Last week, I facilitated a virtual summit on the need and opportunity for profound change in how our society cares for its elderly. And as so often happens in my work, there were lessons for all of us, as we look for wiser, more compassionate ways to care for each other and the Earth.

At times, preparing for the summit felt like sacred work to honor the elderly and those who offer them care, particularly after so much tragedy in long-term care facilities during the pandemic. At other times, I confess that I wondered if this was the best use of my time. As California burns and the sky turns hellscape orange, should I be focusing on something more immediately pressing and with more visible public effect?  

But over the years, what I’ve come to understand is that there is no such thing as immediate effect. There is only thoughtful cultivation of fertile conditions for something more thrivable to emerge. There is only the practice of becoming ever more fully aligned with life. And the end of life is as good a practice ground as any – in fact, it tends to paint our priorities in full starkness and make them clearer.

Within this particular practice ground, then, those who are drawn to care for the elderly are almost universally warm and generous. But in the business of long-term care, it is avoidance of risk that is propped up as the one true north.

To illustrate this point at the summit, we heard stories of people prematurely confined to wheelchairs to avoid the risk of falling, and of Asian elders denied soy sauce to avoid the risk of high blood pressure. We heard that governments avoid risk by adding regulations, and then the paperwork to prove compliance takes so much time that the quality of care suffers. And we heard about the “medicalization” of long-term care at the expense of social, cultural and emotional needs, even though research shows that attention to those needs improves physical health outcomes.

As a result of this focus on avoiding risk, the consensus among the summit’s three expert speakers and 200 participants was that long-term care is characterized by boredom and loneliness, lack of personal choice and control, and a sterile and rigid environment.

And guess what: 100% of people die anyway.

And along the way, caregivers are consistently overworked, underpaid and over-administrated.

The system isn’t working for anyone.

The whole situation was summed up in a startling observation from one summit presenter: without risk, there can be no joy. Risk, it turns out, is inseparable from thriving. Who would’ve thought?

The real risk, then, is not of dying. The real risk is of failing to live. Even in our dying days, we want to live.

This doesn’t mean we should abandon medical care, eliminate all regulations, and throw caution to the wind. It does mean that we need new, creative conversations about what matters most in the dusk of our lives and about how that might be wisely and compassionately stewarded. Stewardship as the combination of reverence and responsibility, as I see it.

Terry Tempest Williams’ lovely little stanza comes to mind:

Once upon a time, when women were birds,
there was the simple understanding that
to sing at dawn and to sing at dusk
was to heal the world through joy.
The birds still remember
what we have forgotten,
that the world is meant to be

And then there are Mary Oliver’s timeless words:

I don’t know exactly what a prayer is.
I do know how to pay attention, how to fall down
into the grass, how to kneel down in the grass,
how to be idle and blessed, how to stroll through the fields,
which is what I have been doing all day.
Tell me, what else should I have done?
Doesn’t everything die at last, and too soon?
Tell me, what is it you plan to do
with your one wild and precious life?

These questions and observations have relevance for all of us, even those of us still in our prime. The dysfunctional elder care system is simply a symptom of a worldview that devalues all life, including our own.

And how could we possibly design a better system for our aging parents without addressing this larger story? The summit invited us to explore “how long-term care homes can be transformed from restrictive institutions into vibrant caring communities, full of dignity and respect, where older adults can flourish and prosper.” But what if we don’t have a lived experience of vibrant caring communities “in the wild”? Our own story can’t be separated from that of our elders.

More than that, there is every indication that we are at the dusk of human civilization, at least in its current form. It’s unclear what will come next – it may well be “the more beautiful world our hearts know is possible,” as Charles Eisenstein says. In the meantime, there can be no doubt that hospicing is called for. And for many of us, grief is a constant, if unacknowledged, companion.

It seems there is a broad need for new, creative conversations, asking:

What is it we plan to do with this one wild and precious Life – the whole miraculous, interwoven web of Life? 

What matters most in the dusk of our civilization, and how might we steward it wisely and compassionately?

What risks are necessary to our collective thriving? What joy do we yearn to express as a healing song for the world? 

How can we tend, most of all, to our social, cultural and emotional needs, trusting that our physical needs will find sustenance within that fertile soil? 

What would help us bring to these conversations the sense of reverence and responsibility we would bring to the care of our own mothers – or that we would want our children to bring as they care for us? 

There are no simple answers to any of these questions, no single solutions for all contexts and all time. There is only thoughtful cultivation of fertile conditions for something more thrivable to emerge. There is only the practice of becoming ever more fully aligned with life. And the end of life is as good a practice ground as any – as is a project or an organization or a community.

The important thing – the starting point – is to risk imagining something new, rooted in reverence and responsibility.

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Image by Sara Heppner-Waldston

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