>>>>The Gilded Cage0The Gilded Cage（1916）0.0片名：The Gilded Cage导演：）&&
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“I never knew what you all wantedSo I gave you everything,All that I could pillageAll the spells that I could sing.
It's as if the thing were writtenIn the constitution of the age.Sooner or later you'll wind upPacing the cage.”
Bruce Cockburn, Pacing the Cage
“The world goes by my cage and never sees me.”
Randall Jarrell
The Center for Disease Control recently called attention to a growing public health problem affecting many Medicare aged seniors in this country. Many of the elderly cling so tenaciously to their personal that they overplay their hands and fortunes and end up so trapped within the circumstances of their lives that they find themselves seldom or never able to leave their homes. They become physically, medically, socially, or economically homebound. Trapped in gilded cages of their own unfortunate devise.
How big is this problem? The Center for Disease Control estimates that over two million American seniors are currently confined to their homes by the circumstances of their lives. By definition of measure they are seldom and sometimes never able to physically leave their residences to conduct the affairs of simple living. To gain a metric of perspective for this social dilemma, consider that only one million and four hundred thousand seniors currently reside in all of the nation’s nursing homes combined.
It is projected that six to ten percent of all seniors aged sixty five years or older, excluding those seniors confined to nursing home care, are homebound. For example, in my little rural county of Monroe, M it is estimated that between two thousand and two thousand and three hundred Medicare aged seniors are trapped in the confines of their own homes. Millions more may be partially homebound.
Conduct your own simple inquiry. Consult the most recent United States Census Bureau data for your home county, to look up the number of domestic residents aged sixty five years or older. Simple math will inform you what six to ten percent of that nu will tell you how many homebound seniors live just off of the back doorstep of your own clinical pharmacy or similar healthcare practice. These homebound patients rarely or never leave their homes. They often forgo even the most rudimentary of medical care.
Homebound seniors fall into several broad categories:
o Physically or medically homebound: sufficiently afflicted by a physical disability, a medical illness, cognitive impairment, or a mental illness to make leaving the home impractical. Other seniors in this group are trapped by dedicatedly caring for partners or loved ones who are disabled or ill.
o Socially homebound: socially isolated by a lack of friends or family, inability to speak English, and limited transportation options. Many seniors lack the ability to safely drive an automobile, and have no-one in their lives to provide alternative transportation for them. Some seniors become so disheartened or depressed by their isolated lives that they lose all interest in leaving the home.
o Economically homebound: unable to afford simple transportation and to pursue simple consumer activities. Some seniors lose the freedom that comes of paying others to provide things, and to perform services that they can no longer do for themselves.
Try walking just one week in their shoes. To polish your own perspective, live in the confines of your own home without leaving it for any reason, for just seven days. You would gain an enhanced appreciation for the prospect of living homebound for months or years on end.
Statistically speaking, homebound seniors tend to be: female, ethnic minorities, unable to speak English, impoverished, in poor health, and Medicaid recipients. However, more broadly speaking, the problem cuts across all social and economic strata. Because Americans are living such longer lives, many more are aging into unanticipated homebound status. Many more-fortunate Medicare seniors are just a disability or serious illness away from being confined to their homes, a risk that is greatly enhanced by advanced age. Living in a rural setting also often worsens this isolation.
Homebound Medicare seniors are poor and inconsistent healthcare consumers by virtue of their life circumstances. They seek basic medical care infrequently and often later than necessary, fill important prescriptions erratically, adhere to medical therapies and drug therapies poorly, fail to immunize, and disregard early important symptoms and warning signs of poor health.
All of this occurs in spite of the fact that these patients usually have robust and reliable health insurance coverage through Medicare, Medicare Supplements, Medicare Special Needs Programs, and Medicaid. How to consume care wisely, however, when caged in your own home? Life just gets in the way.
Homebound seniors tend to show up at emergency rooms sicker than most, and frequently get stuck in the fiscally decaying cycles of morbid, mortal Medicare hospital re-admissions… that drive so many healthcare institutions to their economic knees. We all eventually contribute as a commonwealth to that hidden and growing health expense tab.
Homebound seniors represent a largely untapped patient population for any ambitious healthcare provider. They have terrific and reliable health insurance coverage, and a laundry list of reimbursa prescription needs, immunization needs, cognitive services needs. Who wouldn’t welcome an additional several thousand Medicare patients to their professional practice? They are
all for the mere expense of the networking, shoe leather, telephone calls, referrals, or amateur sleuthing required to identify them. A pessimist sees many opportunities as problems, while an optimist instead sees most problems as glittering opportunities. Homebound seniors recognize the bars that trap them in a golden cage of solitude. They get that. In such cases, pharmacists need to focus on reaping the gold in these unmet opportunities to practice with, to do business with, these medically underserved patients… while offering needed hope, and doing some humanitarian good in the bargain.
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&Looking for more of the latest headlines on LinkedIn?GildedAge,GildedCage；China'ssuddenprosperityb；ByLeslieT.ChangPhotograp；Attheageoffour,ZhouJiayi；ForChina'semergingmiddle；Freedomisnotalwayslibera；FifthgradewasBella'stoug；Thebestpl
Gilded Age, Gilded Cage China's sudden prosperity brings undreamed-of freedoms and new anxieties. By Leslie T. Chang Photograph by Randy Olson
At the age of four, Zhou Jiaying was enrolled in two classes―Spoken American English and English Conversation―and given the English name Bella. Her parents hoped she might go abroad for college. The next year they signed her up for acting class. When she turned eight, she started on the piano, which taught discipline and developed the cerebrum. In the summers she went to
swimming, her parents said, would make her taller. Bella wanted to be a lawyer, and to be a lawyer you had to be tall. By the time she was ten, Bella lived a life that was rich with possibility and as regimented as a drill sergeant's. After school she did homework unsupervised until her parents got home. Then came dinner, bath, piano practice. Sometimes she was permitted television, but only the news. On Saturdays she took a private essay class followed by Math Olympics, and on Sundays a piano lesson and a prep class for her entrance exam to a Shanghai middle school. The best moment of the week was Friday afternoon, when school let out early. Bella might take a deep breath and look around, like a man who discovers a glimpse of blue sky from the confines of the prison yard. For China's emerging middle class, this is an age of aspiration―but also a time of anxiety. Opportunities have multiplied, but each one brings pressure to take part and not lose out, and every acquisition seems to come ready-wrapped in disappointment that it isn't something newer and better. An apartment that was renovated a few y a mobile phone without a video camera and color screen is an embarrassment. Classes in colloquial English are fashionable among Shanghai schoolchildren, but everything costs money. Freedom is not always liberating for people who grew up in a stab sometimes it feels more like a never ending struggle not to fall behind. A study has shown that 45 percent of Chinese urban residents are at health risk due to stress, with the highest rates among high school students. Fifth grade was Bella's toughest year yet. At its end she would take entrance exams for middle school. Every student knew where he or she ranked: When teachers handed back tests, they had the students stand in groups according to their scores. Bella ranked in the middle―12th or 13th in a class of 25, lower if she lost focus. She hated Japan, as her textbooks had taught her to: The Japanese army had killed 300,000 Chinese in the 1937 Nanjing massacre. She hated America too, because it always meddled in the affairs of other countries. She spoke a fair amount of English: \Hut, and she liked the spicy wings at KFC. Her record on the hula hoop was 2,000 spins. The best place in the world was the Baodaxiang Children's Department Store on Nanjing Road. In its vast stationery department, Bella would carefully select additions to her eraser collection. She owned 30 erasers―stored in a cookie tin at home―that were shaped like flipflops and hamburgers an each was not much bigger than a thumbnail, and all remained in their original plastic packaging. When her grandparents took her to the same store, Bella headed for the toy section, but not when she was with her parents. They said she was too old for toys. If Bella scored well on a test, her parents a bad grade brought a
1 clampdown at home. Her best subject was Chinese, where she had mastered the art of the composition: She could describe a household object in a morally uplifting way. Last winter Grandmother left her spider plant outdoors and forgot about it.… This spring it actually lived. Some people say this plant is lowly, but the spider plant does not listen to arbitrary orders, it does not fear hardship, and in the face of adversity it continues to struggle. This spirit is worthy of praise. She did poorly in math. Extra math tutoring was a constant and would remain so until the college entrance examination, which was seven years away. You were only as good as your worst subject. If you didn't get into one of Shanghai's top middle schools, your fate would be mediocre classmates and teachers who taught only what was in the textbook. Your chances of getting into a good high school, not to mention a good college, would diminish.
You had to keep moving, because staying in place meant falling behind. That was how the world worked even if you were only ten years old. The past decade has seen the rise of something Mao sought to stamp out forever: a Chinese middle class, now estimated to number between 100 million and 150 million people. Though definitions vary―household income of at least $10,000 a year is one standard―middle-class families tend to own an apartment and a car, to eat out and take vacations, and to be familiar with foreign brands and ideas. They owe their well-being to the government's economic policies, but in private they can be very critical of the society they live in.
The state's retreat from private life has left people free to choose where to live, work, and travel, and material opportunities expand year by year. A decade ago most cars belonged
now many families own one. In 1998, when the government launched reforms to commercialize the housing market, it was the rare person who owned an apartment. Today home ownership is common, and prices have risen beyond what many young couples can afford―as if everything that happened in America over 50 years were collapsed into a single decade. But pick up a Chinese newspaper, and what comes through is a sense of unease at the pace of social change. Over several months in 2006, these were some of the trends covered in the Xinmin Evening News, a popular Shanghai daily: High school girls were suffering from eating disorders. Parents were struggling to choose a suitable English name for their child. Teenage boys were reading novels with homosexual themes. Job seekers were besieging Buddhist temples because the word for \were living together. Parents struggle to teach their children but feel their own k children, more attuned to social trends, guide their parents through the maze of modern life. \completely turned around,\says Zhou Xiaohong, a sociologist at Nanjing University who first noticed this phenomenon when his own father, a retired military officer, asked him how to knot a Western tie. \Because their parents have such high hopes for them, children are among the most pressured, inhabiting a world that combines old and new and features the most punishing elements of both. The traditional examination system that selects a favored few for higher education remains intact: The number of students entering college in a given year is equal to 11 percent of the college-freshman-age population, compared with 64 percent in the United States. Yet the desire to foster well-rounded students has fed an explosion of activities―music lessons, English, drawing, and martial arts classes―and turned each into an arena of competition.
2 Such pursuits bring little pleasure. English ability is graded on five levels stretching through college, and parents push children to pass tests years ahead of schedule. Cities assess children's piano playing on a ten-level scale. More than half of preteens take outside classes, a survey found, with the top reason being \Parents tend to follow trends blindly and to believe most of what they hear. The past is a foreign country, and the present too. \are a traditional family\was how Bella's mother, Qi Xiayun, introduced herself when I first met her in 2003. She was 33 years old with the small, pale face of a girl, and she spoke in a nonstop torrent about the difficulty of raising a child. She teaches computer classes at
her husband works in quality control at Baosteel, a state-owned company. They were appointed to those jobs after college, as part of the last generation to join the socialist workforce before it started to break apart. Bella's parents met the old-fashioned way, introduced by their parents. But after they had Bella in 1993, they turned their backs on tradition. They chose not to eat dinner with their in-laws every night and rejected old fashioned child-rearing methods that tend to coddle children. When Bella was not yet two, her grandmother offered to care for the baby, but her mother worried that the grandparents would spoil her. Bella went to day care instead. When she entered third grade, her mother stopped picking her up after school, forcing her to change buses and cross streets alone. \So Bella grew up, a chatty girl with Pippi Longstocking pigtails and many opinions―too many for the Chinese schoolroom. In second grade she and several classmates marched to the principal's office to dema the protest failed. Her teachers criticized her temper and her tendency to bully other children. \card, \\The effort to shape Bella is full of contradictions. Her parents encourage her independence but worry that school and the workplace will punish her for it. They fret over her homework load, then pile more assignments on top of her regular schoolwork. \says Bella's father, Zhou Jiliang. \Bella teaches her parents the latest slang and shows them cool Internet sites. When they bought a new television, Bella chose the brand. When they go out to eat, Bella picks Pizza Hut. One day soon, her parents worry, her schoolwork will move beyond their ability to help her. When Bella was younger, her parents began unplugging the computer keyboard and mouse so she wouldn't go online when she was home alone, but they knew this wouldn't last. Recently, Bella's father and his sister and cousins put their grandfather in a nursing home. It wa in traditional China, caring for aged parents was an ironclad responsibility, and Bella's parents have extra room in their apartment for their parents to move in some day. But Bella announced that she would one day put her parents in the best nursing home. \father says. \nursing home and live a quiet life there. This is the education my daughter gives me.\I went to school with Bella one Friday in her fifth-grade year. She sat up in bed at 6:25, pulled on pants and an orange sweatshirt, and tied a Young Pioneers kerchief around her neck. Her parents rushed through the cramped apartment getting ready for work, and breakfast was lost in the shuffle. Bella's mother walked her to the corner, then Bella sighed and headed to the bus stop
3 alone. \Today there would be elections for class cadres, positions that mirror those in the Communist Party. \The bus dropped us off at the elite Yangpu Primary School, which cost $1,200 a year in tuition and fees and rejected 80 percent of its applicants. Her classroom was sunny and loud with the roar of children kept indoors. It had several computers and a bulletin board with student-written movie reviews: The Birth of New China, Finding Nemo. By 8:30 the students were seated at their desks for elections. Their pretty young teacher asked for candidates. Everyone wanted to run. \Biting King,\\officer. \The speeches followed a set pattern: Name a personal flaw, pledge to fix it, and ask for votes. It was self-criticism as campaign strategy. Those who strayed from the script were singled out. \write a lot of words wrong,\me.\\you left out?\The girl tried again. \Bella delivered her pitch for sports officer. \are pretty good,\she said breathlessly. \I have conflicts with other students. If you vote for me, it will help me change my bad habits. Please everyone give me your vote.\In a three-way race, Bella squeaked to victory by a single ballot. Election day, like everything in school, ended with a moral. \you must work even harder. You shouldn't let yourself relax just because you lost.\The language of child education is Darwinian-grim. \themselves,\will face pressure and competition. They need to know how to face defeat.\Some schools link teacher pay to student test performance, and the pressure on teachers is intense. Bella's class had recently seen a drop in grades, and the teacher begged parents to help identify the cause. Lu Yan had just gotten her four-year college degree at night school and planned to study English next. All her colleagues were enrolle even the vice-principal took a weekend class on educational technology. A math teacher was fired three weeks into the school year because parents complained she covered too little material in class. Life will not always feel like this. The next generation of parents, having grown up with choice and competition, may feel less driven to place all their hopes on their children. \is the hardest time,\my generation we have both traditional and new ideas. Inside us the two worlds are at war.\In math class later that day, the fifth graders whipped through dividing decimals using Math Olympics methods, which train kids to use mental shortcuts. They raced across a field in gym class, with the slowest person in each group punished with an extra lap around the track. School ended at 1:30 on Fridays. The bus let Bella off outside her building, where she bought a Popsicle
4 and headed inside. Her weekend was packed with private tutoring, so Friday was the best time to finish her homework. I told her that no American ten-year-old did homework on a Friday afternoon.
\In the five years since I met Bella and her family, their lives have transformed. They moved into a new three-bedroom apartment―it is almost twice the size of their old one, which they now rent out―and furnished it with foreign brand-name appliances. They bought their first car, a Volkswagen Bora, and from taking the bus they went straight to driving everywhere. They eat out a couple of times a week now, and the air-conditioner stays on all summer. At age 12, Bella got her first mobile phone―a $250 Panasonic clamshell in Barbie pink. Her parents' annual income reached $18,000, up 40 percent from when we first met. As the material circumstances of Bella's family improved, the world became to them a more perilous place. Their cleaning lady stole from them and disappeared. Several friends were in near-fatal car accidents. One day Bella's father saw her holding a letter from a man she'd met online. Bella's parents changed the locks and the phone number of the apartment. Her father drove her to and from school now because he thought the neighborhood around it was unsafe. Bella's mother took on more administrative responsibilities at work and enrolled in a weekend class to qualify to study for a master's degree. Bella's father talked about trading in their car for a newer model with better acceleration and more legroom. They frequently spoke of themselves as if they were mobile phones on the verge of obsolescence. \recharge,\Social mobility ran in both directions. A friend of Bella's mother stopped attending class reunions because he was embarrassed to be a security guard. A company run by a family friend went bankrupt, and his daughter, who was Bella's age, started buying clothes at discount stalls. Society was splintering based on small differences. Family members only a decade younger than Bella's parents inhabited another world. One cousin ate out every night and left her baby in the care of her grandparents so she could focus on her career. Bella's father's younger sister, who was childless, thought nothing of buying a full-fare plane ticket to go somewhere for a weekend. Friends who were private entrepreneurs were having a second chi Bella's parents would probably be fired by their state-owned employers if they did that. Bella tested into one of Shanghai's top middle schools, where teachers often keep students past five in the evening while their parents wait in cars outside. She is level three in English and level eight in piano. She still ranks in the middle of her class, but she no longer has faith in the world of adults. She disdains class elections now. \a lot of work,\she says, \the teacher is always pointing to you as a role model. If you get in trouble and get demoted, it's a big embarrassment.\She loves Hollywood films―especially Star Wars and disaster movies―and spends hours online with friends discussing Detective Conan, a character from Japanese comic books. She intends to marry a foreigner because they are richer and more reliable. Her parents no longer he in spoken English she has surpassed them. They lecture her to be less wasteful. \she sits there without saying anything, but I know she doesn't agree with me,\afternoon in the living room of their new apartment, as Bella glared without speaking. \child-raising has been a failure.\ 5 三亿文库包含各类专业文献、中学教育、外语学习资料、生活休闲娱乐、专业论文、应用写作文书、幼儿教育、小学教育、13gilded age gilded cage等内容。
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The Gilded Age in ... In the Gilded Age, people who possessed a calling card___ A.had to make their livingB.were interested in forming business relationshipsC.boasted... The novel depicted the reality of that time so vividly that since then people refer to that period in American history as the ″Gilded Age.″ The ... Tina Wu--1 Tina Wu
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