a happy ending or bitter end?
TAKING CARE OF OUR ELDERS
by catherine vance

Have you had “the conversation” with your mother, with Grandma? Have you talked seriously with Aunt Sue? yet?

I’m not talking about the conversation where you tell them you are no longer a virgin. I am talking about the dialogue that mid-life women should have at some point with their older relatives. The one that starts, “Mom, what do you think will happen when you aren’t able to take care of yourself anymore? Where will you live? Are your finances in good shape?”

Of course, if you are already a wise older woman, as many of us are, the “conversation” may very well be in the form of: “Honey, sit down. I have been thinking about making some changes in my living situation ever since I fell down the basement steps.”

Typically, as women get older and develop disabilities or limitations, they rely first of all on a spouse, if they have one. However, women today outlive men by about six years, and 40% of functionally limited older women report receiving help from a daughter or daughter-in-law, according to a recent National Institute of Health study on women’s health and aging.

Still, while we plan for the births and the college educations and sometimes for the weddings, women’s plans for aging well are often incomplete or non-existent.
In my own family, I have seen the writing on the wall. Two of my aunts, Rita and Eleanor (not their real names) are both 92 years old. They are from different sides of the family and don’t know each other, but their lives followed parallel paths. Each woman left school by eighth grade and went to work in a factory. Each married and lived in her cute little house for over 60 years. Their husbands died years before, and neither woman has children of her own. (Rita never had any children; Eleanor’s only daughter died in her teens.)

Both women were very frugal, and in their sixties had started thinking about their final years. Both had pension income in addition to social security, both had been careful about their spending and had amassed savings that ran into six figures. Finally, both women had reasonably good health until they reached their 80’s.
Despite the similarity of their lives, things turned out very differently for Rita than they did for Eleanor. Rita wound up in a mediocre nursing-care facility without the bulk of her family and friend connections nearby. It was the situation she had most wanted to avoid, and when things fell apart, there was little that could be done. On the other hand, Eleanor’s apartment and inclusive nursing care provides her with an end-of-life quality that is very pleasing to her and her family. She has also been able to structure her assets so that the majority of them will be passed to her heirs.

Rita’s plan was this: she was going to stay in her little house until she died. Only one family member, a sister who was herself in her late eighties, even lived in the same city, so Rita arranged for long-time neighbors to be her caretakers. They would bring her food, check on her every day, take her to the hairdresser and the doctor, do her laundry, even handle her finances.
She trusted them, and in return for their aid, she would leave them her house and her car. Her life savings would be a gift to her surviving relatives, she told everyone, and she had noted in her will how she wanted her houseful of antiques to be distributed.

Always a quiet person, Rita hated to cause anyone any sort of inconvenience. Still, she reassured the family, she had an emergency call service that connected to the neighbor’s house—all she had to do was press the button on a cord around her neck, and the neighbor would be there at any hour of the day or night.
However, Rita had been diagnosed with Parkinson’s in her mid-eighties. She sat all day on her sofa, waiting for her meals and her medicine. Her social contacts were minimal and her mind, like her body, started failing. It was hard for her to get up and walk to the bathroom. Family members urged her to hire someone to stay with her or to think about moving, but she insisted that the neighbors were taking care of things.

Eventually, she had several falls. She broke her right elbow in one of them, and after that she had trouble feeding herself. One night she fell out of bed and hit her head on the night stand. The neighbor/caregiver found her the next morning in a pool of blood. When she was in the hospital, it was revealed that none of the arrangements Rita had told the family about had been legally documented. Rita was no longer competent to make her own decisions, and she didn’t have a medical power of attorney, and her life savings were still in her own name. There was nothing in writing to say that her house would go to her neighbors, and well, the neighbors couldn’t handle this situation any more. When Rita got out of the hospital, her eighty-seven year old younger sister placed her in a nursing home. Her house full of antiques was closed, and her life savings gradually drained away paying for her care.

Eleanor’s plan was crucially different: she was going to stay in her little house only as long as she could. She was a gregarious person—she loved to go to church, shop, attend family parties, and talk on the phone, and she had friends who were willing to drive her to appointments or to the grocery store from time to time. However, she realized that it was getting hard for her to function when she was alone in her home. She could no longer bake cakes and make fried chicken as a way of thanking people for the help they gave her.

A couple of years ago, she’d had her first fall. And her memory was getting scattered. When the time came, she had asked her niece to help her sell the place, and she would use the money to go to an assisted living facility. She had thought about staying in the house and hiring a part-time caregiver. But who would have thought that her little house would appraise for over $200,000! She and George had built it for about $6,000! Sure, it was great to be at home with all the “things” she was familiar with, but honestly, she was looking forward to moving. She had heard that there was a movie theatre right in the assisted living building, and her friend Pat said the food was excellent!

She’d already put the majority of her funds in a relative’s name for management. Eleanor had set up her will, power of attorney for healthcare, and living will long ago.

On her 88th birthday, she decided she might as well go ahead and make the move—at her age you never knew what might happen the next day. Well, she hadn’t been in the new place three months when she had a tiny stroke. They took her right to the nursing wing for a couple of days, then she was back in her little apartment, staying in bed and listening to her favorite soap opera. It was like having a private hospital room and being at home, all at the same time.

Things can end well, and Aunt Eleanor continues to thrive in her new community. Aunt Rita, who was always so loving and helpful to everyone, passed away in December. Despite the way things turned out, I think she would be glad to know that her story ultimately helped women, whether care receivers or care givers, with some important choices.

A WINDOW ON RITA’S WORLD

It is lunch time at Mountain Care Village, and Rita is on her way to the dining hall. She inches her wheelchair down the linoleum hallway with the tips of her tennis shoes. There is a cart of dirty bed linen blocking her way and she can’t maneuver around it, so she stops and waits for someone to notice her.
“I’m thirsty. Can you get me a glass of water?” a woman in one of the rooms calls, over and over. A country-music video is blasting from the community television by the nurses’ station, and the CNAs are busy putting terrycloth bibs on everyone and unloading trays of puréed food.

Finally, one of the attendants sees Rita and wheels her in for the meal. “Where can I put you, sweetie?” she says. “Oh, here’s a spot beside Mr. Smith.” Rita looks around the table at the circle of residents in their identical bibs. Mr. Smith can’t keep his hands to himself—he plucks at Rita’s sleeve and smiles at her with his far-away smile.

RITA’S MISTAKES

~Refused to give up her independence; kept an inflexible vision for her future

~Tried to save money

~Did not modify her house in order to extend her residence there

~Kept accounts in her own name

~ Did not insure that documents reflecting wishes were legally executed; operated on “trust” system with a single caregiver

~Hid her difficulties from family members and friends, didn’t share information


A WINDOW ON ELEANOR’S WORLD

It is lunch time at Lake View Assisted Living, and there is a knock at the door of Eleanor’s efficiency apartment.

“Hi there,” says the CNA, Tracy, letting herself in. “Don’t you look great? Did you have your nails done?” Tracy admires Eleanor’s new burgundy polish and exclaims over the emerald ring that the elderly woman always wears.

“I’m meeting my niece for lunch,” says Eleanor. “That’s great,” says Tracy. “I think they are having a choice of either broiled mahi-mahi or stuffed chicken breast.”
The elderly woman struggles out of her easy chair and reaches for her walker, but it’s all right. The CNA is there every step of the way. Tracy locks the door and escorts Eleanor down the carpeted hallway to the elevator. Eleanor moves slowly, taking time to look at the paintings on the walls as she goes. Her favorite is a landscape of a farm. “My father grew lots of vegetables when I was a child,” she tells Tracy for the tenth time. Tracy smiles.

Downstairs, the dining room’s wall of windows lets in sparkling light from the lakefront, and there are flowers on all the tables. Eleanor hears the soft clinking of silverware and water glasses. “Hello Aunt Eleanor,” her niece says.

ELEANOR’S SMART MOVES

~Consulted with younger family members about her situation, partnered with them
to establish management of her financial and medical affairs

~Maintained a strong social network in the area where she lived

~Acknowledged probability of change to her living circumstances and made a plan

~Transferred accounts to the name of a trusted relative in order to protect assets

~Chose safety and dignity over independence in the end

~Sold her house and picked out an assisted living residence before a crisis came


FAMILY PLANNING

Gayle Doughton, a long-term care master specialist for Genworth Care, says there are really only four options to consider once people need outside help, custodial care, or assistance with daily living. “The person can pay for his or her expenses out of pocket, what I call the U-Do-It Plan,” she says. “Or, children or family members can pay. Medicare or Medicaid can pay for some of it, or, the last option, insurance dollars, paid in advance, can be used. The hard thing is there are different levels of care at different prices. What people don’t realize is that, with planning, even individuals of modest means can have a care situation that satisfies all concerned.”

U.S. News and World Report (5/21/01) notes that a private studio apartment runs about $27,000 a year, which is less than two-thirds the cost of a nursing home. Who would choose Rita’s scenario if Eleanor’s was available at a lower cost, and without endangering the bulk of her resources? “I can’t take it with me, so I might as well give it away before I go,” is Eleanor’s point of view. Family members may resist interfering out of fear that their motives may be misconstrued.

“I wish now that I had not been so concerned about stepping on her ‘independence,” said one of Rita’s sisters. “I volunteered to help, but she didn’t want to come and live with me. She even refused my help with documents. I believed her when she said she had taken care of things.”

“My interest, first and foremost, was for my aunt’s health and well-being,” said Eleanor’s niece. The trust we have between us is important, but we still made things legal.”

Some things family members can do include:

~Insist on a change of situation if indicated by pertinent factors such as inability to perform daily tasks, routine challenges to personal safety, or nutritional deficits

~Ask for copies of documents, lists of accounts and medical powers of attorney and wills, or insure that they are on file with a lawyer

~Be vigilant about health care and behavioral issues that influence decision-making

~Educate your loved ones about the need to transfer personal or joint accounts to a trusted relative or guardian well before nursing care begins

~Be aware that personality does matter—quiet or introverted relatives may need more of a push than outgoing ones

~Start conversations about end of life choices before a crisis happens; look at options ranging from home health care to assisted living