Claudia Fine, geriatric care manager: “When do we stop valuing people, and why?”

I took an instant liking to Claudia Fine, the Executive Vice President of SeniorBridge, a national organization that provides health and care management. We met in her midtown office, following up on a connection I’d made through a journalism seminar. She was warm, candid, and impatient with institutional dumbness. Like the attitude she encountered in social work school, where she’d gone to study adolescent and family health.  “If you say you’re interested in X they make sure that you do Y, because it builds character,” Fine recounted, “so they put me in orthopedics.” Rather to her surprise, the young social activist realized that, “I kind of liked working with this old cohort.”

This was around 1980, when the standard treatment for a broken hip was at least three weeks of bed rest. Most of her patients were old, and by the time they were dismissed, many had completely “decompensated” (bedsores, muscle loss, incontinence, etc.). “They didn’t have a whole lot of time to waste talking about the ‘what ifs’,” said Fine. “Before they actually decompensated, it was, ‘Get me out of here!’ There was a sense of urgency, and I liked that. I’m action-oriented. If you can get them focused on what they want to change, they’ll work to change it and they’ll use what you have,” she continued. “You have to get over a hump, which involves lots of things, including ageism, their own resistance to help, issues around autonomy and independence. But it’s a very gratifying population to work with.”

As a geriatric care specialist, she encounters plenty of interest in the quality of life of older people, lots of Tai Chi and computer classes — until they get sick. “And then we throw them out,” she said bluntly. “There’s nothing worse, nothing more dismissed than an old patient, because we don’t see hope. For some reason we — families, practitioners, society — don’t create goals that we can feel good about.” Instead of turning away, Fine suggests we focus on the aspects of these older people that remain intact. “What are we doing to support their strengths, preserve the essence of who they are? Because if we don’t, then all we have left is the sickness.”

One problem is that friends and family may be stuck mourning the older person as she once was. “Having this person push the shopping cart in the supermarket is a very meaningful activity, and should not be dismissed or devalued, because it’s the right activity for her level of function,” Fine said. “But we tend to think it’s pathetic, or we don’t think about it at all, because she’s not doing what she did before.” Here’s the psychologist’s fallacy again: the presumption that we can know what another person is experiencing. Unless someone is comatose (and even then we don’t know what he or she is experiencing, as Fine pointed out), “they’re a person, and they have 24 hours a day to be alive.”

Even when an older person is cognitively fine, as is overwhelmingly the case, many of us resist engaging.  Maybe we don’t think the old guy will hear us, or that he won’t understand us, or that we won’t find anything to talk about because old seems so “other” — or because we wish it to be so.  “Sometimes people fear talking to an ‘old person’ because it’s going to make them ‘feel bad’ because they’re old,” Fine remarked. “It’s like going up to black person and asking, ‘How does it feel to be black and living in Scarsdale?’ It’s not an unreasonable question, and it doesn’t mean that the person is racist, but we’re all struggling in a society [where those questions are hard to ask].”

I asked whether ageism is inherently different from racism, since everyone ages.  Fine didn’t think so, in that all “isms” are rooted in fear — though not the same fears. “White people aren’t afraid of becoming black, but they’re afraid of anger, of being considered racist, of their own feelings, their own fears. Mostly we’re afraid of becoming old.” Yet, she added, “It’s not about old.” Ageism, she believes, is fundamentally a question about human value. “When do we stop valuing people. And why?”

Fine makes her living helping people cope with complex chronic illnesses, and she’s frank about the challenges. “Getting sick and failing, both physically and mentally, is really tough, and its tough for everyone around you. As we age the prevalence of these problems increases. But it’s not the same as old.”

“Or their wouldn’t be any outliers,” I commented.

“That’s right,” she said. “There would be more outliers if we thought about age differently.”