It occurred to me while preparing for this morningís column that this year marks the 40th Fatherís Day since my own fatherís death. When I received the call he was gone, I remember regretfully thinking that I hadnít gone to see him in a couple of weeks. The trips were difficult. It was my first experience with visiting a family member in a nursing home. Logistically it was on the opposite side of a large metropolitan area and once there, the conversations were all one-sided. He had his first stroke, the serious one, more than 20 years before and suffered several smaller ones in subsequent years. After the first stroke, speech was quite difficult for him, but in the later years, prior to his move to nursing care, the ability to talk had completely left him, as did his recognition of family and friends.

It is interesting to me how our minds will take a memory, pull it out of its historical context and set it in modern terms. That is what I found myself doing. I thought about what it may have been like if modern medicines, therapy equipment and rehabilitative techniques had been available for my father. Before long the mental exercise transitioned to thoughts of my mother. It was only several years later that my mother was in the final stages of her fight with cancer. I began thinking how much more ease and comfort she may have experienced if modern hospice care had been available to her at the time.

Our family recently experienced another nursing home relationship with a family member. After giving up her own home, my mother in-lawís level of assisted care increased as her physical abilities decreased. The process provided an orderly framework for the natural progression of the inevitable. It is striking how different the second experience was from that with my father. The transition from living independently at home to living with increased levels of custodial care was planned and a sequential process, not at all like the situation with my father where the move was rather sudden.

I remember the abrupt change in my father after his last trip home from the hospital following one of his slight strokes. The additional damage and being bedridden for so long did not allow my father to regain independent mobility. Although we had help from visiting nurses, his constant need for care was such that my mother, sister and I were forced to recognize the fact we were no longer able to give him the care he needed at home.

The two experiences nearly four decades apart illustrate how the approach to care for the aging has progressed in our society. Perhaps aided by the advances in sports medicine, rehabilitation techniques and strategies following hospital procedures have advanced significantly. Outpatient programs are designed to aid the recovery process and not merely rely on time and rest. Many patients may still have to go into nursing care because of the severity of their condition, but it does not appear to be a routine outcome. There are levels of custodial care today, from independent living in a campus environment, to assisted living, to full nursing care.

I think my meandering through medical experiences with our parents was in part aroused by a book I read recently by John Katz. ďIzzy and LenoreĒ is a story about the incredible relationship that can develop between humans and dogs. The canine character in the book had spent his early formative years devoid of human contact and socialization.

When Katz rescued Izzy, he enrolled the two of them in an extensive training program, and upon graduation the team became active volunteers in an upstate New York hospice program. Perhaps, it was from his early isolation from human contact or some innate ability that Katz help cultivate, Izzy developed into an exceptional hospice volunteer.

I used to take Otto, our Labrador with me at times on visits to see Carolís mother in Oak Ridge Manor. He did not stimulate speech or any audible response in her like Izzy was able to do with patients, but when he was in the room the focus of her attention was always on the dog. I was reminded of the dog we had that used to lay next to my dadís recliner and the photo I keep of her with her head in my motherís lap while she rested in a chair. It occurred to me what a comfort the dog would have been for them. I believe the term is holistic care ó I know the concept is progress.

Robert Brincefield is vice president and publisher of the Brownwood Bulletin. His column appears on Sunday. He may be reached by e-mail at