ABSTRACT
The denial of dignity at the end of life perhaps is one of the aged's worst problems. Legally and socially, the autonomy of the aged is difficult to protect. A rise in the percentage of deaths occurring in nursing homes mirrors the growth of the institutions and their use as depots for the irreversibly ill, older American. As the period of dependency and weakening has lengthened for the aged, the nature of the care given has shifted dramatically toward long-term institutionalization. Inability to participate in the economic system—first as a producer and then as a consumer—is likely to be interpreted as personal failure. Rejected by family, out of money, many older individuals turn to, almost surrender to, the health care delivery system as a last resort. As one might expect, the aged, the sick, the crippled, and the blind left the public institutions in large numbers in order to qualify for the Social Security payments.
