There is an elderly couple in our parish. They are friends of mine. They live in a very nice home - a showplace. Prior to COVID, they were active in the parish. But he has been in decline for a number of years, first with one serious condition, then another. All of those ailments have left their marks on him, and he never bounces all the way back. At present he has several big health issues to deal with, and cumulatively they have reduced him nearly to invalid status. He is a big guy, and she is tiny, and if he falls, she is not big and strong enough to help him up.
Looking at it dispassionately, he needs to be living in a place where he can get a lot of healthcare assistance. Assisted living, or perhaps even a nursing home. But psychologically and emotionally, they seem not to accept this reality. They have been in love for many decades, and they have lived in this home together for a very long time. It seems they can't bring themselves to close this chapter in their lives.
They have adult children, but the relationship with the kids always has been complicated, at least since I've known them, and the kids live in states far away. I don't know whether the kids are trying to prevail upon them to leave the house behind and move into a situation where he can get some assistance - but if they are trying, it isn't working.
The couple being together may be complicating their considerations of what must be done. My sense is that, as long as they are together, they think they can stick it out together.
This is not the only couple I know of who seem determined that, if/when they leave their home, it will be feet first. My own parents have a strain of that, although (thankfully) their health is better than this couple's. But my parents are in their 80s, and that health picture could change quickly.
For that matter, my wife and I have lived in this house for decades. It seems perfectly set up for us to retire in. We have no plans to leave. As for retirement communities or villages, they don't appeal to me. I want to live in a community with people of a variety of ages, with at least some of our kids nearby, and perhaps grandkids someday. I don't want to be completely surrounded by elderly people - people in decline who gripe all day about their maladies. So to some extent, I am sympathetic with this elderly couple.
I've been pondering what I could say to them which might move them to do what needs to be done. I'm open to suggestions.
Is the home handicapped accessible? Could it be made so? Stairs are a problem. Bathrooms are also, though they can be modified. Handles and railings can be installed in strategic places around the home. Are there visiting nurse/home health aid services available in the area?
ReplyDeleteNow is not a great time to be moving into a care facility. We are just emerging from Covid and aren't entirely out of the pandemic yet. The nursing homes are stressed and short- staffed. Sometimes it is easier and better for the services to come to the elders.
Another option for them would be to move into a handicapped accessible apartment or condo if their present home would be too difficult to modify. If they would consider an assisted living apartment which isn't a full nursing home that might be ideal. It's better for them to be together if that's possible. Their family really needs to be involved, especially if one of them is their power of attorney.
I can certainly empathize. My dad had similar problems in his last couple of years. The only way he was able to stay in his home was with the assistance of family.
I can see that there are things about our house which could really be a problem if we're still here in another decade or so. It's not easy considering that stuff.
But all that didn't really address your question, you asked what you could say to them. The only thing I can think of is to offer to help them research what options are available.
DeleteKatherine, thanks - that is great perspective. As I say, I don't know all the details of how involved their children are in their situation, but it does strike me that it's the family's problem to solve. But if - as is possible - the family has punted on the responsibility, then it seems to fall to the network of friends who love them to try to step in.
DeleteSometimes, thinking about and writing these posts can be a spiritual exercise. It's become clear to me that what I owe them, as their friend and a deacon, is the truth; at the very least, I don't want to offer them false assurances that everything will work out.
When I was on pastoral council, I suggested that parishes needed to become retirement communities for those aged sixty plus, just as they are now educational communities for those under eighteen. My large suburban parish does a great job for those under eighteen.
ReplyDeleteAs a parish retirement community those who are over sixty, heathy and active, would provide support and assistance for those who needed it, mostly those over eighty but some younger with health problems. As a member of the parish retirement community, they could hope to be taken care of as they aged.
Family care is not a workable solution for the elderly. Their family are often scattered around the county, their children are most often still in the workforce, and sometimes providing grandchild care for their own children.
The elderly cannot be left alone to be cared for by their spouses and age-mates. Those age mates disappear because of death, health problems, or moving to be near their working children which usually doesn’t benefit them that much.
The parish retirement community would be well educated in all the resources available in the community that can help as people encounter problems.
Most people want to live in their homes as long as possible. My father lived alone for ten years after my mother died. Every morning at around ten o’clock. I had him call my home number (I was still working and long distance calls were expensive) and hang up after three rings to let me know he was OK. He also walked or drove to our small town post office to pick up the mail. The post office, the center of the town informal network would surely come alert if Dad failed to show up for several days. Neighbors watched over Dad. I called him every Sunday as I had Mom. Periodically his sister and her husband visited him. I stayed with him at Christmas and Easter; he either visited me during the summer or I visited him. When he developed lung cancer, I was able to be with him for the last five months because my employer had a very generous work at home policy for those who had to take care of family members. I commuted the three hours from PA to Lake county to be here two days a week.
Not only do people want to live in their own homes, nursing and assisted living homes are terrible and very expensive. In general, I would not put a loved one is such as place until they were so physically disabled that they needed a strong person to lift them out of bed, etc.
As a deacon I would not make it into a personal problem for either them or their family, I would make it into a parish problem. Of course, as a deacon I would probably not be any more successful in converting the parish than I was as pastoral council member. It is such as serious and widespread problem that parishes have no claim to being a “community” if they do not face it.
Jack, thanks. Our parish probably is typical in its care for elderly and homebound people. We have a team that brings communion to them, I believe once/week. It's done in a caring way, and I am sure that these communion ministers try to keep an eye on the parishioners. But I'm not sure to what extent this ministry is plugged into senior care social services. I think that's viewed as the business of the parishioners themselves and their families, and perhaps their healthcare providers. There also are a few parishioners who drive elderly parishioners to mass and back - but it's not a formal program, and whether these helpful parishioners also drive these elderly folks on the many other errands they need, I'm not sure.
DeleteCatholic Charities in this area has a lot of senior-focused services available, but I'm not aware that the parish is coordinating with them on behalf of our parishioners. That would be a very simple way to make the parish a more senior-care-oriented community (and perhaps it's being done already - there are a lot of things that happen around here about which I don't know all the details).
Research has shown that people prefer voluntary congregational based help to governmental and large non-profit (but also largely government funded) providers such as Catholic Social Services.
DeleteChurches do hold themselves out as communities where families, friends and neighbors help each other. That is what people want, not government or charitable handouts
Believe me, they know the truth, and they know what needs to be done. They know exactly what the dangers are if they stay in their home. They know they cannot rely on their kids for much help. And they know with stomach churning certainty how much it's going to take out of them physically, financially, and emotionally to dismantle their home and move. All that stress is probably making them sicker.
ReplyDeleteThey see this move as a grim step toward death. They do not see that a new situation could offer them respite from their cares and support from staff and other residents.
Your own distaste/fear of becoming like them is palpable. If you don't want to live in an assisted living place, how can you hope to reconcile them to it?
Two suggestions:
Do you know any church ladies willing to take this couple to visit some places where they might live and talk to staff and residents? This might help with their fears.
Does your parish have a crew willing to help these folks with the physical strain of a move? If so tell them that you know they have some tough decisions, but that, when they're ready, not to worry about who's going to do the heavy lifting.
Accompaniment, not being told what they already know, is probably the best way to go.
Jean, thanks - another great perspective, and some very good practical suggestions. This couple does have a good support network among parishioners, and I believe there will be people willing to help them with a move, and to go with them to visit facilities in the area, if/when it comes to that.
DeleteYou're right, I do have a distaste for becoming a person who needs to rely on others (I suppose it's a rare person who has a taste for that). Maybe it will make me a better person spiritually if I need to be less self-reliant than I am now.
They won't ask for help. They may avoid it. Offering ahead of time will save their dignity and possibly get them to make a decision faster.
DeleteI know a fair number of elderly friends and relations who say that they enjoy their lives in assisted living and wish they'd made the move sooner. All of these people have small but private apts with optional meal plans, which helps.
Being reliant on others can spark more gratitude and empathy some days. Some days it just makes you bitter. I wouldn't look for holiness in infirmity, though everyone wants to think that's the silver lining.
This situation occurred in our neighborhood about 10 years ago. A couple a few houses away started to go downhill in their mid-80s. Like the man you speak of, the husband was a big man, heavy, and he did have some falls. His wife called the couple across the street from them several times after he fell. They had 4 children - 3 live in the SW, in Texas and NM. The youngest, who was beginning high school when his father retired from the AF and settled here and so was the only child who experienced MD as "home", stayed in Maryland. As a military family they had lived all over the US. After sinking roots here for 40 years, they did not want to move. They had a 2 story house, that had an enclosed sun porch that could have been converted into a main floor master suite. That would have helped a great deal, especially if they had some regular home-health care assistance.
ReplyDeleteTheir children decided on a surprise intervention-- they arranged for them to move into an assisted living facility near the youngest son. They arrived en masse and informed their parents that they were moving and that they had arranged to sell the house. The wife was upset, and refused to sign the listing agreement even after being moved to assisted living. The neighbors who had helped them told us that she kept telling the adult children that they wanted to move back to their house. She had macular degeneration, but was otherwise healthy. Both were mentally sound. But while both had been unhappy about being forced to move, she felt especially strongly that she wanted to be home. She hated the new living arrangement, missed her home. About 9 months later, they wore her down and she signed the listing agreement. The house was sold. She died about 6 months later, and he died a few months after she did. I do not know the official cause of death -- apparently something like "congestive heart failure" which seems to cover a multitude of causes for people who die without an obvious immediate cause - cancer, heart attack, etc.
After watching this drama play out, I think that nobody should be forced to leave if there is any possible way to help them stay where they want to be. I think - without any concrete evidence - that the stress of the move, sprung on them by their children, and their unhappiness at being forced to leave their home, may have hastened their deaths.
The best solutions cost money. If they live in a 2 story house, perhaps a downstairs room in this "show house" could be converted into a new master suite. Otherwise, modifications could be made as Katherine suggested. Decent assisted living places cost a lot of money. Nursing homes are ridiculously expensive and often the patients receive extremely sub-standard care. If your friends have enough money to cover a decent assisted living facility, they probably could afford full-time, or nearly full-time home care.
Another way to afford help in the home would be to allow a caregiver or even couple to move into the home if there is space and enough privacy, paying a reasonable salary supplemented by providing rent-free housing in a nice area, and perhaps the use of their car (my sister's caregiver drives their long unused Mercedes). Or maybe just a student, perhaps a nursing student, could be given a room for free if he or she will agree to help after a temporary emergency, especially during the nights.
These solutions are expensive, but not more expensive than quality assisted living. Another friend, in his 60s, who has been 100% bedridden for several years with late stage MS has a part-time caregiver, who is there because his wife still works full-time. She works from home, but she does have to work! The part-time care-giver helps with bathing, shaving, etc, as well as with meds and caring for chronic bedsores. The county sends a nurse at times, such as to give them Covid shots in the home. Those with large homes often have options that many do not because their home or condo isn't big enough.
Anne, thanks - another great perspective on this.
DeleteJim, the hearsay we got after their children forced the move was very sad. I suspect they had tried persuasion first, but the elderly parents wouldn’t budge. I also suspect, based on neighborhood gossip, that they felt betrayed by their children because of the “intervention”, rather than cared for.
DeleteGetting old costs a lot of money no matter how you slice it. Once people start falling down, there's tremendous pressure from family and doctors to go to a home, and aging in place is dicey, even with modifications.
DeleteI get why the kids had an intervention: it prevents parents from playing them off against each other and the endless bargaining and foot-dragging.
Congestive heart failure is a real thing. My mother died of it. Likely your neighbor was not as healthy as she seemed.
Maybe worth mentioning that those over 85 have the highest suicide rate in the country:
"It is over four times higher than the nation’s overall rate of suicide. As with most age groups, the majority of elders who kill themselves are male. As high as those figures are, the American Association for Marriage and Family Therapy (AAMFT) suggests that the rates for elder suicide are under-reported by 40 percent or more due to what they refer to as 'silent suicides.' These would include overdoses, self-imposed starvation, and dehydration, as well as accidents. The rate of suicide completion in this age group is also high due to the lethality of methods used."
https://www.psychologytoday.com, Jan 28, 2020
Yes, maybe the intervention was necessary. But I'm not sure they looked into alternatives, at least not based on what I heard from the neighbors who were closest to them as friends.
DeleteI think that sometimes old people lose the will to live, even if they don't reach the point of being suicidal. The data you cite is shocking to me. I knew that suicide rates were higher in older men, especially single older men who have retired and find life to be without purpose, but I hadn't realized how bad it is.
I also know that heart failure is a real thing. My husband is 81. He was diagnosed with non-ischemic heart failure about 2 1/2 years ago at Stanford hospital when we were visiting children in Calif. There was no obvious reason for the HF, which is why it is called "non-ischemic". The recent research indicates that there could be a genetic component, especially in cases like my husband, who was, and still is, extraordinarily fit for a man his age. He does 30 minutes of intensive aerobic exercise every day (and has throughout all of our now almost 50 years of marriage, walks about 2 miles/day with me (I am 7 years younger than he is and have a hard time keeping up with him, and he is still very active with gardening, house maintenance, car maintenance etc, even though he has slowed down a bit since the HF. Fortunately it has been controlled by a combination of low-sodium diet and some very expensive medications that put us in the "doughnut hole" for prescriptions before 6 months are up. However, HF also seems that it's the diagnosis of choice for old people who simply pass away after a long period of slowly failing, and perhaps a hospitalization. He may die of it eventually, but he's doing really well now. I often wonder if some HF patients were ever given the kind of high quality care my husband received at Stanford after going to the ER there, and from a Johns Hopkins Heart Failure specialist since we returned home. I have read that cardiologists are often mystified by the reality that many HF patients don't receive the medication my husband takes. Perhaps they should look into the realities of prescription drug costs for Medicare patients without additional coverage. Doctors seem very clueless at times about the vast inequalities that exist in our totally horrible health-care system.
I think you are right that sometimes people do just give up.
DeleteAs far as interventions, such as the one you mentioned, I think it should be a last resort if the people are still mentally competent. It would be heartbreaking to be forced into a solution that you didn't have an imput into.
My only point is that I hate to see other people assuming they know what's going on in a family. Even people who knew my parents well had no idea of the dysfunction.
DeleteJean is correct that the neighbors of 40 years often don’t know details. I did not tell any of our neighbors that I had cancer surgery and treatments from Sept - January. Their health may have been far worse than we all knew. But I do know that Pat and Don were not happy about the “intervention”. Based on personal experience in my family, I think that interventions can backfire miserably, causing lasting hurt and bitterness. Just my opinion, but I think the situation might have been handled differently and caused less unhappiness.
DeleteMy husband and I need to discuss this also as we are reaching the ages when unexpected health issues could rob us of our ability to live independently within the next decade or so. But maybe we’ll be lucky. We also have multiple friends and family who were able to live independently in their own homes well into their 90s. A close friend’s mother stayed in her home until she had passed her 100th birthday. After agreeing to move to assisted living near her daughter after that milestone, she got terribly bored (“Suzanne, there are just too many old people here who are no fun at all”) and started to lobby for a return to her home, which she still owned. She didn’t move back, but her mind was active until the day she died - of congestive heart failure. She was 105. Few of us are blessed with her genes, but we also don’t want to be warehoused before it’s absolutely necessary, especially without choosing to do so ourselves if we are still mentally competent.
Perhaps concerned family and friends should simply try to check on elderly family members regularly and frequently, in person when possible, if they are mentally competent and not emotionally ready for a major move.
What should be done and can be done are totally unique to each situation and the elderly persons themselves. My friend Lou's mother had dementia but she was very compliant and content with the assisted living facility. I knew my mother needed a familiar place and my house was familiar enough. I was strong enough to lift her from the floor the few times she fell. By the grace of God, she accepted a caregiver who could give her the assistance I could not. Anyway, I don't know Jim's friends and can't figure what they need. My personal preference is, as Katherine mentioned above, staying home with every gadget and grab hold one can install, chair lifts, and caretakers, part time even. Yes, expensive. Nursing homes aren't that great. Elderly fall down anyway. That type of frailty is a terminal condition in itself. You can only love people in that state and do what you can and be with them in their suffering. You can't fix 96.
ReplyDeleteI like Jack's view of applying parish community to the problem. Not enough done there.
When my mother and aunt were living 70 miles from me, I kept an eye on them with internet cameras in the main living areas and hallway. One time, my aunt fell and couldn't get up and my mother couldn't do it. I saw, I called, told my mother to just let her lie, I drove down an hour and a half and lifted my aunt up. I had a method for doing it without breaking her fragile rib cage. Somebody has to make a robotic device for motion assistance, fall prevention and safely lifting the fallen. Luckily, I was fit enough, but even healthy people can mess themselves up moving humans.
I am glad your mom accepted the "spy cams." Mine wouldn't hear of it. It was cops and protective services for wellness checks until I could get up there.
DeleteI cannot say enough about protective services lady. She helped tremendously with the mental health issues and advocated for us with the hospital. I have written tons of thank you letters and sent testimony to my elected reps thanking them for continuing to fund these services.
My inner conservative wants to say that adult children owe their parents care, but when you are working, dealing with your own illness, and have a sibling who disengages, it isn't always possible to provide optimal care and supervision.
Exactly. You do what you can do and what the elders allow you to do. Glad the gummint did its job and was useful to you.
DeleteThe answer to Jim’s question is synodality. No, not a church program, but the practice of people listening to one another. That is what we do here at NewGathering, day after day. The comments to this post provide a rich menu of the diversity of the experience of aging. There are no pat answers. For some people assisted living is an improvement but others do better in their own homes with a variety of environmental changes, both physical and social.
ReplyDeleteThe key to everything is the opportunity to talk about aging with your family, friends and members of the parish, long before it becomes a major problem.
The parish needs both small and large groups but it is important to begin at the grassroots with small groups of parish members rather than a top down, large group, bring in the experts approach.
Likely in Jim’s parish there is a rich diversity of experiences with aging. I would begin slowly with people such as Jim’s couple and make clear that I wanted their help in providing a framework for talking about the process of aging in later years and assembling in the parish a network of people who are experiencing or have experienced problems in aging, both good and bad, or who would simply like to talk about the issues. The aim is to listen to one another and benefit both by shaving our experiences and listening to the experiences of others.
I suspect I would find a lot of people who have dealt with the problem of aging either in themselves or in others, and who would be able to provide leadership in the parish in both small and large groups. In other words, I would avoid becoming the expert, or turning it into a program even if staffed by local volunteer “experts.”
For the large group experiences, I would title them something like “The Golden and Not So Golden Years.” My sixties (post retirement decade) were indeed my golden years. However, I have met people who went back to work because they could not handle retirement. Problems began in my seventies with my balance and related health problems. My eighties which will begin in about a month will have a lot of challenges because the pandemic which will likely permanently restrain my mobility.
The large group experience needs to attract a wide diversity of experiences including people who have major problems in their sixties, and others who are doing well in their eighties and even nineties. It also needs to attract significant numbers of middle aged and young people who are affirming of our aging population.
Besides providing a rich variety of listening experiences in the parishes, the sessions need to help people develop the practice of “walking together” with their own families and friends. The comments provide ample evidence of how difficult we all find this. Most of us are putting this off. It is never too early to begin. We all need to develop our skills in this area.
The local parish is uninterested in this type of thing. I think a place to start is in our own lives. We have helped elderly neighbors with visits, rides, and being their point persons on their call buttons.
DeleteThe archdiocese of Washington DC has an organization called Victory Housing. Out here in the suburbs, they built several assisted living projects on the grounds of parish churches, including both of my former Catholic parishes. . They are very attractive and well- run.
ReplyDeleteMaybe too big an endeavor for parishes, but not too big for dioceses.
https://www.victoryhousing.org/