For years I have been working in the health field – caring for older persons, teaching others to care for older persons and advocating for future needs of older persons.
Sometimes I felt folk were not hearing me – especially 20 years ago when I started to raise awareness about the coming age wave.

One concern about the impending age wave back then was over the future’s shrinking resources. Another was the possible criteria that would be used to determine who gets the dwindling resources.

Well, the age wave has landed and the reality is graver than the research predictions of the 1990s about what would be happening in the current decade.

If a purely age criterion is put in place, will that mean that no one over a certain age will receive surgery? Or could it mean a committee will set criteria to determine if the surgery will be permitted? Criteria questions might be things like: Is the health of the person going to be better?

What will the quality of life be after the surgery? What are the coping skills of the person? Does this person have any vital responsibilities, anyone dependent on them? Is there a supportive family? Will this person economically benefit society if provided the surgery? Is the potential recipient part of a favored group?

In further consideration of the age criterion and shrinking resources, what about the very young? Will there be criteria for frail children who have needs for costly care?

Going a step further is an issue for persons of all ages with documented noncompliant medical history.

We all know folk who just do not follow doctor recommendations for living with chronic conditions. Will resources be allocated away from those who do not comply with healthy recommendations?

You do have several options. You could lock down in a passive mode, thinking your politicians won’t let it go that far. You could become very reactive, leading activist groups thinking you can change the issue.

I suggest that the ship has already sailed and cannot be recalled. It is time to get serious about taking personal responsibility for our health and that of family members. It is time to take serious the opportunities to become an informed consumer of health services and heed instruction about our health.

For those that were passive about my conversations in the past, I want to reiterate a message from the earlier period.

The impact of the age wave on healthcare economics will shift the paradigm from medicalization of older persons to something that will be unfamiliar for the younger generations to live out.

Some may see death as the optimal allocation of scarce resources.

Age-wave economics means that much care of the sick, the suffering and the dying will shift away from market-driven systems of care. Healthcare – bought and sold in the free market – will be for those who can afford to pay privately.

The shift to nonprofessional care in home settings will be difficult for those who have never provided long-term care for a bed-bound person, or sat at the bedside of a dying person.

How will persons learn to change adult diapers? Many have no memories of a grandparent dying in the home and many fear aging, suffering and death.

The shifting of hope and expectation from the wonders of medical therapeutics back to an embodied hope and utter dependence on God will create a spiritual crisis for many.

Just what is the capacity of congregations to provide a ministry of sustaining presence for those treading the gloomy waters when all seems to be lost?

Congregations that can grasp the picture of what is at stake will proactively be involved in teaching about living with less and less professional care over long periods of time.

They will teach about death and dying, and guide members to grapple with the question, “Is my reason for living big enough to prepare me for suffering?”

When individuals have not yet settled the questions about life and living, they are less reality-bound about long periods of declining health, death and dying.

Can I give up the cherished notion that I am entitled to healthcare? What will I do if I can never get another prescription for blood pressure medicine filled, not to mention unable to have Cadillac care for the ensuing stroke? Do I have a role in learning about congregational care ministries?

Can you hear me now?

SybilSmith, a registered nurse, lives in Lyman, S.C. She leads workshops on congregational caregiving ministries and teaches a course on poverty and health.

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