McKnight’s Articles

It’s not morbid to talk about death … a lot

A few weeks back, I attended my high school reunion. I found myself on the dance floor shaking a tail feather with Linda, a friend from 35 years ago who always made me laugh. Time didn’t diminish her sense of humor, but our conversation took a surprising turn when she segued from a quick reminiscence to an impassioned statement about dignity at end of life.

Linda decided, at age 53, to go back to school to become a nurse. She’s passionate about elder care and described the profound honor of aiding at the bedside during one’s passing. Linda didn’t know that in high school I made the decision to become a nurse, nor did she know that I’ve devoted my entire career to the betterment of our elders, especially at end of life.

It’s not morbid to talk about death, even on the dance floor at your high school reunion. Yet in the nursing home, ground zero for frail elder care, we don’t regularly or consistently have these most important conversations about end of life wishes, expectations, hopes and dreams. Do you ever wonder why? Many factors that characterized early American culture have seemingly reversed the reality surrounding, and our acceptance of, human mortality.

For one, the commercialism and escapism of a post-war American society certainly emphasized youth and vitality, marginalizing aging and banishing a consciousness of our inevitable mortality. For another, the many customs and superstitions that have been introduced in the last century due to immigration have discouraged earlier views of death which were more realistic and pragmatic. I personally believe that these widespread theories, which value a longer life over a more fulfilling one, provide a cultural context for our industry’s current reimbursement system, which incentivizes volume over quality, and “minutes” over resident-centered care.

As Madison Avenue figures out how to make aging “sexy” (read: profitable) and we transition to the new PDPM payment system, I am hopeful that the long-term care industry will learn to embrace these difficult conversations around end of life.

Continue reading Steven Littlehale’s guest blog on