Tag Archives: elder care

Aged Out

“I hope I die before I get old.”

– “My Generation”, The Who, © 1965

I’ve thought about this scenario: I’m home alone at age 80-something and I have a stroke or some kind of cardiac event.  I can’t get to a phone and I don’t have one of those Life Alert devices.  As a staunchly independent, childless 50-something with few friends, that thought has crossed my mind on more than a few occasions in recent years.  It became even more glaringly realistic this past January, when I told my mother she needed to take a shower.  I realized she had urinated on her bed; a simple of case having fallen asleep and – given her age, I thought – wasn’t able to make it to the bathroom in time.

“I’ll change the sheets,” I told her, before retreating into the hall.  A moment later I saw she was flailing her right arm and leg.  “What’s wrong?” I asked.  “You need to get up and take a shower.”  But then it became clear.

She’d had a stroke.

It apparently had been a brief event and was already starting to heal by the time she’d arrived at the hospital.  But her left side was mostly paralyzed.  I sat beside her in the emergency room, as she gazed blankly into a flickering light panel, and thought, ‘Now what?’

Years ago, when her mental health started to wane, someone asked why I didn’t place her in a “home.”  “She has a home,” I replied.  “It’s the one she’s in now.”

But the now had changed.  And I was forced to contemplate the unthinkable: putting one of my parents into a “home” – whatever the hell that’s supposed to entail.

I had promised my father that I would do everything to ensure he didn’t pass away in a hospital; ensconced in a strange bed with tubes wrapped around him, as if he was a hostage.  And I was able to help him achieve his desire.

But this situation is different – and far more complicated.  After her hospital stay, I had to place my mother into a rehabilitation center.  I found one nearby and was able to tour the facility a few days before she arrived.  It’s an older building that looked like it hadn’t received a fresh paint job in about four presidential administrations.  On that Friday evening I accompanied her to the place, I felt as if I’d swallowed a tree branch – and it was now stuck.  The center looked even more dismal than when I’d first entered.  And that night, as my mother lay in bed, glancing around the room – her left arm and leg still mostly inert – my heart filled with trepidation.  I couldn’t stay that night, so after more than an hour – assuring her things would be alright and consulting with the amiable staff – I departed.  I almost felt like I’d abandoned my mother into a pit of despair.  And, even worse, I’d violated a solemn vow I’d made to my father more than a decade ago: if he should pass away first, I’d take care of my mother.

Looks, indeed, can be deceiving.  While the rehab center was an aged structure, the staff was incredible.  I did have a good feeling from the start, though, when I first spoke with one of their representatives.  But it didn’t take long for me to realize I’d made a great choice.

I brought my mother home in March, as the COVID-19 pandemic gripped the nation.  The startling number of coronavirus deaths in similar facilities alarmed me.  The center had banned visitors a few days earlier, but I had to get her out of there.  As good as the place had been for her, I didn’t she feel she was safe.  And I knew I could care for her just as well as the rehab center and get her back to some semblance of her former self.  I should know by now that far-reaching plans always look great on paper or in dreams.

After only a week, I had to return her to the rehab center.  Her health had deteriorated in that short period.  But, once back at the facility, she improved.  She’d regained some movement on her left side and was alert.  She still didn’t recall what had happened.

But then, matters became even more complex – and aggravatingly unsettling.  My mother’s lengthy stay at the rehab facility had exhausted her Medicare benefits.  They paid 100% for 21 days, when they lowered the rate to 80%.  My mother – and I – was obliged to pay the remainder.  But she didn’t qualify for a supplemental insurance policy – even through Medicare.  Or the Affordable Care Act (ACA).  The requisites for either make the Harvard Law School entrance exam look like a daycare application.

Medicaid was our last option.  Completing the application for that was tantamount to completing one to be a Central Intelligence Agency case officer.  And my mother wasn’t approved.  With her Social Security and two pensions, she earns too much per month; just a “few dollars” too much, the rehab center associate helping navigate the morass informed me.

And what, I inquired privately in my angry cogitations, qualifies as a “few dollars” too much?  I researched a handful of other available and plausible alternatives – enough to fill a tea cup – and could find nothing viable.  Absolutely nothing.  For my mother even to begin to qualify for some semblance of Medicaid coverage to help with her health care expenses, she’d have to cede all of her assets, including this house – the house she and my father worked hard to get and to keep; give it all up to an omnipotent entity that designed the very system to which my parents (and millions of others) annually pay homage and taxes.

And she earns a “few dollars” too much.

By the end of April, the rehab center – the place that had proved life-saving and life-changing – had reached its financial breaking point with us.  They had to let her go.  They had no choice, they told me – and therefore, neither did we.

Fortunately, Medicare does pay for extended hospice care here at the house.  Representatives with the agency I selected have been incredible – even angelic – in their commitment and service.  They’re as concerned with me, also, as my mother.

Still, I seethe at the thought of the financial fiasco in which we’ve now been placed.  We’re in debt to the rehab facility now, as well as to a slew of doctors and the hospital.  My mother is just one of literally millions of Americans in similar straits.  At current rates, the crisis will only deepen nationwide.  The number of Americans aged 65 and older is expected to almost double from 52 million in 2018 to 95 million in 2060; rising from 16% to 23%of the population.

A half-century ago, programs like Medicare and Medicaid were designed to assist the elderly and poor with health care needs.  They’re not just altruistic; they’re vital.  As with the Social Security system a generation earlier, Medicare and Medicaid provided necessary safety nets for many Americans.  The nation had matured into a contemporary society where even the most vulnerable of citizens were not left to fend for themselves.

As usual, social conservatives scoffed at the notion.  Just like with the post-World War II GI Bill, they denounced such aspirations as welfare and socialized medicine.  These were the same fools who demanded people swear allegiance to the United States, be willing to sacrifice their lives to the Constitution, abide by established laws, and blindly pay money to ensure a safe democracy for all.  They still do.  Yet, when people earn a “few dollars” too much…they shrug their shoulders and change the subject to American exceptionalism.

My mother began working for an insurance company in downtown Dallas in the fall of 1952 at the age of 19 and retired from an insurance company in February of 2003 at age 70.  With the exception of taking off 15 months for being pregnant with and caring for me – at a time when maternity leave was more of a concept – she worked for half a century.  Fifty years.  And, as her physical and mental health decline from years of just being alive…she earns a “few dollars” too much.

“Age is just mind over matter,” my father once told me.  “If you don’t mind, who gives a shit?!”

People have told me that, for being a good person, I deserve a “big reward.”  And I’ve also told some they deserve a special place in the “Great Beyond” just for being themselves.  As genuine and thoughtful as those words are, does anyone have to wait until life in some other realm to be appreciated for their actions?  Is it truly necessary to wait until we’re dead to receive the respect we’re due in life?

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And Me?

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In September of 2012, I was at my parents’ house when my father was getting ready to go have his car inspected, and my mother decided she needed to take out the trash.  I had come in following an earlier and somewhat stressful job interview.  I had brought my dog with me to the house – not the interview.  I suddenly thought that I needed to check on my mother.  I don’t know why; it just suddenly occurred to me.  Good thing, though.  As I entered the garage, my mother was returning from the recycle bin, when one of her slippers got caught on the cracked driveway.  She slammed hard onto the concrete and immediately started screaming.  I rushed to pick her up; her left arm looked broken.  With my help, she hobbled back into the house.

My father came down the hallway, horrified.  “What the hell happened?” he bellowed.  He already has a loud voice, so with any extra effort, he could wake the dead.

I quickly explained the situation, which only made him mad.

It wasn’t the first time my mother had tripped while wearing those slippers.  They were cheap, rubber footwear with a two-inch heel; what I called high-heeled slippers.  A few months earlier I was again at their house with my dog, when he indicated he needed to visit the back yard.  My father decided to take him out; my mother decided to join them.  She leapt up from the couch and tripped on those same slippers; slamming hard onto the tile floor.  In fact, she came out of them.  They literally seemed to get stuck to the floor.  She ended up with a severe bruise up the right side of her leg.  A visit to their orthopedic doctor the following week confirmed nothing was broken, or even fractured.

When she fell in the driveway, my father hurriedly called that same orthopedic doctor.  He told them to come in immediately.  I drove them to his office; the receptionist could sense my frustration, as I signed them into the log book.

“Be patient, hon,” she drawled.

My mother’s arm wasn’t broken, but her shoulder was dislocated.  The doctor and two of his assistants tried to pop it back into place, as she lay on the X-ray table, but the muscles and ligaments around it had swollen too much.  They had to admit her to the neighboring hospital and put her to sleep.  It turned out to be an all-day affair.  We left the hospital around 7 P.M.

My father tossed that pair of slippers – and another similar pair my mother had in their closet – into the trash.  Since they were made of rubber, I switched them over to the recycle bin.  I hoped they could be reincarnated as the wheels of a “Hoveround” and therefore, serve a greater purpose.

She’s not the only one who’s tripped in and around the house.  My father, an avid gardener, has fallen several times outside with no one but himself to get back up.  One afternoon he fell in the master bathroom and couldn’t get back up.  He started hollering for help.  My mother had fallen asleep on the couch and couldn’t hear him.  I had lain down in my old bedroom and – with the door closed – couldn’t hear him either.  My dog’s whining woke me up.

It’s a good thing I was there to help my parents in both those predicaments.  Many senior citizens live alone and often find themselves in compromising situations.  Several years ago I had a friend who volunteered for “Meals on Wheels.”  One afternoon he arrived at the home of a client, an elderly woman who lived alone.  Two of her neighbors were at the front door; frantic because she wasn’t responding to their knocks.  My friend wandered towards the back where he climbed the tall wooden fence – and saw the woman lying on the ground, just outside the back door.  She had stepped out the previous evening and tripped.  Unable to get up by herself, she simply remained on the ground; knowing her “Meals on Wheels” visitor would be there the next day.

As I rapidly approach 50, I’m now seeing all these incidents in a new light.  Who’s going to take care of me when I get old – if I should be that lucky?  I’m an only child.  I’ve never been married and don’t have any kids.  I’m close with a couple of cousins on my father’s side, but they have their own lives.  I don’t know if I’ll end up in this house where I grew up, or if I’ll have a home of my own.  But, if I should have the good grace of living to an old age, who could I depend on for support?  I can see dogs in my future though.  They make great companions, yet unless they can be trained to dial 911, or administer first aid, that’s about the extent of their practicality.  Still, I’d almost rather have a dog than a spouse or a partner.  I’ve never been good at romantic relationships.

It’s a serious issue facing us, as life expectancy in the U.S. and other developed nations reaches ever-increasing highs.  The current (and relentless) American obesity epidemic may put a dent in the welfare of my fellow citizens.  However, medical and scientific advances have allowed the populations of developed nations to experience greater rates of longevity, which is a good thing, of course.  People should be able to live as long as they possibly can.  But, those longer life expectancies also present some unique challenges; a fair trade-off, I presume.  It goes beyond just tolerating old folks’ stories of ‘way back when.’  Older people generally require specialized medications and treatments.  Arthritis, hearing and vision loss and immobility are among many such concerns for senior citizens.  There’s a growing industry within the medical community that targets elder care.  It’s virtually uncharted territory.

My paternal grandmother lived to age 97.  But, in the years between the death of my grandfather in 1969 and one traumatic night in the spring of 1992, she’d spent mostly alone.  She got up in the pre-dawn hours, needing to go to the bathroom, when her foot became entangled in the bedding.  She stumbled forward into the baseboard of her antique bed and fell to the floor – her right elbow cut and broken.  Despite the pain and bleeding in the pitch-black darkness, she managed to pull herself back around to the nightstand where she found the telephone cord; she yanked the phone down and called one of my aunts.  My aunt called one of her sisters, before rushing to my grandmother’s house with her husband.  Someone called the paramedics.  As my aunts and uncles stood outside, they simultaneously realized one terrifying fact: none of them had a key to the house.  One of the paramedics announced he was going to break a window, when one of my uncles remembered he had a glass-cutter in his car.  They used that to gain access to the house.  At the hospital, everyone was startled to learn something more critical than not having a key: my grandmother’s body was riddled with bumps, bruises and cuts.  She conceded that she’d fallen several times in the house and had always managed to get back up.  This time was worst, though, because of the elbow break.  The emergency room doctor looked askew at my relatives.  Elder abuse had become a hot topic in the medical community by the early 1990s, and our family became concerned that someone would look at those bumps and bruises on my grandmother and think the worst.  But, no one did.

Ultimately, my father and his six siblings decided that someone needed to be with her at all times.  My grandmother wasn’t too keen on the idea, though.  She relished her independence and privacy and didn’t want someone monitoring her every move.  But, her children ruled against her.  She was fortunate – and blessed.

A close friend of mine is caring for his elderly mother and an elderly aunt.  His aunt is in her early 90s, and his mother is fast approaching that milestone.  He works full-time, so it’s a challenge to tend to the needs of both women.  On a few occasions, he once confided to me, he literally wanted to pack up and leave Dallas for somewhere else; anywhere!  Just as long as he had no one to worry about except himself.  Alas, he couldn’t bring himself to do it.  He’s not so cold-hearted.  His older brother died a few years ago, and his younger sister has a daughter who just turned one.  His sister also has a 20-something son from a long-ago relationship who lives in the same house as his uncle, grandmother and grand-aunt.  He’s a very responsible young man who finished a hitch in the U.S. Marines three years ago and just earned an associate’s degree from a community college.  But, he also works and, at his age, I don’t think he envisions a lifetime of caring for old folks.  One day, however, he and his half-sister may face the concerns of elder care with their mother.

It’s difficult to watch my parents age.  “It’s hell getting old,” they inform me periodically.  Not until a few years ago, about the time I turned 45, did I really sit down with nothing but my most honest thoughts and contemplate life as a senior citizen.  Aside from previous bouts with alcohol addiction, I’ve tried to take care of myself both physically and mentally.  I’ve suffered from severe depression and anxiety in the past; adverse effects, I now realize, of not being able to kill people who pissed me off and get away with it.  Otherwise, I’m pretty healthy.  People who don’t know me occasionally tell me I look 30-something.  That’s a good thing.  But, surficial appearances can’t make up for a strong inner core.

In 2043, for example, I’ll be 80 – the same age as my parents are now.  Will I still have relatively good vision and the mental acuity needed to drive a vehicle?  More and more older Americans are still driving, even as their reflexes slow.  Some states are approaching the delicate issue of how to deal with the growing number of senior citizen drivers; another effect of longer life expectancies.  Will I learn from my parents’ mistakes and watch where I’m walking?  Falls are the leading cause of injury to the elderly.  It was bad enough that my mother would wear those damn rubber slippers with a two-inch base, but she also had the habit of dragging her feet.  I can understand why.  Joints become stiff with age, as cartilage behind the knees wears thin.

It would be nice for me, at age 70 or 80, to sit around the house and relish the fruits of a successful writing career.  But, at some point, I’d have to do laundry, or go to the grocery store.  If I have dogs – which I honestly intend to have – I must take them to the vet periodically.  It is possible that, in 30 years, grocery shopping will be done strictly online with customers sitting at their computers using web cameras to analyze fruits, meats and vegetables.  I wouldn’t be surprised if the U.S. Postal Service – now fighting valiantly to stay alive and relevant – will be a memory in 30 years; akin to my paternal grandfather’s early 20th century carpenter tools.  But, could there also be a vet who makes house calls?

Twenty years ago, when a good friend of mine died of AIDS, I felt lucky to reach my 30th birthday less than two months later.  Before I knew it, though, the turn of the century came – and went – a rare milestone for most humans now.  I turned 40 just weeks before I marked my first anniversary with an engineering firm – and then came down with the flu for the first time in my entire life.  Now, the first decade of the 21st century is old news.  Yes, technology changes, but so do people.

I’m not a braggart.  I don’t live for the moment, or for mounds of attention.  I’m an introvert who prefers quiet spaces most of the time; a hermit, perhaps, but one who cherishes books more than booze and dogs more than people.  If we’re fortunate, we get to live to see 70, 80, 90 and so on.  But, for me personally, what does that type of future hold?

I don’t cry out, ‘What about me?’  I’ve moved beyond wishing for the adulation of others.  But, seriously contemplating my later years, I really do have to ask, ‘What’s going to happen to me when I get old?’

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