The Final Transition
Bob is 78 years old and has served many years in Asia with his wife Kay. Although he retired more than a decade ago, he is still active in missionary work. He and Kay own a home in the USA, but they continue to serve in various countries around the world. He is now teaching and preaching on an island in the Caribbean, and after a few weeks here in the States, he and Kay are going to Asia for several months. He still sends his prayer partners email whenever he and Kay feel the need of such support.
Joe is 68 and has served many years in the Caribbean with his wife Mary. Joe retired a year ago and would like to go back where he served, but his agency has a policy that retirees cannot return to their country of service. He spends most of his time puttering around the house and yard, and worries much about his health, fearing that he may die of cancer like his father did. He seems to have little zest for living and is quite unhappy. He just sent his previous supporters a Christmas letter saying that it was the last one he and Mary would send.
How can this be? Joe is a decade younger than Bob, but he acts like he is a decade older! Joe is old-old! As noted in the last chapter, Bob is one of the “young-old,” a time defined by attitude and activity rather than by chronological age.
Young-Old vs. Old-Old
There are obvious differences between people at the beginning of retirement and those nearing the end of their lives. Typical people who retire at 62, 65, or 67 years of age often enjoy their retirement, have good health, and have adequate funds to live comfortably and do things they enjoy. They are old as defined by retirement and Social Security, but they are young in attitude, behavior, and thinking. However, at the other end of the spectrum are people who no longer seem to enjoy life, they have poor health, and no longer have much money—and that can happen at any age—including the 60s.
A century ago when life expectancy was between 50 and 55 years of age and retirement had not yet been invented for the masses, only a small percentage of people lived to be 75 or 100 years of age. There were a lower percentage of people living who were over 65, and most of them were working to make a living. However, today with life expectancy nearing 80, the majority of people retire by 65 and they have an average of 15 more years to live, and an increasing percentage will live another 30 years. There is little agreement on how to divide these into categories; however, in this chapter we will consider just the young-old and the old-old.
Many things can move people into the old-old category, but the three most common are the following.
· Loss of health. The longer people live, the more likely their illnesses will be chronic and degenerative. Younger people are more likely to die suddenly of something catastrophic, but when a person gets a diagnosis of cancer or circulatory diseases, it often makes them feel old. In addition, dementia becomes more and more common at this age.
· Loss of finances. The longer people live, the more likely they will run out of funds. This may happen when their savings run out because of inflation, when the “investment” they made was really a scam, when their chronic illness is not fully covered by their medical insurance, or when their compassionate gifts for people back in the host country drain their funds. Of course, any of dozens of other causes may deplete their funds.
· Loss of spouse. The research discussed in Chapter 7 showed that life satisfaction rose greatly during retirement until the death of the first spouse. After that life satisfaction declines. William Bridges, the most read writer on transitions, found that all he had been teaching about making transitions did not work when it came to the death of his spouse. He even quit teaching about transition for many months. This transition is particularly difficult, especially when a man loses his wife.
Deciding How to Live
When most missionaries retire from serving overseas, they choose to live in a house, a condominium, or an apartment. If they purchased a home while on the field and have been renting it, they may move into it now. If they have been saving to build a house when they retired, they may build it now. If they have not made any of these kind of plans they may rent a house or apartment.
When they become old-old, they may not be able to continue living in that housing. At that time they may have to consider different housing. The best information available on this is the book by Carol Levine, Planning for Long-Term Care for Dummies. Published with AARP, this “dummies” book devotes four chapters to choosing one’s living situation including these.
· Modify the present house. For example, install ramps or a stair lift, replace cabinet knobs with pulls, install universal design faucets that have one lever (not two knobs), install a higher commode (or a raised seat), install a louder doorbell, or widen doors for a walker or wheelchair (very expensive), replace door knobs with door levers, etc.
· Independent living in a community. People may buy or rent a unit or patio home in a community that charges a monthly fee for mowing lawns, shoveling sidewalks, plowing drives, repairing things inside, and so forth. The people provide their own meals and transportation.
· Assisted living in which food, shelter, and assistance with such daily tasks as bathing, dressing, getting around with a walker, managing medications, shopping are provided. Cooking is possible if the residents want to cook.
· Other options for group living, such as independent living for seniors, affinity communities, cohousing arrangements, house sharing, and group homes (Levine’s book has website URLs for more information) exist.
· Multigenerational living in which different generations of the same family live together. In 1940 a quarter of all Americans lived in households with at least two adult generations living together.
· Nursing home which offers skilled care by professionals such as nurses, doctors, and therapists. They can give intravenous injections and give physical therapy to help people regain or maintain function. They may have a medical director onsite or a doctor may be on call.
Preparing for after you are gone
Though these legal and financial matters should already be in place, this is the time to check them to make sure they are up-to-date and see if you want any changes made. Of course, if you do not have them, now is the time to make them. Again the best information available on this is the book by Carol Levine, Planning for Long-Term Care for Dummies. Published with AARP this “dummies” book devotes three chapters to legal and financial matters including these.
· Wills. Your will gives you the opportunity to leave anything you have to anyone you want. This includes money, property, family heirlooms, and your personal treasures. If you do not have a will, your state has one for you that divides everything you have among whoever the law in that state determines. Things that friends or family members would treasure may be given to people who just discard them.
· Trusts. A trust lets you give possessions to people over time rather than in a lump sum at your death. There are many kinds of trusts, but some people establish a living trust that they manage and that will be managed by someone they choose if they become unable to do so. This trust is a private document, easy to change, and avoids probate after death.
· Power of Attorney. If you want someone to take care of your financial affairs you can grant them power of attorney. A conventional power of attorney does that while you are competent, but ends when you become legally incompetent. A durable power of attorney continues even after you become incapacitated, such as being in a coma or with dementia.
· Advance Directive. “Advance directive” is the general term for any document which tells healthcare providers what kinds of medical treatments you want—or you do not want. Although there are several kinds of advanced directives, two very important ones are having a living will and having a healthcare proxy.
· Living Will. A living will sets out your wishes in writing. You can use a general legal form for your state or write a more complete statement of your wishes. It is best to discuss this with your physician so that he or she will know exactly what you want if it is not clearly stated.
· Healthcare Proxy. Choosing someone to make healthcare decisions for you when you cannot do that yourself is a very important decision. You need to find someone you trust to do what you ask regardless of his or her own feelings, someone who can think clearly and ask direct questions in times of crisis.
· Funeral/Memorial services. You may want to specify things you would like, or not like, relative to your funeral or memorial service. Some missionaries request that flowers not be sent, but that donations be made to their agency or church. Some request that favorite songs be sung, that a particular pastor or friend preach, and so forth. Getting these things in writing is most helpful to those left behind.
Levine does not mention it, but some missionaries want to donate parts of their body or their whole body for medical services. Organ donation may be done as easily as signing the back of one’s driver’s license and being put on the registry of organ donors. Donating an organ does not mean that one cannot have an open casket funeral because all incisions are sewn up. There are many more people waiting for organs than there are donors.
Body bequeathal is a little more complicated, but is easily done. Simply contact a nearby University/Medical school to learn their process and carry it out. They will send you forms to fill out and sign. Usually the only cost involved is to have someone get your body to the university when you pass away. Your body may then be used in medical research or in the education of future physicians. When that is done, they will cremate your body and return your ashes to anyone you request. Though few family members object to organ donation, they may disapprove of donating the whole body. Be sure to talk with your entire family before doing this. Again, a person may have an open casket funeral if they wish when specific procedures are followed in embalming.
Dying
At the middle of the 20th century many physicians, including psychiatrists, thought that dying individuals did not want to talk about their impending death. However, Elizabeth Kubler-Ross was teaching in medical school when some students questioned what people were thinking during the time they were dying. So they decided to talk to dying patients. To their surprise, they could not find any “dying patients”—none of the first group of doctors would admit that their patients were dying. Finally, they found some dying people to talk with, and they found that those people were eager to talk about it.
After many interviews and much criticism from some people for talking with these people, Dr. Kubler-Ross determined that dying individuals often went through five stages. Of course, some Christians do not go through these stages because of their hope in the resurrection.
· Denial. When they are first told they are dying, they refuse to acknowledge it. They say that the medical tests must be wrong, that their results must have been mixed up with someone else’s, and so forth. They just say that it cannot be so.
· Anger. When they accept the fact that they are dying, they become angry. They often ask, “Why me?” They may feel envy about the health of the people around them. They may go into a rage. They may make it difficult for friends, family, and medical personnel, often over petty issues.
· Bargaining. Anger does not work, so they begin to bargain with the illness, with God, with anything or anyone they think of for more time. They may ask the illness to let them live until their grandchild is married or ask God to let them live until they have completed some project. Of course, the bargain is not successful for very long because the illness continues.
· Depression. Dying people then begin to mourn their own impending death. As they think of the loss of everyone and everything they have found meaningful and realize that their dreams will never be fulfilled, they may become depressed.
· Acceptance. Finally, they begin to accept the fact that they are going to die and face it with a degree of quiet expectation. They are usually tired and weak so they don’t struggle against death but make peace with it. This is not a happy stage, but it is one of resignation.
Further research has shown that people do not necessarily go through all of these “stages” in this order, or even through all of them. They may go through some and then go back and repeat some, or any combination of these and other things. However, these are common reactions to being told one has a terminal illness.
Death
As death gets nearer, two options are available for people with very serious illness: palliative care and hospice. These are related, but slightly different. Both are covered by Medicare and Medicaid in the USA.
· Palliative Care. Palliative care is practiced by specially trained medical people, such as physicians and nurses, as well as those interested in mental health such as social workers and clergy. This improves how individuals function in everyday life as they are being treated for a serious illness (http://getpalliativecare.org/whatis/ ). The emphasis is on relieving pain, controlling symptoms, and improving quality of life even while undergoing unpleasant treatments such as some types of chemotherapy.
· Hospice. Hospice is essentially palliative care but different in two ways. First, people in hospice must have short life expectancies, usually six months or less. Second they must stop further treatment intended to cure them. So it is for people who are not being helped by active treatment or whose treatment is such a great burden that they want to quit. People in hospice may live at home or in a facility such as a nursing home or assisted living.
Resurrection
After death Christians will be with Jesus in heaven. Jesus told the thief on the cross next to him, “Today you will be with me in paradise” (Luke 23:43). Of course this is the hope of all Christians, to be with Jesus in heaven.
The resurrection of Jesus is a central theme of the New Testament. It is recorded at the end of each gospel and Paul wrote about it often in his letters. Because of this event, Christians know that they will also be resurrected at some time in the future. Though we know little about what these resurrected bodies will be like, Paul wrote a lengthy passage about it in 1 Corinthians 15. After writing about different seeds, animals and humans, birds and fish, sun and moon, one star and another, he noted that our natural bodies and spiritual bodies would be different in the following ways.
· Sown perishable but raised imperishable
· Sown in dishonor but raised in glory
· Sown in weakness but raised in power
· Sown a natural body but raised a spiritual body (verses 42-43.
In that same chapter Paul goes on to say the following:
· The perishable will be clothed with the imperishable.
· The mortal will be clothed with immortality.
· Death will be swallowed in victory (verses 53-55).
The book of revelation gives us other glimpses of what comes after death in heaven.
· Never again will they hunger (7:16)—no need for humanitarian workers to provide food.
· Never again will they thirst (7:16)—no need for engineers to provide water
· No more sorrow (21:4)—no need for pastoral care.
· No more pain (21:4)—no need for missionary doctors and nurses.
· No more death (21:4)—no more need for morticians or grave diggers.
There will be no more need for missionaries bringing the gospel to the lost because the lost will not be there. Death will be swallowed up in victory.
The final transition of life here on earth is over!