August 24, 2014
by Mike Preg
In her nonfiction book The Summer of Great-grandmother, Madeleine L 'Engle describes the problems, crises, frustrations and guilt engendered by her mother's rapid slide into senility. Reflecting on her mother's situation vis-a-vis that of her earlier ancestors, she captures the frustrations and sympathies of each of us as we contemplate the encroachment of old age upon our own mothers and fathers.
I look at Mother huddled in her chair by the window and think once more about Mado and Greatie. In a day of what we would consider primitive medical knowledge, and no hospitals as we understand hospitals today, they both lived to a ripe old age, with their wits about them. Up until Grandfather, there is no record of senility in the family.... Obviously, nursing homes have not caused senility in the elderly; but when grandmother or great-grandmother continued to live with the larger family, to be given meaning because she could at least stir the soup or rock the baby, the climate for growing old and dying was healthier than it is today. I cannot reproduce that climate for Mother. Surgery kept her alive at eighty-seven; antibiotics pulled her through pneumonia at eighty-eight. For what? For this?'
The number of aged and elderly persons is increasing as longevity increases. Residences and care for the aged through nursing and retirement homes is a large and growing enterprise in our country. In spite of their high cost and debilitating effect, these institutions have become the commonplace and accepted approaches to this "problem" in our culture. Many Christians are adopting this institutional approach with apparently little ethical reflection on the goals, motives and standards for care of the elderly. It is the thesis of this paper that the normal place of residence and care for the aged people of God should be in the households of their children. This thesis will be examined from the situational, motivational and normative perspectives.
The aging process presents us with many difficulties, as individuals and as a society. As individuals, the fear of death is removed in Christ, but advances in medical technology have made it possible for us to outlive our capacity to cope with sickness. For many persons, there is the threat of long- term illness at the end of life which will both wipe out their financial resources and leave the person hanging-seemingly indefinitely-between life and death.' As a society, the problem of aging has us caught between the twin jaws of rampant escalation in the costs for caring for the elderly and the projected increase in our elderly population-which is expected to double to 52 million over the next 50 years.'
Therefore, in spite of the technologically advanced state of our society, old age is the source of frustration and futility. It is surely a fact that in Adam our bodies along with the rest of creation were subjected to frustration by God (Rom. 8:20; cf. Gen. 3:19). In fact, our physical bodies are a focus of that futility and the redemption of the whole creation is particularly linked to the redemption of the bodies of the sons of God (Rom. 8:19-23). This frustration can not and will not be overcome by the technological advances of man. Gerontology' and geriatrics' are two of our fastest-growing fields of scientific endeavor and while they certainly will continue to alleviate human suffering, the ultimate frustration of the curse of God upon the sin of man will be with us until the end of the age. Gerontologists would do well to study the remarkably accurate description of old age in the twelfth chapter of Ecclesiastes. Even amid the softening effect of the humorous metaphors, we cannot help being struck by the stark reality with which the Preacher begins his description as he speaks of the "evil days" and the years when you will say, "I have no delight in them" (Eccl. 12: 1). The Preacher feels and expresses the same frustration we feel as he cries out in verse 8, "All is vanity!" Here again, the connection between old age and the curse of Adam's race is made as verse 7 echoes the words of God (see Gen. 3:19) to our first ancestor, "Then the dust will return to the earth."
Yet, while the situation concerning the problem of old age is bleak as far as man is concerned, God has provided a solution in Jesus Christ, who alone can set us free from this body of death (Rom. 7:24). God graciously extends salvation to both the young and the old as he did when he brought Israel “with our young and our old" out of Egypt (Ex. 10:9). God has heard the plea of Psalm 71, "Do not cast me off in the time of old age" (vs. 9). The old are given a special place in the Messianic Kingdom: "Your old men shall dream dreams" (Joel 2:28; Acts 2:17) and "old men and old women will again sit in the streets of Jerusalem" (Zech. 8:4). These prophecies are typologically fulfilled in history as we see old men present when the restoration temple foundation is laid (Ezra 3:12). While the ultimate removal of the curse of old age must await the consummation, i.e., "the redemption of our body" (Rom. 8:23), nevertheless, as Christians we can understand that we have been subjected to futility, "in hope that the creation itself also will be set free from its slavery to corruption" (Rom. 8:20, 21). The believer who is united to Christ does not lose heart when he sees the decay of his outer man or physical body because by God's grace his inner man is being renewed day by day (2 Cor. 4:16). In fact, this decay of our bodies would appear to in- crease our attention toward and faith in eternal things as opposed to temporal things (2 Cor. 4:18). Seen in the light of redemption in Jesus Christ, the aging process functions in the life of the believer to wean him away from the temporal, the spurious values of life; and the aging process will be ultimately
From the situational perspective, there is yet another area which we need to investigate which bears more pointedly upon our thesis. Regardless of the important perspective gained from seeing old age in the light of the Fall and redemption in Christ, the fact remains that old people still require care above and beyond that which we would term medical care. The overwhelming approach of our society to provide this care has been and increasingly continues to be in the form of institutions.
Only 5% of our older persons reside in institutions but this figure is misleading; the small percentage accounts for well over one million persons and one fourth of all persons over age 75 will enter nursing homes at some time in their lives. This figure will rise if alternatives are not created or improved.'
This situation darkens, however, when we take a look at the state of the institutions which offer care for the elderly:
Nursing homes have been viewed as "the worst institution ever devised by man," and a U.S. Senate Report in December of 1974 concluded that a majority of this country's 23,000 nursing homes are substandard, with life-threatening violations of state and federal law.
Anyone who regularly visits the elderly in nursing homes, as this writer has done over the past four years, can only have sympathy for this quoted assessment. Given this present situation, however, should we work to improve the institutions or must we ask the more basic question, Are they really necessary? Facilities which offer medical care to the aged, or to any age for that matter, can hardly be eliminated. Should custodial, non-medical care of the aged properly be carried out in institutions?
Studies carried out by gerontologists in the last several years are even more disturbing. As many as 40% of the elderly in nursing homes do not really need to be there ... Many of those now in institutions would probably be maintained at home with minimal assistance…
When we are looking at the care of the elderly people of God, theologically speaking we are in the area of the application of redemption. The church is certainly an important institution in carrying out the application of redemption. Throughout redemptive history, the people of God have been given the responsibility to care for the poor and the infirm. Widows are especially singled out, along with orphans, as special objects of the care and concern of the people of God (e.g., Deut. 14:29; Jas. 1:27). Jesus tells his sheep that it is their special privilege to care for "the least of them" (Matt. 25:40). The dependent status of the elderly in the midst of a society whose basic interest is profit has certainly tended to make them "least" in the eyes of many."
Clearly, then, Christians are confronted with a responsibility to the elderly. In the area of the application of redemption, the question is often one of means-how is this responsibility to care for the elderly to be carried out? Throughout her history, the church has been in the business of old folks' homes.
However, as we look at the primary means through which God is pleased to apply redemption to his people, we see that the focus of the application of redemption is more fundamentally upon the family. The means by which God applies redemption in Christ to his people is through the Covenant of Redemption. God does not covenant with Abraham as an individual but with "you and your descendants after you" (Gen. 17:7). The eternality of God's covenant is expressed by "a thousand generations" (Deut. 7:9; Ps. 105:8- 1 0). Presbyterians have always argued from these passages and their extension into the New Testament (Acts 2:39; Gal. 3:13ff.) as support for the inclusion of infants in the covenant community. Yet the solidarity of the family, a creation ordinance not abrogated by the Fall or redemption, has implications not only for the care and training of our children, but also for the care of our parents. Scripture gives several examples of this covenantal care of children for their parents.
In the midst of a famine in the land, Joseph said to his father, "And you shall live in the land of Goshen, and you shall be near me.... There I will also provide for you . . . " (Gen. 45: 1 0, I 1, italics added). Ruth left Moab and her people in order to care for her mother-in-law, Naomi (Ruth 1:15-17). In particular support of our thesis are Ruth's words to Naomi, ". . . where you go, I will go, and where you lodge, I will lodge" (vs. 16). Even after her marriage to Boaz, we conclude that Naomi went to live with Ruth and Boaz, serving as the nurse of young Obed (4:13-17). Lack of the presence of the older generation "in your house" is seen to be a curse upon Eli (I Sam. 2:31, 32, italics added). Many implications have been drawn from Jesus' concern for his mother, Mary, while he was dying on the cross (John 19:26, 27), but certainly his provision for her serves as the preeminent example of this covenantal care and concern. Again it is significant that the NASB correctly renders the sense of the Greek in relating the response of the disciple whom Jesus loved as he "took her into his own household" (John 19:27). Timothy's sincere faith (2 Tim. 1:5) and knowledge of the Scriptures (2 Tim. 3:15) would appear to be a product of an extended covenantal family consisting of at least his grandmother Lois and his mother Eunice (2 Tim. 1:5).
The Motivational Perspective
The difficulties involved in caring for elderly parents in the midst of our modern homes are legion. To begin with, most of today's homes are not large enough to provide separate apartment-type quarters to an aged parent. However, when the cost of institutional care is considered, the construction of an addition to our home becomes an attractive financial alternative. Most healthy middle-aged adults are physically able to handle the work involved in caring for an aged parent. Emotionally, however, things are somewhat more difficult as a recent study of relationships between the elderly and their adult children indicates.
... poor health can increase the elderly parent's dependency on the adult child with an increase in resentment by the adult child (often caught between caring for his/her own children and caring for the elderly parent), and increasing frustration of the parent, with an over-all poorer relationship between parent and the child as the result
There is no question but that caring for an elderly parent in the home makes an imposition on the entire family and in the face of this difficulty, the motivation for doing so must be particularly strong. There is substantial opinion that the onset of senility or the depression wrongly diagnosed as senility is caused by institutionalization and therefore should be significantly stayed by living as a part of a caring covenantal family. Nevertheless, increasing deterioration in health, forgetfulness, incontinence, immature behavior and bitterness are often the elderly parents' reaction to the care provided by their children. This rejection is perhaps the most difficult to deal with. Constant care is required and the elderly are simply not the cute, cuddly infants who make similar outrageous demands upon our time. In lieu of the day care centers for the elderly being proposed in our society, church members or other family members should volunteer regularly to temporarily care for elderly parents so that their children can have a few free days per week.
The burdens involved in caring for aged parents in our homes are heavy, indeed, but the motivation for doing so is even stronger. John Murray writes of our adoption as sons of God as the "highest and most intimate of relationships. " It is certainly this wonder of God's amazing grace that causes the apostle John to exclaim, "See how great a love the Father has bestowed upon us, that we should be called children of God" (I John 3: 1). John underlines our present status as children of God as he goes on to add, "and such we are" (cf. vs. 2). Murray calls this act of transfer from an alien family into the family of God himself "the apex of grace and privilege." " We now have boldness through the Spirit to address God as Father (Gal. 4:6; cf. Rom. 8:15, 16) and we are assured of the persistence of good gifts from our Father who is in heaven (Luke 11: 1 1-13). This indicative status which we en- joy with respect to our heavenly Father is the gracious ground for our earthly sonship. In his infinite love God has given us, the former sons of disobedience (Eph. 2:2), the right (authority) to become children of God (John 1: 12) and it is this particular love which constrains and motivates us to respond with filial love or covenant loyalty.
But our filial response to our heavenly Father is also to be directed toward our earthly mothers and fathers (Ex. 20:12; Eph. 6:1-3; Col. 3:20). We realize our adoption as sons of God by faith in Christ (John 1: 12; Gal. 3:26) and James points out that our faith without works is dead (Jas. 2:26). Clearly, our faith in our adoption as sons of God works itself out in our proper filial relationship to our earthly parents. This is but a specific instance of our loving because he first loved us (I John 4:11, 12), of faith working through love (Gal. 5:6) and the outworking of our salvation (Phil. 2; 12, 13). Showing love to the unlovable, those who do not appreciate us, our enemies, is the mark of those who show themselves to be sons of their Father who is in heaven (Matt. 5:45; cf. Luke 6:35). Sonship is the consummate expression of the blessing of the covenant relationship between God and his people: "He who overcomes shall inherit these things, and I will be his God and he will be My son" (Rev. 21:7); and this is the supreme motivation for us to rejoice ifl the privilege of caring for our elderly parents in the midst of our extended covenantal family.
The Normative Perspective
Obviously one of our basic considerations is the fifth commandment, "Honor your father and mother." As we have already seen, there is a continuity between honoring parents and honoring God (Eph. 6: 1; Col. 3:20).
Given this clear scriptural imperative to "honor" our parents and more generally, the aged, we must ask whether institutionalization is an obedient covenantal response. The following quotations from our government and social scientists would seem to say an emphatic no!
Institutionalization can be very destructive for many of the elderly; the very process of becoming institutionalized, living in such a total environment, can be rather dehumanizing under the best of circumstances.
The care given in most nursing homes and homes for the aged is limited primarily to nursing and custodial care with no restorative or rehabilitation service. As a result, the great majority of the people in these homes deteriorate physically and mentally to the point of total disability.
At one time most people assumed that the chief mental disorders in old age resulted purely from the inevitable breakdown of the person as an organism. Today, in contrast, the growing belief is that the kind of social relations experienced by the aged, such as isolation, and loss of status, help greatly to produce the disorders.
No longer are we under the mistaken notion that senility is something that "just happens" to older people. Much of it is caused by the emotional repercussions of an empty and forsaken existence. At this stage of life people simply cannot take the despair in being set aside.... forsakenness that these people experience from others can be projected also to God. In fact, they may also feel forsaken by the church, which makes the projection to God that much more logical ...
The implications are clear. The elderly in our churches and our own elderly parents are crying out like the psalmist to God, "Do not cast me off in the time of old age. . . "(Ps. 71:9). As sons of God, and their sons and daughters, we must answer their cry-honoring them, supporting them, lifting them up and delivering them-by the simple act of graciously extending the bounds of our twentieth-century nuclear family to include our aged parents as members of our extended covenantal household. Institutionalization, except for definite medical reasons, would seem to be the twentieth-century equivalent of "casting off" or "forsaking."
1. Madeleine L 'Engle, The Summer of Great-grandmother (New York: Farrar, Straus and Giroux, 1974), p. 194.
2. "The Graying of America," Newsweek, 28 February 1977, p. 56.
3. Ibid., p. 50.
4. Gerontology: the biological science which deals with the aging process of life.
5. Geriatrics: the medical specialty of gerontology which studies and treats changes and diseases
of the aging human system.
6. W. E. Huline, The Pastoral Care of Families, Its Theology and Practice (New York: Abingdon Press, 1962), pp. 175-177.
7. Liz Karnes, Alternatives to Institutionalization for the Aged.- An Overview and Bibliography, CPL Exchange Bibliography #877 (Monticello, Ill.: Council of Planning Librarians, Sept. 1975), p. 2.
8. Ibid., p. 1.
9. Ibid., p. 2.
10. H.J.M. Nouwen, "Aging and Ministry," Journal of Pastoral Care, 28 (1974), p. 166.
11. E. S. Johnson and B. J. Bursk, "Relationships Between the Elderly and Their Adult Children,"
The Gerontologist, 17, No. I (Feb. 1977), p. 96.
12. See, for instance: Hulme, p. 171 and Karnes, p. 2.
13. John Murray, Redemption A ccomplished and Applied (Grand Rapids: Eerdmans, 1973), p. 139.
14. Ibid., p. 134.
15. Karnes, p. 2.
16. Rehabilitation and Aging: A Statement of Rehabilitation Needs, Resources and Programs to-
gether with Recommendations from the 1961 White House Conference on Aging, Series 11 (Washington, D.C.: Special Staff on Aging, US Department of Health, Education and Welfare, June 1961), p. 19.
17. Milton L. Barron, The Aging American: An Introduction to Social Gerontology and Geriatrics (New York: Thomas Y. Crowell Co., 1961), p. 50.
18. Hulme, p. 171.
Barron, Milton L. TheAgingAmerican: An Introduction to Social Gerontology and Geriatrics. New York: Thomas Y. Crowell Co., 1961.
Calvin, John. Institutes of the Christian Religion. Trans. Henry Beveridge, Vol. 1, Book 11, pp.
Chalmers, George. "Geriatric Medicine." Medicineandthe Christian Mind. Ed. J. A. Vale. London: Christian Medical Fellowship, 1975.
Cross, Dennis W. "How Not to Retire on $400 a Month." Aide, The Insurance Magazine from USAA. Spring 1977, pp.18-20.
Dudley, C. J. and Hillery, G. A. "Freedom and Alienation in Homes for the Aged." The Gerontologist. Vol. 17, No. 2, April 1977, p. 144.
Hendriksen, William. New Testament Commentary: Exposition of the Pastoral Epistles. Grand Rapids: Baker Book House, 1957.
Hutme, W. E. The Pastoral Care offamilies, Its Theology and Practice. New York: Abingdon Press, 1962.
Johnson, E. S. and Bursk, B. J. "Relationships Between the Elderly and Their Adult Children." The Gerontologist. Vol. 17, No. 1, Feb. 1977, pp. 90-96.
Karnes, Liz. A lternatives to Institutionalization for the Aged.- A n Overview and Bibliography. CPL Exchange Bibliography #877. Monticello, Ill.: Council of Planning Librarians, Sept. 1975.
L'Engle, M. The Summer of Great-grandmother. New York: Farrar, Strauss and Giroux, 1974. "Looking to the Z P Generation." Time. 28 February 1977, pp. 71, 72.
Maves, P. B. and Cedarleaf, J. L. Older People and the Church. New York: Abingdon-Cokesbury
Murray, John. Redemption Accomplished and Applied. Grand Rapids: Eerdmans, 1973.
Nouwen, H. J.M. "Aging and Ministry." Journal of Pastoral Care. Vol. 28, 1974, pp. 164-166. "The Graying of America." Newsweek. 28 February 1977, pp. 50-65.
US Department of Health, Education and Welfare. Rehabilitation and Aging: A Statement of
Rehabilitation Needs, Resources and Programs together with Recommendations from the 1961 White,House Conference on Aging, Series 11. Washington, D.C.: Special Staff on Aging, US Department of H.E.W., June 1961.