What would Thomas Hobbes think of modern elder care?, by Ira Rosofsky

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In 1651, during a brutal civil war and just after Parliament cut off the head of King Charles I, the English philosopher Thomas Hobbes called life, "solitary, poore, nasty, brutish, and short." Life expectancy was 40.

Fast forward three and a half centuries, and thanks to medical science, life expectancy is 80. Life is longer. Yet is it any less nasty and brutish?

My book, Nasty, Brutish, and Long: Adventures in Old Age and the World of Eldercare  considers that question, and wonders whether the dinner-party host who declined to put cut flowers in water was right when he said, "It only prolongs their agony."

Are the institutions in which we place the frail, elderly anything more than water for cut flowers-only prolonging the agony.

I am a psychologist who spends his days talking to mostly sad, often confused, yet occasionally happy old people in a variety of eldercare facilities across the State of Connecticut.

Alzheimer's, loneliness, chronic disease are my daily fare.

My book presents the stories of the ancient people I meet and casts a cold eye on the culture that sustains them in their final days, weeks, and years.

Their narratives have a compelling intrinsic interest-a personalized oral history of the twentieth century. In the lives of  many nursing home residents, I may be the only person who actually sits down, establishes eye contact, and listens.

But no matter how exciting or mundane the narrative arc of their lives, these nursing-home residents have one and all wound up in a corner of a hospital-style room living in a public space where you can't lock your door and strangers walk by and see you lying helplessly in bed. You might be lying next to someone who spends his waking days screaming, "Help! Please help!" Or you might be the one screaming.

Hannah Arendt looked upon the ordinariness of Adolf Eichmann and saw the banality of evil. I look upon the ordinariness of elder care and speak of the banality of banality.

I work both sides of the street. Along with the nursing home residents is the narrative of my and my wife's caregiving to our own aging parents-the personal meeting the professional, the health-care provider as health-care consumer.

In my book, I also move from the anecdotal to the general, and consider these questions.

• - Do our elderly need to be insitutionalized in places that look and feel like junior hospitals-hospital-lite?
• - Why does the government spend $70,000 to keep a patient in a nursing home while declining to spend only $30,000 for an often more appropriate, more home-like assisted living center?
• - Why do we spend billions on demonstrably ineffective anti-dementia drugs when we could be spending it on basic research and higher levels of staffing?
• - Why do the most highly trained staff in nursing homes-as well as most other human-service institutions-spend the least amount of time with residents?
• - Why do the staff in a nursing home view the closed door in a resident's room with the same suspicious eye as a parent viewing the closed-door of a teenager's bedroom.
• - Why can't you use the word "sex" in a nursing home without "offense" as a modifier?
• - Why is it immeasurably harder to get a simple glass of wine than a powerful major tranquilizer or a lethal cigarette?

Nasty, Brutish, and Long is also my baby-boomer rumination-at 62, I'm old enough to cash in my 401K yet too young for Medicare-about intimations of mortality. In the eyes of the people I see is the not-too-distant future of us all, or at least all of us who would like to grow old.

Ira Rosofsky, Nasty, Brutish, and Long, Avery, Penguin Books