Getting real about getting old

IN 2011, THE FIRST of the baby boomers will turn 65, so it is not surprising that we will start to witness a culture that's finally coming out of denial. Yes, baby boomers will get old, and there is a good chance many will end up in a nursing home. It's also likely that their spouses will age at a different rate, and they may end their lives living apart. Nursing homes, alas, are not organized around the needs of residents, but around the needs of the institution. Baby boomers will wake up when it's convenient for staff; their meals will be regulated by a food service department; and they won't have the privacy, independence, or self-empowerment that their generation assumes is theirs by birthright. Baby boomers should all take a deep breath, because if they don't do something to change this scenario, that's what's coming down the pike.

A documentary, ''Almost Home," will be shown on public television on April 9 and it's a milestone in addressing the issues of old age and long-term care in America. The media, in the past, has contented itself with cartoon versions of aging -- the alarmist coverage of a nursing home scandal or rip-off artists preying on the elderly -- and our culture, in heavy denial, has happily played along. ''Almost Home," though, treats the complicated and sometimes unavoidably painful issues of growing really old in a way that is mature: sympathetic, nuanced, and totally intelligent. It also provides a model of eldercare that is radically new and progressive, and it behooves those who admonish their children, ''Don't put me in a nursing home!" to pay extremely close attention.

The documentary looks at the real-life issues of aging. It focuses on once-happy couples who now deal with the impact that Alzheimer's and Parkinson's have had on their relationships; it depicts grown-up children torn between caring for their parents and managing their own affairs; and it describes healthy elders' fears about one day having to move into a nursing home.

But it also shows a nursing home environment where empowered frontline staff and an earnest young administrator are questioning and struggling to re-invent every aspect of the nursing home experience. If residents want cocktails, is that all right? (Staff decides that it is and they institute a cocktail hour.) If someone wants to sleep until 11 a.m. and then eat pancakes, can -- and should -- the staff acccommodate that? (They decide that they can and will.) If a married, cognitively impaired octogenarian who's been abandoned by his healthy wife wants to start up a romance with someone down the hall, can they honor his wish to do so? (They do.) We see individual residents, profoundly disabled, taken on outings to museums and marinas. This kind of care is significantly more difficult for the caregivers -- they are tossing out ''the assembly line model" to provide truly individual care. As it turns out, this creates another bold departure from traditional nursing home culture: It puts nurse aides and other frontline caregivers at the top (rather than the bottom) of the decision-making totem pole, and creates a world that not only dignifies nurse aides and other frontline caregivers, but that deeply humanizes the elderly.

In 2006, nearly half of our country is dealing either with their own aging or that of a loved one. It's crucial for us to tune in to the kind of future posited by the kind of facility featured in the documentary. The clock is really ticking. It's time for boomers to look in the mirror, note that Woodstock happened 37 years ago, get real, and apply their energy to getting aging in America right.

Len Fishman is CEO and president of Hebrew SeniorLife, a network of care for the elderly.