The Circle of Care
Posted July 25, 2006
Given the importance of focusing one's mind on Krsna during the last moments of life, it's no surprise that the hospice movement carries great importance in Vaisnava society. However, before we leave our bodies, we have a lot of living to do in them, and as those bodies get older, they require more care.
There does not seem to be much of an interest in long-term, convalescent, skilled nursing or custodial care in our society. Perhaps because it is just now that we're seeing the reality of aging and disease, or perhaps because just no one's thought of it; but a great and urgent need is going to exist very shortly, if not immediately, for this kind of facility for devotees.
It is utterly unfair to place the responsibility for this care on temples or on individual devotees, as unfair as asking unqualified people to teach or supervise children. Without proper training and facility, it is easy to visualize frustrations wearing thin and abusive situations developing. Elder abuse, in fact, is an increasing problem in western society, as the 'baby boomer' generation ages, and family members try to assume responsibility for care they may not be qualified, trained, or emotionally able to handle. This care requires 24-hour commitment, and is often complicated beyond just bathing and dressing, involving medical issues and possibly issues such as dementia. It often spans periods of years prior to the time hospice care is required.
Perhaps there may be some individuals who feel called to provide care for certain devotees, but for the general Vaisnava society, it is not reasonable to expect that devotees will just manifest out of the woodwork to devote themselves to changing diapers, bathing, feeding, dressing, perhaps keeping someone from wandering, and providing purposeful activity, expression, opportunities for interpersonal relationships, such medical-related care as can be performed by non-professionals , as well as transportation for doctor visits, obtaining medications, and so on, without assistance, without specialized equipment, in the private sector, with no remuneration or even economic support. This is a full time job. It is not a need that we can just expect to be satisfied without our intervention.
Can we, and would we, simply hand over devotees to mainstream long-term-care facilities? How could we provide assurance that our Godbrothers and Godsisters were receiving vegetarian meals, what to speak of prasadam? How could we provide the devotee association they require, even when dementia prevents them from recognizing us? How could we rest easy knowing their care was not of the standard they deserve, despite the quality of the facility we choose to entrust them to?
In the United States, long term care facilities are very strictly regulated by law, from the design of the building itself to the menus served. Medicare and Medicaid have very particular requirements that must be fulfilled in order to receive reimbursement (and a facility of this nature cannot survive without reimbursement). There are any number of religious organizations in this country that operate facilities such as these who could provide a template to work from. A nursing home cannot by law restrict admission on the basis of religion (and would be required to provide opportunity for religious expression of those of any faith) but it can provide approved vegetarian-only meals and operate under standards acceptable to Vaisnava society. A well-run, clean, and efficient institution would attract not only devotees, but also others, and in itself be a testimony to larger society of our principles, our caring, and our commitment to the Vaisnavas from childhood through the end of life. To this end a long term care facility could and should work hand in hand with our established hospice care.
In addition, establishing a facility of this nature would provide valuable employment opportunities for devotees. This would assist the society from an economic standpoint as well as giving devotees jobs that are in and of themselves service to the Vaisnavas. It would offer opportunities to utilize the many talents and skills of our devotees, and give a forum within devotee society that our many professionals may practice.
To establish and maintain a healthy, functioning society, there are several vital tasks. One is to protect the family unit and to provide all facility for a nurturing and loving home. Next is to protect and educate the children who are the future of our society. Third is to support the adult devotee by assisting in both spiritual and material advancement; those devotees who move from temple life into grhasta society especially require assistance in establishing an educational foundation and employment opportunities adequate for providing economic security. The last task of a healthy society is to care for the aging bodies and minds of our Godbrothers and Godsisters, providing them the needful, both material and spiritual, to live out their remaining years with dignity and the respect they deserve, and, at the appointed time, hospice care to assist in the final moments of this life.
There are no more important tasks than these. The current focus on childhood and the end of life is necessary and overdue; but to ignore what 'comes in the middle' will have devastating repercussions in the years to come.
It is incumbent on the leadership of ISKCON, those devotees with the
material facility, and those with the professional qualifications to
do everything possible to immediately establish an organization to
address the care of our aging, sick, and otherwise
unable-to-care-for-themselves Godfamily, and to complete the circle of
care in our Vaisnava society.