Bringing in the mail recently, I was pleased to see a thick 5-by-7-inch booklet among the catalogs and bills. The anticipation of reading a few Reader’s Digest short stories and “Humor in Uniform” made the evening seem pleasurable. But when I opened the 244-page Reader’s Digest-sized booklet, I found the “Senior’s Blue Book for Greater Boston.” Here was page after page of assisted living communities, retirement communities, skilled nursing facilities, and on and on. I was overwhelmed by the number of listings. There must be a tremendous demand for such places. In my family medicine practice, which has been in the same community for over 50 years, I have met the patient as a young parent, then a middle-aged parent, then a grandparent and then finally as “the elderly.” At the same time, I am treating their aging sons and daughters who are wondering what to do about Mom? Or Dad? Or Mom and Dad? It is my distinct impression that most of these Moms and Dads don’t want to be a problem for their children, but they would really like to age in place — in the home they built and have lived in for 30 or 40 years, in the neighborhood they chose and have been comfortable in and in the town they chose to rear their children. So what is the need for this avalanche of “facilities” to care for Mom and/or Dad? Before any decision is made about care for Mom and Dad, one question must be answered and answered truthfully: Is this decision being made to benefit the aging parents or their caregiver children? That question needs to be considered and answered honestly many times over at every step of “the process.” My impression, confirmed by multiple interactions with elderly patients, is that 80 percent to 90 percent want to age in place surrounded by their familiar household items and memorabilia and memories. When the memorabilia are tossed out, oftentimes the memories go with them, and memories are very important to the elderly — often being more enjoyable than the present realities they face! The “facility-finders” emphasize safety and influence the children-caregivers to think the same way. But these veterans of WWII and Korea and Vietnam did not live their lives with safety as the ultimate goal. Quality of life has trumped “safety” every time in their experience. Google confirms that 90 percent of elderly Americans want to remain in their homes. At one time, it was considered an absolute necessity that any retiring person would need a one-floor home. The current thinking is that climbing the stairs once or twice daily is not such a big deal. Done at a leisurely pace, unencumbered by packages or laundry, the carpeted stairs with railings on both sides can be safe and secure and an opportunity for some sorely-needed exercise! Additionally, our elderly parents have felt secure sleeping on the second floor, which is relatively safe from intruders, for many years. Suddenly having to sleep on the first floor can be quite disconcerting to someone not sleeping well anyway. What can the children do to facilitate the happiness of their elderly parents and enable them to age in place? Something as simple as installing a first-floor lavatory and laundry off the kitchen will make it possible for their parents to achieve their dream. It may not add to the home’s value (or may even diminish the home’s value — and the children’s inheritance), but it will make the parents so happy, so content. Much has been said about the isolation and loneliness of elderly living alone in their homes. Much of this, however, is by choice. When I used to visit seniors in senior housing, I would ask them why they didn’t join in the community events within the housing complex. “He’s a bigot!” or “She always talks about her illnesses,” and “He never bathes,” and so on and so forth. They often like their isolation and really enjoy picking their own friends. Most communities have senior centers and councils on aging, the VFW and the Legion and church guilds for those who really crave socializing. These places give the aging parent a wider selection of acquaintances to choose from, rather than just those assigned to their lunch table at their “facility.” Most elderly have a select group of friends whom they enjoy being with when they want to, but forced socialization does not make our elderly parents happier. A common mistake is when the elderly have children who live some distance away; the children invite them to move to a “perfect facility” near them, so they could “see each other more often.” If the parents do move — leaving all their friends and the community they know and love — and then find that the children do not visit more often, it’s a tragic scenario. It may be less of a burden for the children to no longer have to get on a plane to visit Mom and Dad, but Mom and Dad have gained nothing. And what they have lost is immeasurable. There are other arrangements that can be made to accommodate elderly parents, limited only by the ingenuity and inventiveness of the parties. When I was a young boy I lived next door to my grandfather. Grandchildren and grandparents are natural affiliates. I would rush home from school, change into play clothes and race next door, where Grampa was sitting in the sun. Sometimes I would bring him the newspaper, and he would go directly to the obituaries and read them one by one, occasionally laughing at someone whom he had outlived. At four o’clock, I would race up the stairs to the second floor where he lived and get his “medicine.” Precisely two ounces of Four Roses in a glass with one ice cube was his tonic, which was a reward for him for making it through the day. In Canada and in Roanoke, West Virginia, zoning ordinances have been enacted that allow adult children to lease campers from the government and park them in their own backyards, tapping into water and sewer and electricity and thereby creating a place for Mom and Dad. The elderly are close and accessible to their families yet independent from them. These backyard campers are called “granny pods,” which are ingenious. For the elder who likes his pipe or cigar, or who has a small beloved pet, they are a godsend! When the elderly parent passes on, the campers are cleaned and recycled by the government and then re-rented. The stumbling block for the children often seems to be the minimal, yet essential changes needed at the “Old Homestead.” The basic renovation includes installing a first-floor lavatory and washer/dryer. Often these are best located near the kitchen so that existing plumbing can be tapped into; sacrificing a breakfast nook or pantry for the sake of allowing Mom and Dad to age in place is well worth it, if that’s what it takes. Children struggling with the concept of putting money into their parent’s house need to think about the dollar value of pride and self-respect for their parents. What is the price paid in feelings of self-worth when the former CEO is mainly concerned about his supply of Depends? Everything the elderly can do to make themselves self-reliant is a great accomplishment and makes them feel good about themselves and makes them happier. The decisions required in these situations are complex, and they are different for each individual. But, if the child can make each decision from the point of view of what will be best for the parents’ total well-being, the child will live the rest of their lives knowing they did their very best. In a perfect world, perhaps their children will follow their example, and they will be the recipient of thoughtful, wise, and loving care in their old age. Source
