The inordinate number of deaths of elderly and their caregivers during the pandemic were not inevitable, and it’s time to change treatment and attitudes about aging, says professor Jane Thrailkill.
Thrailkill, a scholar of American literature, crosses disciplines as part of Carolina’s literature, medicine and culture program. Her work draws on the sciences, social sciences, arts and humanities to examine the human condition and our ethical obligations to each other. She is Bank of America Honors Term Distinguished Professor in the College of Arts & Sciences’ English and comparative literature department.
Seen through the lens of health humanities, the COVID-19 death rate among the elderly was not inevitable, Thrailkill writes in “Who Counts? Old Age in COVID Times,” an essay scheduled for December 2020 publication in the journal American Literature. She describes how skewed perceptions and social factors endangered the elderly: the belief that older adults are intrinsically frail, coupled with the economic disparities of health care workers in skilled nursing facilities. The almost $200 billion industry has a profit motive to understaff; care homes were disastrously underprepared with personal protective equipment.
“We’re all shut-ins”
Thrailkill also writes that thinking with old age offers fresh insight for younger people and older adults who think they’re not old. During the lockdowns, “We’re all shut-ins. We’re all experiencing some facet of what it feels like to be old,” she said.
Since news of increasing death in skilled nursing facilities broke in Washington state, the experience of the elderly has shone a light on their lives and those of workers, often people of color who work multiple jobs to make it socioeconomically. Care work is hands-on, intimate, essential. Staff often take public transportation and lack health care or sick leave: an ideal recipe for contagion.
Six months in, we don’t know the full extent of deaths. With the Centers for Disease Control and Prevention recently requiring states to report COVID-19 cases and deaths in care homes, a lack of standardization has led to what the American Association of Retired Persons calls “a patchwork of inconsistent data.” Still, analysis by organizations such as AARP and the Kaiser Family Foundation indicates that from one-third to one-half of American deaths have been in nursing homes. The World Health Organization reports that up to half of European pandemic deaths were in long-term-care facilities such as nursing homes.
“There is every reason to believe that what the WHO reports is true in Europe is true in the U.S., maybe more so,” Thrailkill said.
But it’s about more than the numbers for Thrailkill. While neither of her parents died from the coronavirus, both lived in a nursing home after their health declined. She had a front-row seat for understanding writers, both present-day and past, such as Rudolf Virchow, who prophetically wrote in 1848, “Medical statistics will be our standard of measurement: We will weigh life for life and see where the dead lie thicker, among the workers or among the privileged.”
The statistics, as saddening as they are, may serve as catalyst for transformation. Thrailkill expresses a hope that “the enforced empathy of COVID times ─ along with the devastating accountings of death of staff and workers in skilled nursing facilities ─ might lead to transformations in how we look at, and look after, the elderly and frail in our prosperous nation.”
“What it means to be old”
The essay contains 49 citations and quotes from people who have written about old age, cared for aging family members, provided medical care and observed firsthand the ravages of COVID-19.
The pandemic, Thrailkill writes, “provides a massive test case for the ontological uncertainty of what it means to be old” and has drawn a clearer starting point of old age. With decades of governmental definitions of old age such as legal mandates or social security and stereotypes of the elderly as nonproductive and innactive members of society, the pandemic exacerbated thinking of the elderly as expendable, vulnerable and commoditized.”
With occasional humor, the essay offers insights from Thrailkill’s life and others, centering on how stay-at-home orders have given most of us a taste of life in nursing homes, where isolation increases loneliness, boredom and hopelessness ─ three “plagues” that have solidified in “the popular mind with being elderly.”
“The pandemic is like a lamp, illuminating this experience, which is existential. In this weird way, I feel like COVID time is making us all into philosophers, if we’re paying attention to the precarity of our existence and the extent to which we are interdependent on people we don’t normally see. Grocery workers and people in nursing homes and prisons,” Thrailkill said.
Now is the time to re-imagine eldercare, Thrailkill writes, to improve conditions for residents and workers in congregate settings.
Until society reintroduces the concept of old age to include dignity, wisdom and cultural richness, then “we are all diminished if the elders among us are shelved,” she said. “Until we get those kinds of qualitative, nonfinancial, nonnumerical elements back into our social structure, older adults will be expendable in the sense that they are interchangeable.”
As a Baby Boomer, Thrailkill has some possible solutions on her mind for improving life in old age:
- co-housing, combined with a nurse’s care;
- routine discussions between older adults, their adult children and health care providers;
- opportunities to be and feel useful through activities such as garden work, cooking and animal care;
- less-restrictive laws and regulations on programs that offer meaning and purpose;
- more programs to address spiritual, emotional and existential needs of older adults;
- improved institutional food; and
- a federal commission on aging with purpose and dignity.
Thrailkill teaches the analytical methods of health humanities to undergraduates and medical students, seeking creative solutions to healthcare problems. A humanistic perspective, she said, has benefits that extend beyond the medical context. Thinking about old age in the time of COVID-19 can reframe all our lives.
Lacking purpose can be an existential disaster, she said. “We’re apparently the richest country in the world, so why don’t we try to imagine the meaningfulness of older age?”
By Scott Jared, The Well