The nature of long-term care communities is defined by the demographics of age and by impairment, both physical and cognitive. They are combined because the healthiest of older people will often remain living in the greater community, either alone, with a partner, or with extended family. When age and impairment coincide, death occurs in that community more frequently but with a different kind of shock than in the larger community.
There is no surprise in the fact that sick, old people die, but there is shock in the constant changing of the environment in a long-term care community. More residents die or move to higher levels of care because there were more of them concentrated in the one community. This academic explanation cannot describe the impact of these changes on staff, residents, families, and other visitors. The remarkable swiftness of the passage from life to death should never cease to amaze us but the frequency of the passage in long-term care settings can be distressing to all involved.
In How We Die Dr. Sherwin Nuland points out that death has always been a subject of both terror and attraction to societies advanced and primitive. Since the beginning of the 20th century, people with access to modern medicine have expected that, if they did not die violent or accidental deaths, they could expect “a good death”—dignified, pain-free, with some conscious time to interact lucidly with loved ones. That rarely happens now and it rarely happened prior to the modern medical experience. The more medical interventions and the more sophisticated means used to defer death, the less likely the patient will experience whatever they perceived as “a good death.”