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You awake at 3:00 AM, drenched in sweat, paralyzed and unable to remember the name of -- or call out to -- your spouse of 20 years.

Four days later, in the Neurological Intensive Care Unit, your attending physician explains that you've had a "cerebral vascular accident," a stroke. Talk will soon turn to post discharge planning, skilled nursing facilities,  adult day care, speech therapy, and the "spend down" of your life savings. Your  children, scattered across the country, and with families of their own, are torn between the need to protect the continuity of their own lives, and their roles as potential caregivers. Ironically, despite your sudden loss of independence and the daily challenges of any protracted medical condition, it is your spouse  who will suffer the longest and hardest during the months and years that follow. You may recover from the stroke, but it is unlikely your spouse will ever regain her/his equilibrium - chronic stress, anxiety, and depression will continue long after you have survived your brush with death.

As the bills for the skilled nursing care and medical equipment begin to pile  up, and the expanded world you were part of begins to shrink, claustrophobia sets in and you first experience the "dark moment": the moment you realize that  your very survival exacts a heavy toll on those you love the most; a moment that your own mortality becomes negotiable. It becomes crystal clear: the longer you live in this condition, the more your family will suffer psychologically, emotionally and financially. Now your feelings of helplessness turn to despair  and panic -- like a person who is slowly being pulled into a piece of farm  machinery; the outcome inevitable, but powerless to intervene.

Welcome to the world of long-term care.

Arthur Schopenhauer, perhaps the most influential philosopher of the nineteenth century, described the three stages in the recognition of any truth:  first, it is ridiculed; next, it is resisted; and finally, it is considered  self-evident.

Our long-term care (LTC) delivery system is on the brink of collapse, and  most Americans are either unaware of or indifferent to this reality.

"There's a train wreck up ahead waiting to happen, Mr. President, and I'm  afraid it's going to be ugly" I told Jimmy Carter during a phone conversation we had in 1998 on the subject of aging and long-term care - a conversation I've also had with more than thirty members of Congress and a number of leaders in the private sector.

Today, more than 70 million Baby Boomers are passengers on that train - a  train with no engineer or brakeman, traveling hundreds of miles per hour faster  than it was designed to.

As the train continues to pick up speed, three of the nation's largest nursing home chains have recently sought protection from their creditors in the  courts, citing that Medicaid cutbacks mandated by the 1997 Balanced Budget Act,  and the US Health Care Financing Administration's (HCFA) new Prospective Payment  System (PPS) have created "an untenable and severelyprejudicial financial  environment."

Even the insurance industry is beginning to show signs of concern. The recent  announcements that Fortis and the Travelers were selling their LTC insurance divisions sent shock waves through the financial services sector, setting the  stage for what now appears to be an inevitable series of consolidations, mergers  and acquisitions.

Do I have your attention? Good, because now that I've taken the time to  painstakingly lay the groundwork, it's time to tear down the entire foundation and tell the truth.

This nation's current long-term care crisis has little to do with long-term  care. Oh, the metaphorical train is real alright, as is the unnecessary  suffering of countless elders who will live out their last days in abject despair. But "unprecedented population demographics," lack of private long-term care insurance, or congressional indifference are not the root cause of, or the solution to, this crisis.

The real crisis we face is one of aging, a human condition for which we have very little tolerance or empathy.

In America, the natural cycle of birth and death has been replaced with slick  ads from 35-year-old Madison Avenue executives. And as Dr. Ken Dychtwald  continues to share his vision of 'perfect aging' with his anecdotes of  92-year-old couples who bench press their grandchildren before breakfast, the  cover of Modern Maturity now touts provocative glossies of Susan Sarandon and  Sophia Loren as examples of 21st Century gerontological miracles.

We are a nation of extraordinary individuals. To paraphrase Dickens, the very  best and worst of what mankind has to offer can be found in these 50 states. And  amidst our comings and goings, our victories and defeats, and the ongoing, ubiquitous collection of "stuff," we grow older.

In a tradition that predates time itself, we age, preparing for the day when we will completely and irrevocably surrender, allowing our form to return to  Spirit. And yet, despite the certainty of our aging and death, we battle in ways that would embarrass even Dylan Thomas.

What is the "essence" of the problem? Frail elders are not hearty producers  or consumers. We understand the logic of the marketplace, but we draw a blank when it comes to primordial imperatives. In short, we embrace the 80-year-old  who is still a successful entrepreneur - until they become weak or frail.

On Jan. 5, 2000, the Governor of my home state, George Pataki, delivered his State of the State Address. Seven thousand, two hundred and fifty two words, and  not one mention of the challenges the face our state's frail elders. This, in spite of a state budget that earmarks more money for long-term care than any other item except education. Imagine. he managed to talk about our "prison population," but not a word about our population of elders.

Recently I spoke at length with Oren Lyons, Faithkeeper, Turtle Clan,  Onondaga Nation, Haudenosaunee, Six Nations, Iroquois Confederacy about the  subject of aging and our elders.

Chief Lyons, now 70, said, "...when an elder speaks they carry an authority  and wisdom that only comes with age and experience - when the sharp emotions of  youth are worn down and rounded. There is a standard in the Natural World, where the elders always are, in which they are perceived as leaders. In a buffalo  herd, the eldest is the leader. In the forest, the oldest, largest trees are the  most fruitful and productive. They are the great seed bearers.

If you look only to the Natural World, you will see the value that nature  places on aging.

In many of today's industrial nations, they generate their power and authority from youth - they build their foundation on the strength of their  young, and this is a great loss; a great disconnect between that society and their elderly.

The vision of Chief Lyons is not "new age" or even new for that matter. It is  simply a manifestation of the natural world - a world that many of us have become strangers in.

Martin K. Bayne

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