Will you still need me?
https://www.youtube.com/watch?v=HCTunqv1Xt4
“Will you still need me?” is an iconic, reverberating and absolutely not rhetorical question posed in song by the Beatle’s Paul McCartney at the age of 15 to honor his father. [1] I recently turned 64 and I cannot stop thinking about how throughout the world we are responding to Sir Paul’s question in the negative: “No, we do not need you, nor will we feed you. We need people who are productive members of society. Please feed yourself or we will pay minimally for someone else to do so.” As of November 2020 according to the CDC, almost 80% of COVID-19 deaths (c.172,000 out of 217,000) are in the United States are of people 65 and older. Over 40% of the victims of COVID-19 in the United States lived or worked in eldercare facilities, nursing homes and assisted living for seniors. One does not need 20/20 vision to see the thinly veiled truth that the pandemic has exposed; Americans are failing to care for the elderly among us.
“The longevity revolution has changed the landscape of human society.”
The longevity revolution has changed the landscape of human society. Over the last 40 years, I have asked classes of high school students “How old is the oldest person you know?” During that period the responses have grown from septuagenarians to centenarians. The extraordinary development is a mixed blessing. Our elders are older, but are our elders living better? We can celebrate scientific advances in health care that are keeping people alive who would have died in generations past and, at the same time, we need to admit that our social ethics have not kept pace with scientific progress.
Are old people whole people? The legitimacy of this question arises from the 21st century institutions that are dedicated to care for the elderly. As Jessica Silver-Greenberg and Amy Julia Harris stated bluntly in a report in The New York Times in June, “More than any other institution in America, nursing homes have come to symbolize the deadly destruction of the coronavirus crisis.” [2] As of November 5, 2020, the CDC has reported that almost 80% of Covid-19 deaths in the United States (approximately 172, 000 out of 217,000) have been people 65 and older.[3] In this respect, America is not an outlier, as researchers at the International Long Term Care Policy Network found in a study of fatalities in more than 20 countries that 40.8 percent of reported COVID-19 fatalities took place in nursing homes. It is sobering if not scandalous to note that 0.6% of Americans live in long-term care facilities and the people who care for our vulnerable elders are among the most poorly compensated in our society.[4]
In the midst of an unprecedented longevity revolution, we are failing our elders throughout the world, and we were failing them before COVID-19. The pandemic is shining a laser on the plight of the elders in the wealthiest society in human history. The phrase “underlying conditions” is being used to explain, and perhaps explain away, the inordinate death rate of people over the age of 64. However, the “conditions” in which our elders are living involve more than their physical wellbeing. They are living in confined, concentrated environments, eating in large groups and cared for by people, ironically recognized as “essential workers” and “heroes” only during the pandemic. Nursing homes and assisted care facilities may be economically efficient, but the COVID-19 pandemic has exposed them as viral incubators. Not all eldercare facilities are equal, and, in retrospect, there will be time to learn which designs and processes mitigated the devastating impact of COVID-19. Although the disproportionate death of elders from COVID-19 is being treated as a medical emergency, it also needs to be understood as a social, moral and spiritual emergency. We need to reconsider how to relate to our parents, grandparents and great-grandparents so that their increasingly long lives can also be full lives animated by love.
When we invoke God’s blessing for healing, the words רפואת הנפש, healing of the soul, precede רפואת הגוף, healing of the body. I believe that we can learn from the scope and sequence of this prayerful healing curriculum. We forget our souls at our peril. The pathology report may describe the cause of a person’s death according to accepted medical terminology, but “a broken heart,” “despair,” and “existential loneliness” are all lethal. Mental health is health, and it is long overdue for us to accord mental well-being the same status that we ascribe to physical well-being. COVID-19 is not only a disease of the body. COVID-19 has killed human spirits as well, and in particular the spirits of the elderly who languish without human contact and suffer from depression.
II
“Will you still need me?” is a theological question because theology is personal. As Rabbi Laura Geller wrote: “All theology is autobiography.”[5] “Will you still need me?” is a theological question because theology is relational. God began the conversation by asking אייכה, “where are you?” to the first human.[6] “Where are you?” is a question not only of physical location, but also of meaning and vocation. Where are you in relation to where you want to be?
The manner in which we relate to our elders is a reflection of our theology, of our understanding of what it means to be a human being created in the divine image. When the covenant between God and the children of Israel was sealed and renewed the elders were prominent, if not preeminent.
From the Book of Deuteronomy:
You stand this day, all of you, before the Eternal your God—your tribal heads, your elders and your officials, all the men of Israel, your children, your wives, even the stranger within your camp, from woodchopper to water drawer— to enter into the covenant of the Eternal your God, which the Eternal your God is concluding with you this day, with its sanctions.[7]
And that premise is renewed in the Book of Joshua: “Joshua assembled all the tribes of Israel at Shechem. He summoned Israel’s elders and commanders, magistrates and officers; and they presented themselves before God.”[8]
In the Sinaitic covenant and in its renewal Moses and Joshua emphasized a sacred value; the ancients’ elders were honored because age and sage were intimately connected. In the biblical narrative, the elders of the community were venerated. Our contemporary elders, however, are too often more vulnerable than venerable. They are more of an afterthought on the periphery of our society than an esteemed center of attention and appreciation. The underpaid people who care for them often have no history with them and no shared memories of them. They only know the epilogue of their life story. The myriad accounts of people over the age of 64 who have died from COVID-19 testify to the tragedy of two pandemics—one medical and one moral, one caused by a virus and the other caused by human selfishness and neglect. We have not yet developed a vaccine for COVID-19, but it will probably take much longer to develop a vaccine for the ageism that discriminates against the elderly. Such indictment is categorical, not universal. There are exemplary eldercare facilities and extraordinarily devoted caregivers. There are families who honor and love their elders. However, they do not exonerate the culture that treats old people as something less than whole people.
In a CNN.com opinion piece, Ed Adler wrote, “As the virus swept across the US, a city official in Antioch, California, said Covid-19 should be allowed to run its course, even if elderly and homeless people die.”[9] This example is egregious, but it is not unique. Texas Lieutenant Governor Dan Patrick said that he would be willing to die to revive the American economy for the next generation, and felt other grandparents would agree.[10] I am one grandparent who vehemently disagrees with the Lieutenant Governor and with the value system that prioritizes livelihood over life. Elders are not to be sacrificed as though they are pawns in a game of chess. The COVID-19 crisis has not created ageism, but it has caused its ugly head to plumb new depths. There have even been suggestions that it is God’s will to thin out the elderly population, attempting to shift responsibility from humanity to divinity, claiming that it is beyond our control to care for our elders.
III
The first time I remember visiting a nursing home I was five. My mother, Dr. Amy Katzew, of blessed memory, was a podiatrist who specialized in caring for elders. I did not realize it at the time, but I was to learn a lifelong lesson that day. As we walked down the long corridor that smelled like an admixture of urine and disinfectant, we paused next to an open door. “I would like you to go into that room and say hello to the man inside. He is very nice. You will like him, and he will like you. Both of you enjoy fishing.” I recall nothing of our conversation, but I vividly remember my mother’s response when I asked her later why she wanted me to speak with that man. “You may have been the first person who is not a doctor or a nurse or a nurse’s aide to have visited that man in years.” As the second chapter of Genesis reminds us, “It is not good for a person to be alone.”[11] Some of the most painful, gut-wrenching stories of suffering and death as well as some of the most heartwarming vignettes of empathy and compassion during the pandemic have borne witness to the timeless nature of this truth. Loneliness is an unhealthy, unethical state for a human being. The presence of aides, chaplains, paramedics, nurses, doctors and other medical personnel cannot always save lives, but they can preserve the dignity of life, which is a sacred act in and of itself.
Fifty years after my mother brought me on my first nursing home visit, she was a resident at an eldercare facility where she had served as a doctor for more than three decades. The clear-minded decision to live there was hers. She wanted to live in proximity to her partner and close friends who would visit her frequently. Living with my spouse and me would have resulted in significant periods of the day when my mother would have been alone or with a caregiver. I respected her wishes and decided to speak to her daily and visit her twice a month. I grew to understand why our Sages focused on the mitzvah to honor our father and our mother during the time when we are adults and our parents are dependent upon us. Adult children share the sacred responsibility of preserving our parents’ dignity as long as they are alive. Although we revisited the question of moving my mother in with us several times during the six years she lived in the eldercare facility, each time my mother said that she wanted to stay where she was living. Nevertheless, driving or flying back to our home my inner dialogue replayed the conversation wondering if we had made the best, most caring, most life-affirming, most love-affirming decision. More than once my mother said to me: “Most people here treat me like a patient; a few relate to me as a person.” The distinction between “patient” and “person” makes all the difference. A patient is an object to be treated, a means to an end. A person is a subject to be greeted, an end in herself.
Joel famously prophesied that the day would come when, “Your elders shall dream dreams and your youth shall see visions.”[12] Intergenerational harmony and empathy are signs of God’s presence and approbation. The old and the young foresee a shared future. The elderly have both memories and hopes and dreams. Rather than waiting to die, they are daring to live. The Psalmist pleads, “Do not cast me away when I am old: when my strength fails, do not forsake me.”[13]This verse from the Psalms was woven into a prayer that punctuates the Yom Kippur liturgy - שמע קולינו (Hear our voice). The voices of our elders deserve to be heard every day as on the holiest of our days. “Do not cast me away when I am old” is a plaintive plea as well as an admonition from generation to generation. I was once you and one day you may very well be me. Whatever you decide to do with me, do it with me rather than to me and do it with dignity. Our 21st century treatment of the elders in our society, the richest materially in human history, borders on moral bankruptcy. COVID-19 has exposed the painful truth that along with inequities and injustices in gender, class, race and nationality, American culture suffers from a disrespect for the elderly. Elders are primarily dependent beings. They depend on their children and the succeeding generations to care for them and accord them dignity and honor they have earned. The longevity revolution, just like COVID-19, caught us woefully unprepared.
“Our 21st century treatment of the elders in our society, the richest materially in human history, borders on moral bankruptcy.”
IV
Torah teaches that our future depends on how we relate to the people who have given us life and love. “Honor your father and your mother that you may long endure on the land that the Eternal your God is assigning to you.”[14]Honoring one’s parents is an exceptional mitzvah, one of only three in the Torah whose fulfillment lead to a long life.[15]Fittingly, this mitzvah is the subject of extensive rabbinic commentary. From Bavli Kiddushin 31a:
Rav Yehuda says that Shmuel says: They asked Rabbi Eliezer: How far must one go to fulfill the mitzva[h] of honoring one’s father and mother? Rabbi Eliezer said to them: Go and see what one non-Jew did for his father in Ashkelon, and the name of the son was Dama ben Netina. Once the Sages wished to purchase precious stones from him for the ephod of the High Priest for six hundred thousand gold dinars’ profit, and Rav Kahana taught that it was eight hundred thousand gold dinars’ profit. And the key to the chest holding the jewels was placed under his father’s head, and he would not disturb him. The next year the Holy One, Blessed be God, gave Dama ben Netina his reward, as a red heifer was born in his herd, and the Jews needed it. When the Sages of Israel came to him he said to them: I know, concerning you, that if I were to ask for all the money in the world you would give it to me. But I ask only that money that I lost due to the honor of my Father. And Rabbi Ḥanina says: And if this is related about one who is not commanded by the Torah to honor his father, as Dama was a non-Jew, and nevertheless when he performs the mitzva[h] he is given this great reward, all the more so is one rewarded who is commanded to fulfill a mitzva and performs it. As Rabbi Ḥanina says: Greater is one who is commanded to do a mitzva[h] and performs it than one who is not commanded to do a mitzva[h] and performs it.[16]
In the rabbinic mind, Dama’s status as a non-Jew elevates and enhances the significance of honoring parents. The command to honor one’s parents transcends Jewish life; it applies universally to human beings. How we honor our parents will depend on the uniqueness of each parent-child relationship. However, in every case honoring our parents depends on factoring their dignity into every decision we make, including where and how our parents live and who cares for them. We learn from Dama that to honor one’s parents requires self-sacrifice, a willingness to forgo personal gain for the sake of caring for the physical and emotional wellbeing of one’s parents. The Sages claim that Jews have a special obligation, even greater than that of Dama, to honor our parents because we have been commanded to do so. Jews have no excuse whatsoever for failing to honor our parents. It is not only the right thing to do, it is our sacred obligation to fulfill.
As Abraham Joshua Heschel wrote in the late 1960s in The Insecurity of Freedom:
What we owe the old is reverence, but all they ask for is consideration, attention, not to be discarded or forgotten. What they deserve is preference, yet we do not even grant them equality. One father finds it possible to sustain a dozen children, yet a dozen children find it impossible to sustain one father. Perhaps this is the most distressing aspect of the situation. The care for the old is regarded as an act of charity rather than as a supreme privilege. In the never dying utterance of the Ten Commandments, the God of Israel did not proclaim: Honor Me, Revere Me. God proclaimed instead: Revere your father and your mother. There is no reverence for God without reverence for father and mother.[17]
In the present crisis, these words have taken on even greater significance. Nearly one quarter of American Jews have lived to 65 or longer. The changed landscape of American Jewry requires a soulful and ethical accounting of our relationship to our elders and the will to respond, yes, we still need you.
[1] I dedicate this article to my mother, Dr. Amy Katzew, ז״ל, who brought me on my first visit to a nursing home and to my spouse, Cantor Lanie Katzew, who as a director of pastoral care for the elderly, exemplifies the best of compassionate eldercare.
[2] Jessica Silver-Greenberg and Amy Julia Harris, “They Just Dumped Him Like Trash’: Nursing Homes Evict Vulnerable Residents.” The New York Times, June 21, 2020.
[3] “Weekly Updates,” Covid-19 Provisional Counts, Center for Disease Control. https://www.cdc.gov/nchs/nvss/vsrr/covid_weekly/index.htm#AgeAndSex. Accessed November 10, 2020.
[4] E. Tammy Kim, “When You Are Paid 13 hours for a 24 hour Shift,” The New York Times, June 30, 2020.
[5] Rabbi Laura Geller. “All Theology is Autobiography: Reflections on Forty Years in the Rabbinate.” eJewishPhilanthropy, January 4, 2017.
[6] Genesis 3:9
[7] Dt. 29:9-11
[8] Joshua 24:1
[9] Ed Adler, “I’m Over 60. Stop Talking About Coronavirus ‘Culling’ Me,” CNN op-ed, June 13, 2020.
[10] April Siese. CBS News, March 24, 2020.
[11] Genesis 2:18
[12] Joel 3:1
[13] Psalms 71:9
[14] Exodus 20:12
[15] In addition to the mitzvah of honoring one’s parents, sending the mother bird away before taking the eggs from the nest (Dt.22:6-7) and having honest weights and measures (Dt. 25:15) lead to a long life.
[16] Babylonian Talmud Kiddushin 31a
[17] Abraham Joshua Heschel, The Insecurity of Freedom. Farrar, Straus & Giroux, 1967, p.70. (“To Grow in Wisdom”, White House Conference on Aging, January 9, 1961).
