As Norman Mailer tried to claw his way out of the crucible that was the 1968 Democratic Convention in Chicago, he bumped into the daughter of Eugene McCarthy, who was decidedly not thrilled to see Mailer scuttling away.

 

Smiling into “the proud disapproval of her eyes,” Mailer considered a reply: “‘Dear Miss,’ he could have told her, ‘we will be fighting for 40 years.’”

 

Mailer could be brilliant, and ludicrous, and sinister, and confounding, and clear-eyed—often all in the same paragraph. But, if anything, his insights here were eerily prescient, and yet strangely understated.

 

As baby boomers like to remind people, they lived through America’s war in Vietnam, and the protests over it. They lived through the grand and noble marches and demonstrations for civil rights, and the horrid and horrifying race riots in America’s then-rotting cities. They lived through bras being burned on campus and Kitty Genovese being butchered while her neighbors (supposedly) clicked through their television dials.

Most boomers, it is true, were mere spectators in the pageant of their own lives, but inasmuch as this country has divided itself, time and again, over what boomers came to call “identity politics,” it has been the result of an intra-generational argument spilling over into the country’s body politic.

This is the generation, remember, whose members claim to get misty over Dr. King (but still voted for Richard Nixon). It’s a generation whose members still flash knowing grins whenever “Puff the Magic Dragon” plays (but gave 10 weeks of the Billboard Hot 100 chart to Debbie Boone).

These controversies—some grand, some absurd—haven’t been resolved so much as they’ve faded into memory as new generations have risen. (Gay marriage and pot, for instance, have only become legal since the millenials—the kids and even grandkids of boomers—attained the franchise.) And there are those who argue that aging will actually be another front in boomers’ long culture wars (see sidebar).

So, as the flower children fade with their own, long sunsets, the question is, will they take their culture wars into America’s long term care centers with them?

“It’s a big challenge,” says Jodi Lyons, chief executive officer of Senior Sherpa, a group that helps elders adjust to their care (and their caregivers adjust to the elders). “The baby boomers are consumers. The prior generation used to accept the medical profession as being able to issue edicts. They said, ‘Thou shalt…’ and everyone did it. The boomers have gotten good at getting what they want, and not what people tell them to take.”

Take, for instance, the matter of gay rights. A June 2015 poll by the Pew Research Center found that millennials and genXers overwhelmingly were okay with gay marriage, the silent generation (those born from the mid 1920s to early 1940s) were overwhelming opposed to gay marriage, and boomers were split almost exactly down the middle.

Already, some gay rights activists are voicing concern that their elder brothers and sisters and being forced “back into the closet.”

And, at least in the Medicaid context, administrators will in real time be admitting residents who may well have thrown rocks at each other during bus riots in their hot youth.

So will boomers make care centers a house divided?

“It’s going to be interesting,” says Love Dave, administrator at Elmhurst Extended Care in Chicago’s western suburbs. “The next generation of adult children is going to be myself, and people like me. It’s going to be interesting to see how we’re going to handle it.”

This isn’t just some boomer think-in, either. A whole bevy of recent studies has found that the most common abusers of elders in care centers is… other elders. Aggression is, of course, one of the many terrible offshoots of dementia. But just think of what might happen if a lifetime of angry protests, or heavy drug use (say), is added to advanced dementia.

Boomers were the generation, remember, that famously made the personal, political. Or, as Mailer put it, “the last property of political property is ego.”

Providers and provider advocates are already mapping out boomers’ egos and finding their fault lines—civil rights, sexual freedom, feminism, consumerism; they’re trying, as best they can, to make care centers earthquake-proof.

For many experts, the collisions aren’t just going to be intra-generational.

“There is bound to be significant frustration when the boomers age and are cared for by a generation of workers who are unlike them,” says Clifton Porter II, senior vice president for government affairs at the American Health Care Association/National Center for Assisted Living, who worked his way up the ranks in the Deep South (and has the stories to prove it).

“Many boomers have had different lifetime events post WWII that younger staff, many new to the U.S. or from different racial backgrounds, did not experience in the same way.”

Porter has thick skin and a broad back, so it’s hard to hurt his feelings with mere insults. Still, he spends a lot of time thinking about the paradoxes that boomers will bring to long term care. First, “person-centered care,” if it means anything at all, will have to mean that residents have a right to their own thoughts, feelings, and ideas—even ones that are offensive to others. But Porter says he can understand how a frontline worker—toiling, often thanklessly, for long hours—would not quite be in the mood for some (shall we say?) old-fashioned values.

“Staff in long term care have high turnover rates already. We’ve got significant work to do so that everyone respects the multi-generational, multi-ethnic backgrounds of employees and the patients in their care,” he says.

It’s not just racial baggage that boomers may carry with them. People can tell a lot about different boomers by whether they refer to “feminism” (and specialists will even refer to “second-” or “third-wave feminism”) or “women’s lib.”

The point is, though, the boomers were the first generation to test whether a woman can really have it all. As the adult caregivers of their parents, boomers have already demonstrated that they may or may not have it all, but it won’t take much to convince them they’ve had enough, says Senior Sherpa’s Lyons.

“In most cases, the women are the caregivers—on top of everything else,” she says. “It’s a career, it’s the kids, and it’s the parents.”

Boomers were raised, or learned, to be vocal about their needs, Lyons says.

“And I’m not sure the profession is prepared to deal with all these competing interests of family caregivers,” she says.

Boomers were the first generation, as the late, great Christopher Hitchens pointed out, who were able to separate sex from reproduction. But they’ve learned that free love ain’t free.

According to SAGE, a nonprofit group that advocates on behalf of gay and lesbian elders, exactly half of new HIV/AIDS infections were among those 50 years and older. By the end of this decade, 70 percent of new infections will be 50 years or older. (Hoping to stem the tide, SAGE has embarked on an ambitious publicity campaign, reminding folks that “Age is Not a Condom.”)

As ever, dementia makes things worse (as it is bound to do). Already, providers find themselves caught in the horns of dilemma as their residents express themselves sexually. Does anyone think these questions will get easier as boomers age into care centers?

As it stands, many providers better hope so. A survey by the American Medical Directors Association last year found that only a quarter of care centers had anything like advanced training for staff on how to handle the tough questions of sexual intimacy among those with dementia. Nearly one-third offered no training at all.

Medical marijuana is now legal in 23 states and the District of Columbia. (Every-day-use marijuana is legal, tout court, in Alaska, Washington, Oregon, Colorado, and the District of Columbia.) And there is growing evidence that once-notorious drugs, such as psilocybin (found in mushrooms), Ecstasy, and even LSD have healing powers.

Yet federal laws are clear that 1.) These drugs are still very illegal; and 2.) Worse, from a provider’s perspective, no federal funds shall cover the use of illegal drugs. (That’s why, for instance, Colorado dispensaries have had to hire armed guards for their cash: No bank wants to run afoul of federal anti-drug laws.)

The Obama administration has been, at best, ambivalent about the changing attitudes toward formerly anathematized drugs. But what if the next president has a clearer sense of purpose?

Whether or not boomers have made great music, they’ve certainly made their feelings known. No one expects that to age well, either.

“The biggest change long term care providers will face as the baby boomers take over our centers will be the involvement that they will demand with their care, and the strong opinions they will bring,” says Robin Hillier, an Ohio provider and secretary treasurer of the American Health Care Association.

“Baby boomers will bring a lack of respect for authority and will not hesitate to question the advice of their physician or the team. They will be more vocal about the goals they want for their care and will have strong opinions regarding the interventions used. They are used to googling symptoms and diseases and will approach care planning with more information than did previous generations.”

Over at Elmhurst Extended Care, administrator Dave is already seeing some of the first signs of conflict.

“I had a resident with mild to moderate dementia,” he recalls. “We had to bring in family members to try to have a sit-down and say, ‘If you don’t want care by that group of people, that’s your right. But when it comes to making derogatory remarks, that’s unacceptable.’ That was a case of moderate dementia. It’s a lot harder in advanced cases.”

Dave says he thinks such moments are outliers. Baby boomers, after all, tend to be better educated than their parents’ generation. Still, one of the evils of dementia is how it takes over someone’s mind, he adds. A caregiver simply doesn’t know what might come out of a resident’s mouth.

 

“I can’t withhold care because of the era someone lived in,” he says. “My job is to make sure that residents are well taken care of.”

 

Mailer was no boomer, but he identified with at least one segment of their number. Now, as that restless generation packs for its trip into what used to be called “rest homes,” there is no doubt that they will change everything around them. The question is, will it be for the better?

 

“We may yet win,” Mailer wrote. “Heaven help us when we do.”

 

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter,

@ProviderMyers.