“ Worth More than Many Sparrows ” (Matthew 10:31) 

A Reflection on Caregiving and the Dignity of the Elderly

Maria Teresa Morgan

It all went down like this: While trying to coordinate my next dental appointment with my mother’s schedule, the young receptionist asked me her age. “One hundred and two” I replied. “Oh, is her mind clear?” she asked. “No” I answered, “she is bedridden and has no speech.” She responded: “Cuando se ponen así, no vale la pena.” (“When they get like that, it’s not worth it.”) Two words struck me: “vale” and “pena,” both nuancing economic, emotional and time investment; two words that are inclusive of a love, sorrow and compassion that were rendered a total waste by her statement. On these two words I base my reflection. I am sure she meant well, not realizing what her words implied. But it struck me that “worth” in her mind, and in that of many in our society, (John Paul II, Letter to the Elderly, 9) is measured by clarity of mind, strength and usefulness and those of advanced age have outlived their worth. Considering the current and projected increase in longevity in the twenty-first century and the physical and mental disabilities that accompany old age, those who are deemed “unworthy” will become more numerous in our midst. The above anecdote illustrates that prevailing views in our contemporary society regarding those of advanced age call for engaging a Catholic moral praxis that addresses the dignity and worth of vulnerable elders and the multiple challenges faced by those of advanced age and their caregivers. 

Elaborating on St Anselm’s classic definition of theology as “faith seeking understanding” Ronald Thiemann states that theology is “faith seeking to understand the relation between Christian convictions and the broader social context within which the Christian community lives” (Constructing a Public Theology: The Church in a Pluralistic Age, Louisville, KY: Westminster/John Knox Press, 1991, 21. Cited by Sarah M. Moses, Ethics and the Elderly; The Challenge of Long-Term Care, Maryknoll, NY: Orbis, 2015, 8) a statement that closely mirrors the teachings of Gaudium et Spes. My reflection brings together the above two definitions for, as a theologian, what I live up close and personal becomes a habit of faith that seeks to understand my own circumstances and from that vantage point, to understand as well the experience and pastoral needs of others affected by the same issues. This article considers the dignity and worth of those in late old age (those over 85) and suggests caregiving as a way of discipleship. My intention is to raise awareness of the challenges presented by advanced aging, the issues raised by long term care and their effect on caregivers, as well as to encourage ministries at the parish and diocesan level that attend to the needs of the caregiver through education and emotional and social support.  

I should know something about what “lo que vale la pena” is and isn’t, based on academic training on end-of-life issues and on personal experience. For my greatest and most exacting apprenticeship has been that of caring for my elderly family members for the last fifteen years. Among the complex issues I have encountered three particular areas have been chosen: 1) the challenges of being a caregiver together with the disproportionate role of women fulfilling this need; 2) the discarding attitude of many in society in relation to the very old; 3) the financial burden of care for the aged. I will also offer a brief consideration on Catholic doctrine regarding euthanasia. 

The Challenge of Caregiving 

They call it “the long goodbye.” Loving and caring for someone with dementia (I choose “dementia” and not “Alzheimer” because the latter is only one of several forms of dementia) carries the greatest “pena” for we watch our loved one(s) descend into an incoherent world of cognitive deterioration, hallucinations, agitation and personality changes that can be terrifying and bring indescribable pain for the person afflicted by dementia and for the caregiver. One wonders where the person went. Those we love no longer remember us and the shared history that bound us together is slowly erased. Social isolation becomes the norm for the patient and the caregiver and estrangement from family members who abandon or blame, object and direct from a safe distance is not an uncommon experience.  (“Part of you dies as well”: the toll of caring for loved ones with dementia, The Guardian, May 8, 2023). The new reality exacts a heavy price on caregivers as they are progressively thrust into a lonely and surreal world and watch as their own mental, physical and economic resources dwindle. There is also the guilt experienced when coming to terms with the limits of our patience towards our loved ones. Recently, a woman approached me weeping with regret at her impatience and harshness toward her elderly and confused mother. The encounter with this graced woman reinforced my acute awareness of the pressing need to minister to those who tend to their loved ones. Solidarity, one of the foundational principles of Catholic Social Teaching, demands that the faith community should assist those who bear the burden of caring for their old and infirm. If “synodality” means “walking together” I hope that the coming Synod on Synodality will consider this issue.  

As a woman, I know first hand the inequity of family caregiving. Studies indicate that caring for a family member falls mostly on women and has a negative impact on their physical and mental wellbeing (Moses, Ethics and the Elderly, 30). Women spend an average of 18 years caring for an elderly family member (ibid.). I once asked my father to get my three brothers involved with some aspects of his and my mother’s care because I was overwhelmed. He matter of fact replied “pero tú eres la hembra” (“but you are the female”), words that made me rage against centuries of patriarchy that have laid the burden on women because, basically, we are expendable and men have a higher purpose. I gained a new perspective on the brother of the prodigal son (Lk 15:25-28) for I am the one who stayed. But then, confronted with no other choice, I reframed caregiving as a way of filial discipleship for there is plenty on the way of this self-giving that leads to Christ and to the Gospel. By necessity, caregiving involves a consideration of the dignity of those who are unable to care for themselves and to that, I now turn my attention.

The Dignity of the Aged 

I begin this section by mentioning that Pope Francis at 86 years old is a prophetic and wisdom figure for our times for in spite of his increasing physical disabilities he exemplifies in his person the abundant gift of those in late life. John Paul II, who experienced suffering and the multiple diminishments brought about by old age, wrote poignantly on the dignity and worth of those in late life in his October 1, 1999 Letter to the Elderly (LE). This inspiring text provides a source of meditation on old age and the societal need to honor those who reach length of years. Among the highlights is the Pontiff’s lament on the devaluing of the old in some cultures, an attitude that sadly leads the elderly to question the worth of their own lives (LE, 9). John Paul II calls for aged persons to not be marginalized but to be included as a vital part of a society that needs the wisdom that can only be forged by the lessons of a long life (LE, 10). Honor and respect, inclusivity and listening, visiting and asking about their experiences… those are practices that acknowledge the dignity and contributions of the aged and appear in his Letter. He identifies the elderly as “the guardians of our collective memories…the link to generations past” and warns that to exclude them cuts us off from the continuum of time that weaves past, present and future (LE, 9-12). The document also lays a rich Scriptural foundation by tracing the central role of those of advanced age in salvation history: Abraham and Sarah, Moses, Nicodemus, Elizabeth and Zachary, Anna and Simeon…(LE, 6-7). I did not find, however, a consideration of those afflicted with dementia, a population whose care and respect is most at risk of being deemed as “no vale la pena.” Throughout my own journey, I have found the verse from Sirach 3:12-15 to be a guiding light:  “… help your father in his old age, and do not grieve him as long as he lives, even if his mind fails, be patient with him; because you have all your faculties do not despise him.” While doing research for this essay I found a brief article on remembrance written by Dr Simone Brosig, Liturgy Consultant/Director of the Diocese of Calgary. Her reflection on “The spirituality of dementia” offers deep theological insights in addressing loss of memory, cognitive disability and personhood and how these issues erode the sense of self-memorialization in the caregiver, all crucial questions that were raised in the previous section. The author, whose mother has dementia, places the loss and recovery of memory in the context of anamnesis, or liturgical remembrance. She locates memory in God, in Whose memory we live. I was theologically awed by her affirmation that God is the abode of memory both for the one who no longer remembers and the one who is no longer remembered. “We are not what we remember rather, God remembers us.” In the same manner, when thought process is seemingly gone, Brosig affirms that “we are not as we think” but rather, the anamnesis of God’s salvific gift in Christ Jesus continues our salvation.  

Financial Considerations in Long Term Care

The financial aspect of long term care presents an urgent need that calls for economic resources to alleviate the expense incurred by families in caring for an aging population (Moses, 27) Some families, like ours, decide to keep their loved ones at home while some families are unable to manage this option. The expense between care at home or at a nursing home is roughly the same while the difference in the quality of care is significant. But I emphasize that the option for home care is not possible for many families because of circumstances beyond their control. People may argue that long-term care insurance is made available today, but this option is expensive and out of reach for even middle-income families. Others will refer to Alliance for the Aged, which I tried to obtain for my father but after filling out numerous pages that required a physician’s input (doctors are not happy to fill out forms) I waited five years until his turn became available. By then my father had passed away and the surprise of the agent when receiving this information made me realize how out of touch they are for my father died in his 99th year. 

Lastly, any consideration of the challenges of old age cannot fail to mention euthanasia. Catholic doctrine is unequivocal in upholding the sacredness of life from conception to natural death. John Paul II called physician-assisted suicide “an inexcusable injustice” and referred to euthanasia, no matter the intentions, as “an intrinsically evil act” (Evangelium Vitae, 66). I include here an excerpt of Pope Francis’ vespers address at Jerónimos Monastery in Portugal given recently, August 2: “Where are you sailing, Europe and the West, with the discarding of the elderly…Where are you sailing if, before life’s ills, you offer hasty but mistaken remedies like easy access to death – a convenient answer that seems ‘sweet’ but is in fact more bitter than the waters of the sea?” 

It must be noted that Catholic tradition upholds the law of “double effect” (EV, 67) as well as affirming that there is no obligation to use artificial means of prolonging life when there is no reasonable hope for a positive outcome (EV, 65). What constitutes artificial means is easily identified as feeding tubes and airway intubation. But the problem lies in the grey areas of what is to be defined as “artificial means” and what is to be defined as “basic healthcare.” For instance, writing a living will was simple some thirty years ago. Today, I find the different “levels” of care presented in “living wills” hospital forms to be complicated and to raise a red flag. My experience, limited as it is, has been that healthcare today leans towards “passive” euthanasia of the very old, meaning withholding or rationing of treatment that can by no means be considered “artificial” or “extraordinary.” On four occasions I have seen that some healthcare professionals and some hospitals favor and pressure for that approach. I suspect economics is one of the influencing factors.

Conclusion    

Sometime in the Florida Spring (yes, we do have one!) our yard is filled with hundreds of birds that chirp and play among the trees and fountain. I don’t know if they are sparrows, but they are small and delight us with their carefree joy. And then, in a couple of days, they fly away. Watching these tiny creatures I like to believe they come for a respite during their migration because they feel safe and sheltered among us and I think of my loved old ones. My father is gone; my other ones too will soon be gone, continuing their journey toward God. But for a brief time they have felt safe and loved with me, in spite of my limits and shortcomings. The passage from Matthew 10 comes to mind, the one which speaks of God’s providence and care for those small creatures that are sold for next to nothing and sometimes fall to the ground trembling and confused, the one that speaks of our value, small and insignificant though we may become in our need and frailty: “Are you not worth more than many sparrows?”

Dr. Maria Teresa Morgan is Assistant Professor of Theology at St John Vianney College Seminary where she also coordinates the Humanities Program.  Her interests lie in Theological Aesthetics and Carmelite Spirituality. She has been a presenter at national conventions and her writings have been published in the annual volume of the College Theology Society.  She is a member of the Editorial Board and a resident columnist of El Ignaciano.