Daily Editors' Notes

Tuesdays with Kathy

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Elizabeth Newman, McKnight's Senior Editor
Elizabeth Newman, McKnight's Senior Editor

Amour isn't just a movie about an elderly couple. It also thoughtfully provokes questions about how families interact when confronted with long-term care situations. It also raises questions for caregivers.

Elizabeth Newman: Hi, Mom. I know our readers must be thinking, “What is this weird format today?” It's because I'm writing about Amour, a production in French that is essentially a long-term care movie. It's nominated for a slew of Academy Awards, including Best Picture. The Oscars will be televised Sunday night.

It's fair to think, if you are a long-term care employee, “Out of all the Best Picture nominees, why would I go spend time seeing a movie about my life, only in French?” But Amour, which follows an elderly couple in their apartment after the wife has a serious stroke, is what you and I think of as a “must-see,” so I've invited you here to plead our case as to why a director of nursing or administrator should seek it out in their cities. WARNING: I don't think this is a movie where spoilers are a big issue, but we do discuss plot points below.

Kathy Leis: We should tell people, that, full disclosure, I am a French teacher, so I love most French movies, and I've dragged you to a fair number of them. But I think everyone should see the movie.

Amour has a fairly simple plot, which is Anne and Georges are in their 80s, and Anne has a serious stroke.

The movie asks the question, “What would we do if our loved one truly wanted to die and we couldn't bear to let that happen?”

Anne has such strong feelings about not wanting to go back into the hospital, and it forces those watching to ask the question about what we want when we grow infirm.

May I remind you, dearest daughter, of what you once said to me: "I don't care what you put in that DNR: I'm reviving you no matter what." So although that was really funny at the time, I learned later that a family member can, in certain circumstance, override a DNR. Now that is scary, although you are also the child who is going to take care of me in my old age, so there is that.  

Elizabeth Newman: That brings up a really good point, which is what did you think of the daughter's relationship to her parents? I couldn't decide if she was self-absorbed or whether her babbling away was her way of coping. I thought it was pretty realistic that she was demanding her mother receive a second opinion. I suspect a lot of readers have seen family members insist there's something else to be done for their residents, when it's clear there's nothing else that can be done.

Clearly the daughter and her parents have issues, but I believe the point is there was no real falling out. It's not a secret that you and I are pretty close. Otherwise, we probably wouldn't be talking about end-of-life care and French movies within a McKnight's blog posting.

So while I can't empathize with the daughter, her relationship reminded me that in many cases, people don't have an official estrangement with their parents. They just drift away, leaving friends, neighbors or, ultimately, nursing home employees to pick up the slack when it comes to the care.  

There's also the question of independence. George says to his daughter at one point something along the lines of, “You have your life and we have ours” — or is this something you have seen with people in your age bracket?  

Kathy Leis: I think the daughter was self-absorbed in the problems of her own life, and totally in denial that her mother's condition was so serious. Remember on one of her visits, she was so distressed that her mom could utter only syllables? Like she was expecting her to spout Proust? It makes you wonder what expectations people have when their parent becomes ill. Of course the daughter wanted a second opinion.

Among my friends, there seems to be one sibling or a single family member who assumes the responsibility for the aging parent(s). I do think the French are much more reluctant to put their folks in long-term care facilities, but whether that is cultural or whether the facilities aren't as good, I'm not sure.

One of my French friends said that, in general, people in France are afraid if they go to the hospital, they're not going to be able to come back. I'd say that was a pretty universal fear. It also can be problematic in Catholic countries such as France or Italy to have a feeding tube removed.

I do remember visiting a beautiful rehabilitation center in France a good 40 years ago where the dining room was set up with cloth napkins, and thinking I wouldn't mind living out my days there.

Elizabeth Newman: It's good to know you've set your expectations realistically. Might I suggest you consider a local continuing care retirement community instead?

In all seriousness, I would like to think that I would have enough medical knowledge to understand that if you had certain types of illnesses, you would not be getting better.

You and I have different opinions about the long-term care aide who is hired to care for Anne. I thought she wasn't malevolent, but misguided in how she treated Anne. And her attitude toward Anne I suspect is not that uncommon in long-term care — it's one of cheery condescension. What did I miss?

And what was the symbolism of the pigeon?

Kathy Leis: Oh, I totally disagree. I thought the aide was cruel … maybe burned out too?  But truly mean.

I have no clue what the pigeon means. Taking flight? If you love something, let it go?

Elizabeth Newman: Well, we'll throw that question, and others, to the people who have seen Amour.  Thanks for joining me. Mom. We should watch another movie about long-term care together sometime — it's a great way to get an outside perspective.

Readers, please post your thoughts below about the movie, or if you haven't seen it, the issues we've talked about.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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