of the sweeping changes that the same researcher foresees. He admits the growth of many new stresses on family life, among them the shakiness of so many marriages, the complex challenges involved in balancing work and family life, and the difficulty of finding caregivers for the elderly.

Despite what he calls “the astounding changes” that have taken place in a single generation, he finds remarkable staying power in family ties. Members of the so-called “Generation X”, compared with the Baby Boomer group, display surprisingly similar feelings.

Bengston displayed a graph showing that, over a 26-year generation gap,  young people feel as much solidarity with their mothers as mothers now middle-aged felt with theirs. Feelings of connection with their fathers remain almost as great.

Some other professionals at the conference, however, did not buy into Bengston’s rosy scenario. Philosopher Harry R. Moody responded by questioning what he called Bengston’s “relentless optimism.” “What if massive trends are undermining the system?”he asked.

Moody sees little to celebrate about a grandmother needing to take care of 11 children, some of whose parents are in prison. He also worries about a global culture increasingly inhospitable to family life.

Jack Cornman, a consultant with wide experience in the field of aging, sees the basic question as “to what extent society should help cope with pressures on families.” He criticizes social policies that “consist of throwing more choices at people.”

A researcher from Harvard’s School of Public Health, Norman Daniels, also made a sober judgment about the larger picture. “Looked at globally, the family situation is very threatening,” he warned.

Unless people like me, nested in our middle 70s, break the 100 mark, some of these issues may have no immediate practical impact on us. They will perhaps remain questions for the social policy wonks to cope with. Meantime, I hope we can enjoy two-way communication with and support from younger members of our extended families.

As you can judge from the snatches of the discussion relayed here, the Boston College conference provided no one dominant view on family issues. But it did raise questions that will remain central as our society continues to face changes that will help shape the future of family life in America.

Incidentally, it struck me forcibly that a conference for which professionals came from various parts of the country to Newton in the Commonwealth of Massachusetts, not a single presenter said anything about the impact that the legalization of gay marriage might have on family care.

I will not soon forget the photo last month of a lesbian couple, Del Martin 83 and Phyllis Lyon 79, who have been partners for 51 years and, at San Francisco city hall, joyfully presented themselves to get married. What effect would or will the legal blessing on this and other monosexual unions have on elder care within their families?

Richard Griffin