Old love is marvelous, uncommon and mostly hidden, and it is also socially beneficial. In modern societies old love saves public expense, gives compassionate care, and shows a truly praiseworthy sacrifice.
One Social Benefit
In western countries, persons are often entitled to nursing home care. The eligibility standards vary, but nonetheless, when one partner elects to care for another who is terminally ill, society is spared the otherwise eligible cost.
In England, where John and Iris lived (last week’s post), and in the U.S., eligibility for public assistance depends on one’s income and wealth. In both countries the income and wealth thresholds for public assistance usually admit only poor patients (for general guidance, see here for England and here for the U.S.). If Iris would have qualified for some public help, when John elected to care for Iris, he saved mother England that cost. If she was ineligible, then John’s decision conserved their private wealth.
In a highly individualistic society, one in which people had to pay their own way if friends or family were unavailable, there would be little direct public saving when one spouse cared for another. The U.S. was like that 100 years ago when social safety nets didn’t exist. Increasingly, however, people are entitled to care at public expense, implying that those who privately give that care save the rest of us substantial public spending.
More Social Benefits
Beyond costs, maybe the biggest advantages to partner caregiving are love and familiarity. One partner’s compassionate regard for another fuels years of caregiving. I have characterized this love in the previous two blog posts, and it implies a huge advantage to an ill partner.
Living together for a long time gives partners a familiarity that helps each one adapt to a progressive, serious illness. Partners know their food preferences and habits. At home patients are near their possessions—familiar furniture, books, pictures, videos, old clothes. We suffer more easily in our homes, and when asked, the majority of us say we want to stay in the comfort of our homes for life-ending illness.
Caring for a loved one at home offers flexibility. There are few restrictions and standards that apply, and the partners are free to adapt as the illness progresses. They don’t need to wake, bathe and breakfast everyday at the same time.
Now, with access to the Internet, private caregivers have a vast array of available resources to help understand their chosen path, preserve their own mental health, and give better care. Each instance of good private caregiving adds to the overall quality of elder care in the U.S.
At the same time, not everyone is capable of private caregiving. Many people lack the blend of personal resources that allow such huge amounts of sacrifice.
For many, institutional care may offer advantages. Trained, professional staff may be more capable of treating patients without the mounting frustration that plagues partner-caregivers. John Bayley described bouts of temporary madness in his years of caring for Iris.
Professional care often embodies the most science-based care. Nursing homes have dietitians; the facilities have specific safety features and the patients are kept away from stoves, kitchen knives, guns and dangerous environments like high decks with low rails, stairs without railings, or tool-filled garages.
Yet nursing homes are often plagued with problems. There is an ever-present need to contain costs, which sometimes leads to excessive use of chemical or physical restraints, low levels of staffing, and poor quality control.
When old love exists and one partner can offer care for the other, we all benefit from the low cost, flexible, and compassionate care that results. No doubt the caregivers suffer along with their charges. But their sacrifice redeems the rest of us in that their steadfast care testifies to the best aspects of our humanity.
I’m thinking now of the two protagonists in the Pulitzer prize-winning novel, “Lonesome Dove,” by Larry McMurtry, which was made into a television mini-series. Captain Woodrow F. Call (Tommy Lee Jones) promised his long-time friend, Augustus McCrae (Robert Duvall), who was dying from gangrene poisoning, that after he died Call would take him back to Texas and bury him in a little grove of cottonwoods where Gus had once picnicked with a woman he loved. Viewers of the series will marvel at Call’s determination, against severe hardship, to live out the promise he made to his dying friend. In the privacy of their home, we can easily imagine that John Bayley traveled a similar journey with Iris Murdoch.