Prescription Disadvantage

“I don’t know what they’re trying to do to elderly people.” That is what a friend, on the verge of her 87th birthday, says about elder service program cuts that she has heard talk of recently.

For the past six months or so, she has been enrolled in Prescription Advantage, the state’s drug program for people over 65 and low-income people under that age with disabilities. She finds that it provides excellent coverage, regards herself as lucky to be on it, and hopes the program will continue.

Some human service advocates are worried, however, about what has already happened to the program and what is likely to happen in the future. Already, as of February 1, the state office of elder affairs has cut off any further applications for membership. And Governor Romney’s budget, if enacted, will require increases in costs for current members. As of now, those increases are planned for April 1.

For the last two years, however, Massachusetts residents have enjoyed the benefits of “Prescription Advantage,” getting badly needed help with the costs of drugs. Our state has thus stepped out in front of the nation in doing something practical about the health needs of some of its most vulnerable citizens

But the new elder affairs secretary, Jennifer Davis Carey, has pronounced Prescription Advantage to be “unsustainable” because of insufficient money given her in the new budget. And yet she has cut off new enrollments despite expert opinion that larger enrollments are the key to making the program affordable for the state.

If the reductions kick in, Massachusetts will run the risk of surrendering its position as a leader in helping older citizens to meet their prescription drug needs. The only state plan in the whole nation to offer prescription drug coverage to all citizens over age 65 will have lost much of its clout.

The amounts required in premiums, co-payments, and deductibles will take the advantage away from the prescription program. These higher costs may cause many moderate-income elders to drop out.

It’s no use waiting till politicians in Washington take care of those of us over 65 and those younger but disabled. The pols of both parties have frittered away opportunities to include a prescription drug package under Medicare. Last week the president was again talking about taking action but talk will not do it.

With huge amounts of money promised or spent on tax cuts, military forces sent to the Middle East, and even some 30 billion for Turkey, there will be nothing left for Medicare improvements. No time soon, it appears, will relief come from Washington.

Many of us, perhaps, will have to see if we can buy drugs in Canada, as residents of some other states have been doing. Perhaps the Commonwealth will have to charter buses for us to travel to Montreal and other points north.

Other reasons for concern have emerged from the new governor’s budget priorities. What is happening to the drug program is of a piece with cutbacks in vital services to elders in need. The home care program for which Massachusetts decades ago established a nationwide reputation finds itself at its lowest ebb since the 1980s. Advocates such as Al Norman of Mass Home Care report that 2000 fewer elders are receiving services than 14 months ago. Adequate funding is being nibbled away.

These advocates worry about the shrinking of home care, in part, because it may drive many more people into nursing homes. This is likely to have the self-defeating effect of costing the state more money by driving up the costs paid through Medicaid.

It also seems that the state office of elder affairs is  losing much of its clout. Again, Massachusetts was the leader back in the 1970s as one of the first states to establish a cabinet level office to serve the interests of older people. Through the intervening years, it has functioned remarkably well, giving organized elders leverage to ensure that their needs are met by state government.

Last week when Governor Romney announced his budget plans, it became clear how far the elder affairs office has fallen in his hierarchy. Instead of reporting directly to him, he wants it to answer to the secretary of health and human services who will control the money and determine budget priorities.

Al Norman characterizes the elder affairs structure that will be left as only a “shell organization.” It does seem a shame that what so many leaders such as Frank Manning and Elsie Frank fought for on behalf of older citizens may now be sacrificed in the name of reorganization.

Yes, Massachusetts, like all the other states that face severe budget shortfalls, must make changes. The challenge is to make changes that will serve the greatest good and ensure the well-being of those who are most needy.

Richard Griffin

Winter Storm

This long hard winter seems endless. Despite the breaks offered by the arrival of a few relatively warm days, it is hard to believe in the promise of spring.

The skin that covers my hands bursts in protest against days of freezing temperatures, producing small but painful fissures. Even bundled up against the cold I feel the winds going through my winter jacket and I get my feet wet sloshing through puddles.

I feel impatient about putting on heavy clothing every time I leave my house.

But a great blizzard brings with it some redeeming virtues. The new-fallen snow, three feet of it in some drifts, has a beauty about it that is altogether special, at least before the dirt sullies it. People, young and old, walk down plowed streets finding delight in the splendor all around them. Some sporty types convert these passageways into avenues for cross country skiing.

Even the arduous labor of digging out my car becomes a social experience filled with good feeling. Two neighbors come over to help me and take on the task with gusto. Soon we have cleared the snow off the roof and hood, freed the wheels, shoveled out the snow surrounding the vehicle and thrown it to the other side of the street.

Then I am ready to gun the car in the effort to break out to the roadway. It works; I’m in the clear, and the space can be occupied until someone else comes along and takes it when I leave. I resist the impulse to place a barrel there illegally, to save the space against poachers. The area is public, after all; it belongs to the whole community, even if someone else sends me around city blocks searching for another parking space.

I relish conversing with the two neighbors who help me dig. They are decades younger than I, one a fellow writer, the other a high-powered freelance entrepreneur. Gathering together around a common task on a bright, sun-lit morning brings out the good feeling among us. We banter about the storms and about our neighbors, all in a lighthearted spirit infused by the joy of our task.

Where is the spiritual meaning in this experience? Is there anything about the snowstorm and our response to it that goes beyond?

Surely the wonder of it all rates reflection. Nature continues to provide nourishment for us. The water that comes down from the sky in frozen form renews the earth. And the storm presents us with the gift of panoramic beauty, white coating for the landscape.

The coming together of people in response to the snowfall is worth thinking about. I love the community of feeling that results from the shared experience of natural forces. We have something in common that brings us out of our houses and gives us something to talk about together.

The austerity is worth something to the soul. The cold, the inconvenience, the exercise against resistance: all count.

Perhaps these experiences of natural beauty, struggle, and social cohesion are not the most profound soundings of spirituality. But they do have their own depths deserving of contemplation.

The storm can, of course, be seen as simply the cause of widespread inconvenience. It strands some of us and forces us to miss connections on trips and disrupts our work. Even many of us hardy New Englanders, at this point in the winter, wince at the prospect of yet another storm.

The searching soul, however, can find matter for pondering weather just like all the other areas of daily life. What happens in our world outside has its meaning for the world within.

Even when we remain inside the house and let the storm outside simply accompany whatever we choose to do, that has its virtues too.

This, at any rate, is what Billy Collins, currently poet laureate of the United States, suggests in a poem called “Snow.” About snow falling he writes:

“It falls so indifferently / into the spacious white parlor of the world, / if I were sitting here reading / in silence, / reading the morning paper / or reading Being and Nothingness, / not even letting the spoon / touch the inside of the cup,  / I have a feeling / the snow would even go perfectly with that.”

Richard Griffin

Molly and Andy, Pet Therapists

A golden retriever named Molly has a remarkably fine record as a pet therapist. Her handler, Bonnie Malm of Lexington, tells of the impact her dog had on one person who was a patient at the geriatric psychiatry unit in Mount Auburn Hospital:

“A gentleman had five family members visiting. This man never smiled. I brought Molly in and she headed right for him and put her head in his lap and now he had the biggest grin on his face. He loved the dog.”

Another woman, Lynne Peters of Arlington, speaks in similar glowing terms about the work of her dog Andy, a greyhound: “There was a lady here, she was quite depressed, you could not see any recognition of anything from her. Andy went up to her and gave her a little kiss and looked at her and she looked at him and they said that was the first time she had recognized anything around her in some months.”

Lynne Peters points out another beneficial effect of Andy’s presence: “I think it’s a good thing for family members, too; they enjoy seeing their loved ones enjoy themselves and seeing others care about their relative.”

Watching Andy and Molly interacting with elderly patients at the hospital on a recent Sunday afternoon was my introduction to the Caring Canines program. Started in 2001 by Marilyn Gilbert, a Winchester resident, this program now boasts 92 dogs who are trained, approved, and registered for visits to facilities where elder citizens, children, and others of various ages welcome them.

Another of the dogs I have met is Zoe, the English cocker spaniel handled by my friend Deana Furman, an 11-year-old girl who lives in Arlington. She and her mother, Carole Bohn, take Zoe to several elder residences and nursing homes, much to the delight of elderly residents.

Of the dogs who visit Mount Auburn, Marilyn Gilbert says: “I select them very carefully; in a psychiatric unit you need our most engaging dogs.”

Andy has a special trait: he is trained to lean against people. “He leans, so he’s a good therapy dog,” boasts his handler Lynne Peters.

The patients in the room where the dogs were visiting all seemed delighted with them. “Molly and I are buddies,” announced one man.

Two other patients, both women, also praised their visitors: “They’re beautiful, they’re so friendly.” Another explained why the dogs please her: “I like the dogs because they’re very well behaved. They have nice personalities.”

My only problem with the program is that so little  time is given to visiting. At Mount Auburn, the dogs come only once a month and stay for a half hour or so. Marilyn Gilbert says it’s because the program does not have enough dogs and volunteer owners to satisfy the demand from nursing homes, hospitals, adult day care centers, and assisted living residences.

To take part in Caring Canines, a dog’s handler must follow a series of rules designed to safeguard the patients’ well-being and comfort. You can find these rules and other information about the program at its web site, www.caringcanines.org. This site features handsome photos of the dogs, along with tallies of how many visits they have accumulated thus far.

Throughout my first experience of pet therapists, I kept wondering if Phileas J. Fogg, our household cat, could ever take part in such an activity. Unfortunately, I knew the answer as soon as the question rose in my mind: Phil is simply too ornery ever to submit to the discipline required of pet therapists.

In looking for reports of research done on pet therapy, however, I did find mention of two cats who take part in animal visitation at Bayside Medical Center in Springfield. They have visited patients in intensive care units and, according to nursing staff there, “eased the patients’ isolation and depression symptoms.”

An article with the arresting title “Take One Pet and Call Me in the Morning,” appeared two years ago in the periodical “Generations.”  The author says research suggests “the human-animal bond is perhaps stronger and more profound in late life than at any other age.” That conclusion, however, is based on companion animals who live with people rather than visiting animals.

A huge number of Americans have such companions at home, some 60 percent of households.  Of these the author says, “Companion animals offer one of the most accessible enhancements to a person’s quality of life, increasing happiness, and improving physical functioning and emotional health.”

Obviously, more research needs to be done if the value of visitations is to be proven scientifically. But many people do not need to wait to be convinced: they already experience at first hand the benefits of visiting dogs like Andy, Molly, and Zoe. 

To inquire further into the program, you can call the director at (781) 729-8285.

Richard Griffin

Spirituality and Dementia

This week I am still mourning the death of a friend of many years. By current standards of longevity, Jack was not old when he died; his life was cut short by Alzheimer’s disease, that terrible illness which continues to afflict so many people.

Some four million Americans currently suffer from this disease, despite the intermittent progress achieved by scientists trying to discover a cure or a means of prevention.

Like others whom this disease has hit, my friend gradually lost the ability to think logically and to recognize other people. With the loss of memory, Jack eventually could no longer function on his own.

In time, he became resident in a special ward in a Veterans’ Administration hospital so that he could receive skilled professional care. Little by little, the disease broke down his body’s defenses until he finally succumbed.

Alzheimer’s disease and other related dementias, in addition to posing challenging medical questions for doctors and research scientists, also raise vital spiritual issues for all of us. When patients lose all mental ability to function on their own, what do they have left and how should they be treated?

The temptation is to think of them and deal with them as if they had ceased to be persons. In a society that tends to esteem people to the extent that they do something of monetary value, we can consider those afflicted with dementia as of no account and, moreover, a drain on the nation’s resources.

I am glad to report that my friend Jack’s family members and friends did not respond to his illness in this way. They continued to treat him as the unique person he was and showed him love and affection.

A colleague and friend, Stephen Sapp, has written insightfully about the spirituality of relating to people with dementia. A professor at the University of Miami and an ordained Presbyterian minister, Dr. Sapp has clearly reflected and, I suspect, prayed deeply about this subject.

His first bedrock principle is that all humans are “created in God’s own image and are worthy of respect and protection, especially those who cannot care for themselves or who do not measure up to the world’s standards of value.” Even if we cannot, or can no longer, produce anything or even think rationally, that does not make us any the less deserving of reverence.

Professor Sapp identifies several mistaken notions behind the common American negative attitudes toward people with Alzheimer’s.

First, if people are impaired in one way, we tend to judge them as deficient in many ways, even making of them deficient persons. Just because a person cannot remember names, for instance, does not mean they cannot profit from spiritual exercises. They may recognize in familiar words and sacred actions support from God in their struggle against the dark forces of their disease.

A second tendency is to judge declining brain ability as eliminating the person’s character, personality, and preferences. That can lead to ignoring patients’ lifelong taste for certain foods or other pleasures.

Another fallacy is to assume that the actions of people with dementia are meaningless. Some actions, apparently nonsensical, may have a significance for a sick person, except that we do not know what it is. A patient who wanders may in fact be seeking to perform some action that will guarantee his or her safety.

One woman with advanced Alzheimer’s used to scream loudly every time nursing home attendants took her for a bath. No one could figure out why that was happening. The water was not cold and she was not in pain or suffering for any other obvious reason. Finally, someone figured out that she was screaming because the door to the bathroom was being left open without regard for her dignity.

Ultimately, we do not know what goes on in the soul of a person with dementia. On the surface, only confusion may show but that does not mean nothing positive is happening inside.

There is no denying the terror that Alzheimer’s brings, but maintaining personal respect and reverence for the soul and body of the person afflicted brings us closer to the mystery of that person’s experience. And it may lead toward a spirituality that gives us the courage and insight to cope with a difficult situation.

Richard Griffin

A Friend Approaches Death

On entering the room, I began to weep.  For the first time in many years, I could not stop crying. The sight of my friend Jack lying on a bed, his eyes closed, his mouth open wide, and him obviously dying caught me by surprise. I had come to the Veteran’s Hospital knowing of his entering into crisis but I did not expect to see him this much changed.

Next to him in that narrow room stood a priest saying prayers that go with the Anointing of the Sick. Around the bed stood members of Jack’s family –  – his wife, their sons, and one daughter-in-law, all of them holding hands as they joined in the prayers and blessings. Seeing them stirred my emotions further, as I felt solidarity with them in our common loss.

My two companions and I, arriving late, were embraced and made to feel part of this community of shared grief. We extended our hands in the prayer circle and also received the priest’s blessing. He consoled us by saying how good it was to have other people with him as he prayed over Jack

The pity of it! The pity of it! Those words of Shakespeare welled up in me as I looked upon my friend of six decades. He was asleep so deeply as to seem already removed from the world. The disease that had worn him out was now breaking down his last walls of resistance.

It had been a long and agonizing struggle over the last eight years or so. Alzheimer’s, at first subtle in disclosing its presence, gradually took away Jack’s power to think logically and finally his ability to recognize old friends like me and even family members. In time he had become entirely dependent on others.

He had become lost several times, so lost on one occasion that a helicopter had to be dispatched to search for him. His profession had been lost too, a legal career in which he had shown much brilliance. Finally, he could no longer stay living at home.

What had stayed with him and even grown in power, however, was the love directed toward him by his wife, grown-up sons, and other family members. With courage and devotion his wife Penny had kept coming to see him and to attend to his needs, even when his responses were not identifiable.   

The old fashioned pool in which I swim every day  reminds me of Jack and our first week as college classmates. In those days, entering freshmen had to pass a swimming test in that pool, a feat I could not have accomplished since I could not swim at all. Sizing up my situation, Jack offered to take the test for me. With my connivance, he jumped in, swam competently up and down the lane, and posed as me until I was registered. Dubious ethically, this was an act of charity on his part that I still appreciate.

We had also been classmates in high school, two among the 21 boys who entered our new school in 1943. Jack was a far stronger student than I in math and science and so beat me out academically in our last two years. Instead of being resentful, I admired his all-around ability especially his excellence in analyzing  problems and solving them with confidence.

He finished his college studies in three years and then went on to law school where he continued to excel. After a stretch of military service, he did further studies in financial accounting, preparing himself carefully for his career in a prominent Boston law firm.

I provide these details, not so much for their own interest, but because they witness to the sadness of Jack’s decline. He was intellectually sharp, a person whose overall abilities and judgment stood out. To observe the relentless stripping of these native gifts has been terribly painful, as it is in all those who suffer from this illness.

When I saw him on his deathbed, I also recognized something of the fate that awaits me and everybody else. Only some of us will get Alzheimer’s, but we all know that death lies ahead. As the Jesuit poet Gerard Manley Hopkins says, “It is the blight man was born for.”

I have always believed that death does not finish human existence. Faith in resurrected life continues to form part of my response to dying. I hope for Jack to live on in what my spiritual tradition calls a place of comfort, light, and peace.

But no matter what consolation I find in this faith, to see my friend dying was unutterably sad. My tears gave expression to a sorrow I could not express otherwise. I was about to lose an old friend and that loss cut into me deeply.

Richard Griffin

Food and War

For years, a truck filled with food has gone around the city where I live. On the outside of this vehicle are painted the words: “When I feed the poor, they call me a saint; when I ask why the poor have no food, they call me a communist.”

The truck belongs to an agency called “Food For Free” that purchases fresh fruit and vegetables, receives left-over bread from bakeries, and then distributes most of it at 40 centers where poor people come. Agency staff members also make home deliveries to some people who are unable to get out. In warm weather, staffers glean food from area farms and also take contributions from farmers’ markets.

The quotation on the truck comes from the late Helder Camara who was archbishop of Recife in Brazil. Physically small, but spiritually a giant, Dom Helder (as his people called him) was widely known because of his passion for social justice. I had the privilege of spending time with him on two occasions in the 1970s when he visited Boston.

The work of this spiritual leader, who died in 1999 at age 90, came back to me this past week as I joined others in celebrating Janet Murray, a woman who has spent many years working with  Food  for Free, serving the hungry people of our community. On the occasion of her recent retirement, those who have supported her came together in a local movie theatre to honor her for her service to the poor.

There is something spiritually uplifting being with people who reach out to others in need. For me it serves as a moral tonic to talk with fellow citizens committed to the least fortunate in the community. They strike me as what another writer has called “wisdom people,” those who have discovered how serving others makes for a fulfilled life.

Janet Murray, typically of her, seemed to be just one of us in the crowd. Unassuming, ready to give credit to others, she radiates love for family members, friends, associates, and people like me who had simply come by to do her honor. Again, contact with such a person serves as a strong stimulus to be more giving of oneself.

Two weeks  previously, on Martin Luther King Day, I had stopped by a demonstration outside our city hall to talk with people who oppose making war against Iraq. On possibly the coldest day of the winter, some 450 people were parading in a large oblong formation, many holding signs and calling out their reasons why this war should not be started.

“I wasn’t happy about going out in the cold, I hate the cold, ” 87-year old Boone Schirmer told me. “I’ve broken the same hip twice and I’m deaf as a post,” he continued, “but I’m glad I went.”

His wife, Peggy Schirmer, is a year older, walks with difficulty, and is suffering through the early stages of Alzheimer’s disease. “When you get old, you are more limited,” she told me. “But you live within your limits.” She and her husband went up and down the line twice, she in a wheelchair.

I found inspiration in such courage on the part of old people. Of course, it helps that I share their misgivings about the planned attack. Taking my cue from the bishops in my spiritual tradition, I remain unconvinced about the moral justification for undertaking this military action.

The stark contrast between the preparations for war against Iraq and the plight of the poor among us at home struck me forcibly. Chad Cover, who currently serves as director of Food for Free, puts this contrast clearly: “We’re willing to spend 100 billion dollars to fight a war, but we can’t provide basic social services to the needy.”

Like many another public servant,  Chad Cover draws inspiration for serving the poor from the spiritual tradition in which he grew up. And that same tradition moves many of us to resist the war that may  be fought in our name.

Following the lead of Helder Camara, I long for the day when our nation devotes more energy to finding out why so many people here and elsewhere in the world have to scrape for food, and less energy to building up the Pentagon’s budget.

Richard Griffin

Maggie Growls

Of all the women I have met in my years of working with older people, none can quite equal Maggie Kuhn for personal dynamism. Big ambitions for changing society, willingness to defy convention, skill at manipulating politicians and media figures, courage in the face of physical decline – she had qualities of leadership that were altogether unique.

This physically small but soulfully impressive woman, who came to look like an ideal grandmother, accomplished a surprisingly large amount of her agenda. According to a new documentary on her life, “Maggie Kuhn changed the way we think about aging.”

Before Maggie, the film claims, “older people were not allowed to work, were not expected to socialize with people of other age groups, were not expected to have sex, were not expected to contribute to society.” Like other sweeping generalizations, this one cries out for qualification, but it bears enough truth to suggest what Maggie’s leadership meant.

Founder of the Gray Panthers, a name associated with militancy, Maggie Kuhn did not lack a sense of humor. In this spirit, she taught her followers how to growl. They were to stick out their tongues, turn toward another person, and make a deep sound from the throat. The new film shows an auditorium of people following Maggie’s instructions and growling with laughter.

A friend, Art Mazer, recalls another instance of Maggie’s humor when local Gray Panthers presented her at Boston City Hall. When introduced, Maggie had to rock back and forth a few times to get out of the low-slung chair in which she was sitting. Arrived at the podium she quipped: “That’s called the rock of ages.”

This film, entitled “Maggie Growls,” is scheduled for Boston-area showing on Monday, February 17th at 10 P.M. on the PBS channel 44. I recommend it for sheer human interest, and because the film recounts how one woman helped to change America in the period between her forced retirement in 1970 and her death in 1995 at age 90.

Maggie had radical ideas about how to improve American society. We needed to abolish compulsory retirement that put people on the shelf at 65. Our country desperately needed single-payer universal health care coverage. And we had to transform our basic ideas about older people and the experience of growing old.

A way of achieving this last goal was to help change the way older people were portrayed in the media. The “Media Watch” established by the Gray Panthers served for a time as an effective device to ensure change in television, movies, and advertising, change that has taken hold to a considerable extent.

It was not only her agenda that differed from most other people’s; so did her methods. She believed it a mistake for older people to push for change only with those of their own age. Rather, she wanted old people to join forces with the young.

Similarly, she thought old people should not advocate for changes primarily for themselves. Instead, she thought their advocacy would have much more credibility if they tried to bring about change benefiting the nation’s younger generations as well.

Despite her brilliance as a leader, Maggie was not successful in all her enterprises. Her organization, the Gray Panthers, never did turn into the alliance of old and young that she envisioned. I remember attending one national convention of the GPs, and immediately noting the absence of young people among the delegates.

And she never was able to develop effective leadership to direct the Panthers after her death. Even before 1995, her organization had lost its momentum and now has only a faint heartbeat. But it was never much of an organization; instead it was a movement with all the strengths and weaknesses of minimal structure. Never would it become an AARP, but Maggie would sooner have died rather than for that to happen.

And, of course, we still seem no closer to her goal of assured national health care for everyone. Even getting prescription drug coverage for Americans under Medicare has proven maddeningly elusive.

Maggie’s ideas about sexuality did not please everyone; in fact they shocked even many of the Panthers. She once recommended to an audience of older women the practice of lesbianism, and an embarrassed silence followed. She herself liked young men and once had an affair with one fifty years younger than herself.

When someone expressed to Maggie regret that she had no spouse or children, she replied, “I am completely happy with my life; I have no regrets.”

She suffered much pain in her latter days. I remember having dinner with her one evening and feeling some of that pain myself as I watched her eat with difficulty.

When the end came, she lay in bed in her house in Philadelphia. A friend watched her wake up, sit up in the bed and say “I am an advocate for justice and peace.” Then she went back to sleep and never woke up.

Richard Griffin