Another Sign of Social Decay: Seniors Alone, Unable to Care for Themselves

The Wall Street Journal has a sobering new article on a phenomenon that heretofore had gone largely under the radar: the elderly, or per US-speak, seniors, isolated in their premises and either too feeble and/or too cognitively impaired to take care of themselves. They are casualties of the progress of the market economy, which as Karl Polanyi described long form in his seminal work The Great Transformation, undermined social structures by commodifying labor, as in people, and nature. Although there were always individuals who still wound up in desperate circumstances and might wind up the mad person in rags begging in the town square, old people tended to be cared for by family members, often helping with child care and household tasks until they became infirm. Churches also would provide support for the poor and old who’d wound up on their own.

My uncle Dick was a borderline example of this phenomenon. He’d never made much money, and his wife divorced him after he became a lobsterman. His lawyer managed to present his gross income as if it were his net, leading to punitive alimony and child support relative to his earnings. He was also subject to severe depression, sometimes staying in bed 22 hours a day and finding it too taxing to see people (don’t even ask how many medications he tried; he was so desperate he even sought out electroshock). This was a genuine shame because he was one of the nicest people you would ever meet; he was the sort who would give the shirt off his back to someone in need.

Dick quit lobstering due to damage to his knees and diabetes ruining his balance. He lived below the poverty line in a house he inherited. The child that lived nearest was an hour away, so she could not do much. He got by due to having a close friend, Russ, who would make sure he had provisions, take him to the VA hospital as needed for checkups and care, and visit him often. He also had some people who knew him who’d drop by off and on. And he did odd jobs he could do at home to generate a little cash, like repair lobster traps and pick out crabs, so that also kept him in contact with people and gave him some structure. He also took up knitting; I have a scarf and headcap he made. But if you visited him, you’d see how difficult his situation was. His bed was in the living room, and his main activity was using the computer which was on the desk a short distance away.

When his friend Russ unexpectedly dropped dead, Dick went to a VA nursing home in a part of Maine well away from where he had lived. His daughter would sometimes take him out but he could stay away for only three nights; more and they’d have to put him through the intake process again. He clearly didn’t like being there; he didn’t get on with his roommate and the other residents would eat any nice food he got or was sent and had to store in a shared refrigerator.

At least Dick had lived in a bona fide community, had a family member in the picture, and was well liked. Too many seniors don’t have close relatives nearby, or even if they do, they often can’t provide the level of support needed. And even though there are agencies and private services that can help (short of the costly solution of brining in home health care aides or going to a facility), many, by the time they need help, lack the energy and organization to investigate options, make choices, and get in their various systems.

From the Wall Street Journal. Note the chart; I guarantee financial exploitation is grossly under-captured, since the main perps aren’t fraudsters who target seniors, but family members and caregivers:

Rising numbers of older adults are unable to care for themselves, often leading to serious health problems and even death, according to state and local government agencies.

So-called self-neglect cases generally involve the inability to perform essential self-care, such as providing oneself with food, shelter, personal hygiene, medication and safety precautions.

Seniors who no longer drive, for example, are often unable to get to medical appointments, exacerbating health problems that can render them incapable of caring for themselves. A fall can result in a hip fracture leaving one bedridden and unable to care for oneself. Failure to pay bills for the phone or other utilities could lead to service cutoffs. Forgetting to pay rent could lead to the loss of a home….

The reasons seniors stop caring for themselves vary, including illness, dementia, depression and poverty. The loss of the spouse or a neighbor who previously kept an eye on an individual often triggers a decline into self-neglect, experts say.

About one in four Americans age 65 and older, or 14.3 million, lived alone in 2017, according to government data, up 31% from 10.9 million people in 2007. Those age 60 and over spend more than 10 hours of their daily measured time by themselves, compared with less than five hours for people in their 40s and 50s, according to the Pew Research Center. Daily measured time refers to all waking hours except those spent on personal activities such as grooming…..

Experts say the key to reducing self-neglect cases is providing services to enable seniors to remain in their homes safely, such as reliable transportation for medical appointments and grocery shopping, as well as affordable home help with chores and regular monitoring.

Paige McCleary, Virginia’s Adult Protective Services Division director, said agencies in her state try to help older adults who are struggling with self-care by arranging for cleanups or finding home-care services covered by Medicaid.

But in a small number of cases in which individuals are determined unable to live alone, the agency petitions a court to place them in short-term guardianship.

Most seniors keenly want to stay in their homes rather than go into a facility, particularly since the ones that are non-institutional typically require large non-or-only partially refundable deposits ($500,000 is common) and have waiting lists. But managing caregivers takes some organization and firmness, and physically vulnerable people are often concerned about asserting themselves lest they get fired by the agency for being difficult (don’t kid yourself, I had an agency go into the “Maybe we aren’t for you” line when they seemed uninterested in their aides not performing basic required duties) or get assigned someone even worse.

Needless to say, some Wall Street Journal readers thought they had this all sorted out. For instance, from one David Hill:

Where are the adult children?

Why wasn’t a Durable Power of Attorney executed before the parents went into this downward spiral?

I set up a Revocable Trust years ago when I was in my early 30’s and executed the documents needed , Durable Power of Attorney, HIPPA and so on so that my two adult daughters can take over for me when and if I become mentally or physically unable to deal with life.

Copies of certain documents need to be given to physicians and others as needed.

Most of these can be obtained by, for example, the State of California.

For odd reasons parents refuse to deal with these issues. My ex-wife refuses to even disclose her assets to her children. Nixing these critical steps can wind up looking at the couple in this article.

Notice the assumptions? Money and children willing to and nearby enough to help. Legal agreements are only as good as the people involved in them. What if the kids are overwhelmed by illness, divorce, or a career crisis? What if the kids disagree about what to do? What if one of them decides to siphon money or property out…after all, they’ll presumably get some of it down the road anyhow.

And I love his naive faith in his documents. Hospitals reject medical powers of attorney all the time. I know a California lawyer who presented his father’s financial power of attorney to Wells Fargo, who said, “We agree that this is correct under California law, but we don’t care. We are sending our notary over and nothing happens until he signs our document.”

Lawyer replies, “He’s being loaded into the ambulance right now to go to a skilled nursing facility and I need access to his funds to pay the deposit.”

Wells didn’t care. (You might ask why the father was with Wells; his experience was that all the other banks were as bad and he didn’t want the hassle of moving accounts).

The father died quickly. The son got himself appointed executor with record speed. He marched into the branch and closed the checking account…a seven figure withdrawal.

Ed Johnson was more realistic by virtue of experience:

My first post began with: “Regrettably” because the cold, hard reality is that society will not devote the resources necessary for decent care.

My Mom had a room next to one occupied by the mother of the owner of a NFL team; sometimes I would answer her call button when I was visiting because the staff was so busy.

To provide decent care, CNA’s would have to be paid at least $40/hour + overtime + benefits and that would jack up costs to the point where only NFL owners and the like could afford the skilled care.

I was a one-man band and I did the best I could for my Mom, but I just could not handle the 24/7/365 care required by myself; she didn’t want me to try.

From my experience even the “best” facilities can be Dickensian at times.

For myself, the solution is to manage as best as I can as long as I can — eg today I plowed and fixed more fence.

When I can’t do that, then I’m going to check out rather than go to a facility.

Other people may prefer a facility; I respect that.

I wish there were better answers, but as I pointed out with my example from Italy, even things like public community centers for seniors would be a great help, but we don’t do that in individualistic/privatized America.

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  1. ambrit

    I agree with your observation that one big ‘driver’ of the decline in care for the old is the “Rugged Individualist” philosophy. My Mom shuttles back and forth between my two little sisters. Luckily, one sister married a fellow from a first generation immigrant family; Spain. He still embraces the extended family philosophy. The other sister never had children, but is very close to Mom. Her husband goes along with the idea. Both families are ten percenters. This is a factor. Non-high worth families would have to accept lower standards of living due to the resource sharing with the elder members of the extended family. The older cohort may have most of the money, but, as is often remarked, it is not evenly distributed.
    Couched in more political terms, extended family living is a small scale variety of socialism. Such is about as far from neo-liberalism as one can get.
    Personally, I agree with Mr. Johnson. If my old age is going to be forced into a ‘rugged individualist’ h— scape, then I would prefer not to participate.

  2. John

    My niece realized any inheritance she might receive from her parents would be eaten by the parasitic Christian facility where they thought they would be well cared for. She yanked her dad out of the $12K/mo dementia unit after realizing that this would probably drain the assets before her mother died. The Christian plan was to drain all the assets as quickly as possible and then get the survivors on Medicaid with a “promise” not to kick the survivor out. She is now building a tiny house for her surviving mom while there is still some money left and will care for her as required. She has cut loose from the Christian parasites just doing the neoliberal status quo. And they are not anywhere near as bad as the regular biz elder care parasites.

    1. bluefoot

      Care facilities (not just Christian ones) are basically money extractors. My siblings and I had to put my father in one (temporarily, thankfully) and the amount of financial information they required before they would even look at the application was insane – his bank statements, total retirement, latest assessment on my parents’ house, social security payments, Medicare/Medicaid plan info, supplementary insurance info, life insurance info (I presume so they would still get paid once he died) plus any info on anything he co-owned with my mother. They know exactly the maximum to which they can bleed you dry.

      We were really lucky in that once the acute need passed, most of his care could be done from home by the family, with a daily visit from a nurse. But we could afford it, I have a lot of siblings though we live far apart, and all of us found ways to take time off to be there. We also had a lot of community support since my parents had lived in the same place for 50+ years. And it was only for two years. We would not have been able to sustain it more than a few years.

  3. jackiebaass

    I’m old enough, 78, to observe how society has changed in my life time. Where I grew up a lot of the families lived on the same street.I would walk to visit my grand parents and aunts an uncles. I had cousins to play with. In my small town everyone knew all of the people. You could walk through anyones yard and even pick an apple from their apple tree. No-one ever complained. Often I left home after breakfast with a bagged lunch and just roamed around exploring the area. Supper was at 5:00 PM and it was mandatory to be home for supper. Can you imagine allowing a child today to leave at 8 and return at 5? All family members sat down and ate supper together. We didn’t have TV until I was 14 years old. Evenings were spent listening to the radio and playing cards or board games. My parents bought their first car in 1956 when I was 15. On Sunday we either went to visit relatives or relatives came to visit us. There were always extra people for Sunday dinner. In many households a grandparent, usually grandma, lived with a relative. Every year in the summer all of the family gathered for a family reunion. There were over 100 people in attendance. Our small town had a nice business district so people shopped in town.As jobs disappeared in our community people moved away. That was the beginning of the decline of our and other close family ties. Fast foreword to today. Mothers now work out of the home. Families often don’t sit down for an evening meal. Children move out of the area for job opportunities. My two children live far away and I only see them once a year. My kids have both offered to take care of me if necessary but I wouldn’t want to impose that burden on them. I have seen enough of nursing home so it would be a blessing to never end up in one. People wish for the day they are able. to retire. As long as you are healthy it’s great. Unfortunately health problems catch up with most old people. Then being old is no longer a great thing. I’m sure my life isn’t unique. I just wanted to share it so younger people might get a glimpse at the past. The so called good old days.

    1. hoki haya

      An invaluable account, thank you. Tears in eyes, by the end of reading it, I said to myself, “You mean, America used to have People in it?”

      It wasn’t until I was a young adult and had the good fortune to know some farm families in North Dakota that I experienced the sit-down-together meals and communal time afterward, all generations represented.

      Here and in many other parts of the world, it remains as you describe. In Yerevan, children roam freely, alone or in groups, until 10pm or later. The entire city is their neighborhood; they are safe, revered and in charge.

      Thanks again for your depictions.

    2. Amfortas the hippie

      that’s how we were until my grandparents died…the last of them lingered but turned faux newts crazy at the end, which was pretty unnerving.
      they grew up in the Depression and came of age during WW2, and benefited greatly from the New Deal.
      my grandads never forgot how lucky they were, and never got complacent about their privileges.
      my parent’s generation was/is the polar opposite….they embraced the neoliberal/neoconservative bootstraps/tough love selfishness that seems to be a generational trait…kick the burning ladder down with a benign smile and assurances that it’s for your own good…with the clock stopped in either 1995, or 1965, depending on the situation.
      i’ve seen my dad(live next door to my mom), my brother and one cousin in person over the last 15 years…dispersed and alienated from the rest of them.
      of course, i’ve played my part in the alienation…got tired of the holier than thou blacksheep treatment long ago, and moved way out here,lol.
      the understanding with my mom is that i keep her out of the nursing home(she’s 78)…and i use that gingerly when she gets out of hand, sometimes.
      i would love nothing more than for my boys to be able to either stay around here, or come back…if there were any opportunity, at all.
      there is not, really, unless they become teachers or coaches(assuming that public ed stays a thing in our society)….if things go as i foresee, they can come home and be yeoman farmers with dear old dad.
      my wife’s mexican american familia is very different….a lot of it due to poverty. they’re tight knit and help each other…but even here, the larger sociopolitical paradigm creeps in…since it’s the soup they swim in.
      interestingly, wife’s cancer has shocked them out of their bootstrapdom…at least regarding healthcare.
      not so much my family,lol….”just get better insurance…”

      1. hoki haya

        “tough love selfishness that seems to be a generational trait […]”

        for that and other passages, just, thank you.

      1. Amfortas the hippie

        that’s us…except we’re czechs and irish and mugwumps.
        the grandparents held it all together, even in spite of my folks’ divorce.
        they were all dead but one(who went fox news) by the time i was out of high school(i was the eldest grandkid), and it was like a quiet explosion.
        i’ve missed it ever since(ur-homelessness is a thing)…found an analog in wife’s familia…and hope to be able to create it for my own kids.

    3. JCC

      jackiebass, I’m 11 years younger than you are and essentially grew up in the same environment and town. It wasn’t perfect, but it sure was nice. I spent my earliest years in a large city when my father was “off to college” and even that had more “community” going for it than small towns today.

      But when I moved to my parents’, grandparents’, aunts’ and uncles’ small town, I remember thinking of it then like it was living in DisneyLand.

  4. hoki haya

    A much-appreciated subject and anecdote, thank you.

    Last week the head of the philology dept at one of the universities here and I were discussing her ailing and elderly aunt’s upcoming birthday. The family wanted to take her to a restaurant and celebrate it properly, but the aunt, who is cared for by another of her daughters, resisted the notion. The family modified the celebrations, understanding that it was better to sacrifice their own idea of what might bring her joy in favor of comprehending the state of her need and desire.

    I couldn’t help but contrast their inherent selflessness with how my aunts and uncles treated my beloved grandmother near the end of her life. Tho they moved her against her will to an assisted living place, she kept her cabin on a lake in northern Minnesota and I would drive her there anytime I could visit. If extended family showed up, they barely acknowledged her existence, more interested in getting on the jetskis and firing up the grill.

    My first living situation here in Armenia was renting a room in a flat owned by a woman with her ailing mother. Her mother’s decline required much effort to make comfortable, but as she said, “She gave me everything when I was young and helpless; it’s only normal we give our parents everything when they need us.” Any other way is unthinkable, unnatural and unhealthy, antithetical to the parent-child relation, is the given more here.

    One of my current neighbors is an elderly man who was a sniper in his time. He’s one of the few whose family is spread out in far distances, but it is so heartening to see how he is treated and respected, visited every day by his contemporaries and sought out by the younger men in the neighborhood.

    I think of finding my grandmother fallen out of bed again, laying helpless on the floor of her assisted living facility.

  5. OpenThePodBayDoorsHAL

    The good thing about the way we organize things is that the system can produce a few hundred people whose wealth is measured in the thousands, and even tens of thousands, of millions.

    The bad thing is the way we organize everyone else in order to achieve that outcome.

    1. Expat2uruguay

      I don’t think that producing great wealth for some of the members of society is a good thing. I think it’s evil. How can you hope to organize the great masses with the tiny leftovers after the big fish have gobbled everything? To have a decent Society, we have to stop producing big fish. Or were you making a sarcastic remark?

  6. Andrew DeWit

    From here in Tokyo, forgive my saying that extended family only gets one so far. The latest White Paper on the Aging Society (2019) indicates that of all the over-65s, those living alone were 10.7% in 1980 but 26.4% in 2017. Also, elderly couples were 16.2% in 1980, bu had doubled to 32.5% in 2017. As population declines, climate costs mount, etc, care for the aging has to contend with the need to maintain critical infrastructure (JPY 5.2 trillion in 2018), disaster risk reduction, etc. It is perhaps better, as the Japanese are already doing, to address all these issues (“crises” seems more apt) as a package via cross-sectoral policymaking institutions and well-funded programs. Some of the latter are disaster-resilient compact cities whose multi-function public buildings have the elderly housed with day-care etc services and within walking distance of shopping, recreation, etc.

  7. sd

    I’ve mentioned before that my mother lived with us. She was always fiercely independent. She’d been living in San Francisco and was still working into her late 70s. Rents there escalated, $ signs started flashing in her land lady’s eyes, and she found herself forced out of the apartment. There was no affordable housing to go to which meant leaving San Francisco which meant losing her job that paid the rent.

    She moved in with us. She had modest savings in a 401k and. IRA most of which would be eaten up 5 years later by medical bills. Social Security covered her phone, food, car and other needs but it didn’t cover rent. As her health deteriorated (cancer) she required assistance to get to appointments and run basic errands. My brother and I paid for a senior helper 1-1/2 days a week. It always boosted her energy for a couple of days after the helpers working days – in addition to running errands, it provided vital social engagement beyond our family circle. What would she have done had she not had children who could provide just that little bit extra?

    The United States has an absolute tidal wave of baby boomers on the horizon, and this country is ill prepared for what’s coming. The housing and transit infrastructure that should have been built in communities through out the nation is not there to care for them. There are not enough aides to staff housing even if they could be built in time. It’s a brewing disaster of epic proportions that once again, “no one saw coming.”

  8. iburch

    In a very individualised society, community caregiving looks quite desireable, and I agree that communal and social structures have been weakend far too much. But…

    Caretaking 24/7/365 in a family depends on sharing the burden – possible, if there are several or many children, impossible with industrialised societies’ birthrates since the 1960s. See, e.g. the huge and growing problems in China with its one child policy, where the first generation of single children is getting closer to retirement. Even if possible, still, there is a price to pay – and it will not necessarily be shared fairly, even among family. A greataunt of mine, born around 1900 in a family of, at best, smallholders in southern Germany, did not marry, partially due to lack of money and expectations. By default, she was assigned by her (married) siblings to be caretaker of their parents, with a livelong right to live in their parent’s house, but without financal independence and a chance of a family of her own, and was quite bitter about it all. Imagine being a vulnerable senior – is this the kind of care you would want to receive?
    A close-knit community usually takes care of its own – but how do we define “our own”? How much conformity does it take to belong and what about those that do not fit in? My mother, born 1940 in the same southern German village, tells me that moving to a larger town was the best thing she ever did. For her, the close-knit community was stifling – prevailing prejudices, because her greatgrandfather was born out of wedlock, her family trying to marry her off to a guy who had some fields to go with the farmhouse she was supposed to inherit, being treated as mentally deficient just because, due to some childhood illness, she was nearly deaf…
    In a community as well as in a family, your ability to obtain care will depend on the mercy or goodwill of others or your own leverage (aka money, inheritance). For me, I would prefer an additional saveguard in the form of a strong national safety net.

  9. rd

    Long-term trends are interesting. I think part of what is happening is that people are looking at a brief period of history when “The Greatest Generation”, the parents of the Baby Boomers, was just older than 65 and has termed it normal, when it is actually abnormal. An interesting graph is labor participation of men and women over 65:

    In the 1940s, men over 65 had nearly 50% participation in the labor force with a much shorter life span than today for numerous reasons. Basically, many men simply worked until they died. This participation rate dipped to below 20% in the 80s and 90s and has started to climb back up to around 25% today.

    Women in general had a low labor force participation rate and it has been steadily increasing for women of all ages since the 1940s.

    Life expectancy at birth started rising dramatically in the late 1800s in the developed world due to both reduced childhood mortality and improved medical care for adults.

    So we are now facing the challenge of an aging population with a much greater percentage of the population over 65 than before, greatly increased lifespans beyond 65, reduced social interaction because they are not working, and the dramatic reduction of people in agriculture means that families are more likely to be dispersed than before. This is a new challenge that has not been faced at anywhere near this scale at any time in history, so we are going to have to think it through. I expect it will be one of the key elements that will define social souls over the next three decades.

  10. Michael Fiorillo

    “For myself, the solution is to manage as best I can for as long as I can… when I can’t do that, then I’m going to check out….”

    We all hear, and find ourselves saying, variations on this theme, but there’s an inherent dilemma that is likely to trap most of us: while the conscious “I” recognizes the horrors of contemporary US-style “Elder Care” and rightfully seeks ways to avoid it, the Organism is often heedless of that and wants to continue living.

    As my mother started becoming increasingly feeble and depressed in her 80’s, she told my wife (though not me) that ,”I’m weaning myself from life.” (Great line, right?). But the Organism disregarded that, and she lingered on for years in a nursing home once it became impossible to care for her at home.

    1. pretzelattack

      good post. my late retirement plan is a gun, but as you say, it’s easy to postpone that decision (“now i’ll never know how game of thrones comes out”– or some such).

      1. Jus’Thinkin

        The real problem is by the time you are ready to pull the trigger you are too decrepit to be able to muster the strength to pick it up and pull the trigger.

      2. Wyoming

        Sometime back there was a fire at one of our towns assisted living apartment buildings. The entire on duty police force and a number of fire companies showed up to evacuate the building. I was assigned to keep an eye on a large group of the seniors who we had quickly moved to the far end of the parking lot. It was cold and windy and chaotic. I was constantly running after someone who was just wandering away and could not devote much time to any of them. One woman in a wheel chair who I had taken from one of the other officers at the door and run out into the parking lot kept telling me to just leave her in the building as she wanted to die in the fire. I naturally told her that was a bad idea and we would take care of her. I kept watch on her and she tried a couple of times to head back to the building. As I kept talking to her when I could I eventually got the story that she had been divorced for many years as her husband beat her, that all her children were dead (and that the last child had died just a few days previously on her birthday – yikes!). She said she just did not want to live. Like most folks would, I think, I did not really think what she was saying was a real threat or desire, but just grief and trauma. And I lost track of her in the chaos and forgot to tell anyone at the facility she was talking about wanting to die. A week later she drove her electric wheel chair out to the far side of the parking lot and shot herself in the head.

      3. Petr from Georgia

        My mother (75) came home early from dinner with friends to find my father (76 and hobbled with a litany of illnesses and predicaments that have left him near decrepit and in constant, excruciating pain) sitting in his car in the garage with a composed suicide note. He did not finish the deed as he put the pistol on the roof of the car when entering and lacked the will and/or strength to stand up and retrieve the pistol.

        It will be harder than most think to finally commit suicide.

        1. ambrit

          Have to agree there. That’s why pundits refer to many sorts of self murder as “deaths of despair.” Are humans hard wired to keep on if any sort of hope at all is left?
          Several of the commenteriat suffer from various forms of depression. Dealing with that alone is a full time “temporary job.” Personally, my deepest troughs occur during times of isolation. Having people around, just around, is therapeutic. Community can be a life saver. Often, communion is two.

        2. Oregoncharles

          Thanks to the initiative, Oregon has an assisted suicide law.

          Several churches circulated petitions to challenge it; repeal was rejected by a much larger margin.

      4. Tom Bradford

        Our TV news featured one of the passengers on the rejected cruise ship reporting that the ship’s pastry cook was keeping up everyone’s spirits, as death by chocolate seemed a better alternative to Coronavirus.

        Death by chocolate seems a better alternative than a gun, too.

    2. BobW

      You’re right, many people say that they would check out, but when it comes down to it almost everyone chooses life, as bad as it may be, it’s life. Anecdotal for sure, but my father was an example. He said one place was where you went to die (it was a hospice-like hospital), and he would never go there. But he did go, and did die there. He was not too feeble, with the exception of needing a walker.

    3. shinola

      I’ve long subscribed to a line from The Who song ‘My Generation’ from many decades ago:

      “I hope I die before I get old…”

      It just seems, though, my definition of “old” keeps moving.

    4. eg

      My father’s death was a blessing — a pancreatic cancer diagnosis for which he refused treatment and entered immediately into palliative care. Maybe four months total — enough time to arrange affairs and say his goodbyes: no dementia, no lingering, no financial catastrophe.

      Now we wait and hope that Mom will be so lucky … :(

  11. furies

    Pretty sure this is my fate. My feverant wish is to obtain the tools necessary to end the suffering swiftly and without suffering. (Would love some of that ‘pink juice’ veterinarians have…)

    My adult children only visit family members with money.

    It was a huge mistake to stay home when they were young (before the divorce). My Social Security check is tragically tiny.

    It does get lonely, but I have wonderful friends. Unfortunately, they’re old too.

    If these increased reviews for disability happen as planned, I will be unable to pay rent on my tiny cabin. The thought of being dependent on any friend’s authority, no matter how gentle, makes me extremely anxious. I’d rather they’d just send the black pill already.

    It’s eugenics, pure and simple.

  12. JTMcPhee

    I See Vulture Capital is getting into the death-for-profit business. “Investing” in hospice (ruining what in some places was at least a caring environment to die out of) and doing the cost-cutting and conglomerating. Pushing assisted-suicide legislation. Encouraging or facilitating “suicide tourism,” “Harvesting” body parts, from morgues, death row patients, hospices, and from people whose bodies were supposedly “donated to science” to help train new classes of physicians or for research, but as one person whose father was “parted out” this way said, “I guess we’ve gotten to a world where everybody just makes money off of everything,” :

    We aren’t quite to the point of “suicide parlors” and other euphemisms yet, a la “Slaughterhose Five” and “Soylent Green,” but hey, it’s just another way of “making money,” right?

    Is resistance futile?

    1. Calvin

      JT and Skip: Here’s an illuistration of what you are talking about:

      “Brius has repeatedly been fined, sued, and sanctioned by local, state, and federal agencies for providing substandard care to nursing home residents. According to the Sacramento Bee, Brius-owned nursing homes were “tagged with nearly triple as many serious deficiencies per 1,000 beds as the statewide average in 2014.” Families and residents have filed multiple lawsuits against Rechnitz and Brius for allegations including wrongful death and elder abuse. According to allegations in one lawsuit Brius chronically understaffs and under-resources its nursing homes in order to maximize profits.”

    2. ambrit

      The idea of Suicide Parlours goes at least as far back as Robert W Chambers 1895 book, “The King In Yellow.”
      Curiously, the idea is linked to social decadence, Mauve Decade style. History may not repeat, but is sure does rhyme.

      1. Monty

        Have you ever seen the film, “Children of Men”? I always thought that the drug called “Quietus” would be a big seller in the US, if it got FDA approval.

        1. ambrit

          Yes, I did. A curious plot to come from the mind of someone primarily known as a mystery writer. Society become one giant crime scene.

      2. neo-realist

        Suicide Parlours might become a thing with further cuts in the safety net for the elderly—medicaid, social security. Once you spend all your life savings on a senior care facility and don’t have any more money to pay for your accommodations, nor friends and relatives that can care and deal with you, suicide may be preferable to spending your golden years sleeping in a tent.

        Hopefully they will provide a menu of options, e.g., morphine drip, speedballs, etc.

    3. Kaleberg

      Kurt Vonnegut predicted ethical suicide parlors with purple roofs to match the orange of the adjacent Howard Johnson’s?

  13. Skip

    Long ago I was in the state AG’s office in Kansas. One of my tasks was reviewing and tightening new nursing home regulations.

    I was alarmed by how many of the complaints residents sent me were anonymous because of fear of retaliation.

    With no brothers or sisters, when my dad died I moved my mom from KC to DC, a great adventure for her. As she’d been with her dad long ago, and then with my dad, who was older, she was a major caregiver for my kids, including during a major medical challenge my son had.

    We were gifted with twenty-three years before losing her at 101. I was very aware of how the stimulation of a chaotic household, of kids growing up, and of her contributing what she could do to work around the house, energized her. When things got more difficult for her, as things always will, there was never a question of payback. Knowing her fear of institutions, one that I share, I shelved a number of pursuits the last couple years to be the main caregiver. I realize everyone’s situation is different, and in many respects we were lucky with my mom’s health and her example of perseverance through challenging times. But for those who are able to accommodate more time looking after a parent, there are rewards that are hard to quantify, particularly lessons of tolerance and awareness to young people in a household, and a sense of one’s continuity through time.

    I once interviewed a polio victim and former Senate staffer who was the steam behind the Americans with Disabilities Act. He told me I was one of the temporarily-abled. It’s not the most cheerful thought, but one to bear in mind when plotting one’s course.

  14. The Rev Kev

    Lots of great comments here and lots to think about and re-read. I’m thinking that the only way to cope with old age is to have an end to the idea of the nuclear family but go back to extended families and relations again which will be a tough sell. You see it at work in poorer communities because they know that it is a model that works against adversity and old age does come to us all eventually.

    The trouble is that there have to be a massive change of attitudes which will be tough. Here in Oz when parents get too old, many people stick them in an old people’s home and walk away. Saying that, I do remember the SKI clubs of the 90s in which SKI stood for Spending the Kids Inheritance which you saw on stickers plastered on expensive vehicles and camper vans. Pretty soon the bell will toll for them which gives me some satisfaction.

    1. Oregoncharles

      I’m one of 5 children (my wife’s one of 4). That was typical when we were growing up.

      Those 5 are spread literally from one end of the country to the other, with just one brother in our old home town. I certainly had no desire to live in Indiana. I suspect Australia, another pioneer country, is similar. It’s very hard to maintain either extended families (we all at least get along, but I’ve heard horror stories) or deep communities in those circumstances.

      1. The Rev Kev

        Same with my siblings being spread across the country and rarely meeting up. Now that both our parents are gone, I suspect that I will never hear from the eldest brother at all. It can be good when we meet up but the distances involved make that a rarity.

    1. Arizona Slim

      I considered a cohousing community here in Tucson.

      After five months of meetings, more meetings, and even a meeting about the meetings, I left the planning committee. I simply couldn’t take it anymore.

      In addition to the heavy meeting load, I noticed that the committee was attracting more than a few people who, shall we say, were high maintenance. I couldn’t help thinking that they’d run through every support group in town, and, hey, look! A cohousing community is forming! Perhaps it can give me what all those support groups couldn’t.

      I wound up purchasing the Arizona Slim Ranch instead.

      Later, I heard that the co-founders of the planning committee had a falling out with the rest of the group. They never moved into the cohousing community.

      Whew. More drama avoided.

    2. Oregoncharles

      There’s a successful co-housing community in my town – but only one. There’s also a commune of sorts right around the corner from it – that’s the “alternative” end of town. Not far from our place.

      Shorter workdays are definitely a good idea – granted that I’ve always been self-employed and could set my own hours; they get shorter as I get older. shorter commutes is a bigger challenge, but certainly desirable.

  15. Off The Street

    Welfare check, which is a visit from police or social services personnel, can be very helpful. The visit may involve breaking in to ensure the health and well-being of the person.

    Those commercials about I’ve fallen and I can’t get up only capture one of the risks. What if the solitary senior has a medical condition that needs routine attention and medication? Now ask how many seniors, perhaps with some hint of dementia or other impediment to normal cognitive function or mobility, are living alone and just don’t feel like or remember to take that vital medication. Insulin is one of those that demands regular usage to prevent many problems. Failure to stay on the insulin regimen can lead to death, or maybe just some brain fog and seizures that make one pass out.

    You see how easy it can be for senior, or anyone infirm, can fall through the cracks. Look around your neighborhood, talk to your family, notice who isn’t on your radar any longer. It takes effort but someone’s life might be at stake. I’ve seen it.

    1. ambrit

      I was involved in such a drama relative to our next door neighbor a few years ago. She was late seventies and fiercely independent. Her sons lived about a hundred miles away. Anyway, one day a door to door salesman knocks on the door and asks if anybody lived in that house.
      “Well, yes,” I replied.
      “Someone is yelling over there,” he says.
      It ended up with me “breaking in” to the house, (without breaking anything, the fruit of a misspent youth.) [Most windows are dead easy to ‘jimmy.’]
      Elizabeth was lying in a heap on the floor of her living room. She had fallen and hurt her leg and couldn’t get up. I opened the front door and let the other neighbors in. {Everyone is fascinated at the misfortunes of others.} We called the closest son, and he took the rest of the day off of work and drove over to coordinate his mothers ‘recovery.’ It was watching this process that drove home for me the essentially extractive nature of our societies ‘elder care’ paradigm.
      If the police became involved, they would automatically call an ambulance. Evidently, the word of a neighbor about the person’s wishes holds no weight. A family relative or “power of attorney” is required to make decisions. (Elizabeth had been down for several hours and wasn’t in exactly the most coherent of states.) So, calling the son was the right idea. We got her up and in to his car and he drove her to her family physician. There, he told us later, he had to fight with the admitting crew at the medical practice to stop them from calling an ambulance themselves to take her to an Emergency Room. (Each time, the patient is ‘responsible’ for the ambulance bill.) She was visibly not seriously hurt. She did not have any of the symptoms of serious internal damage. The admitting crew wanted to send her to an Emergency Room as part of “business as usual,” instead of letting the physician look at her first. The System was trying to take the place of the physician.
      The upshot of this was that Elizabeth was diagnosed with early Alzheimers. She ended up in a ‘nursing home’ three years later. As has been the case in several instances of this that I have been aware of, she lasted about six months. Once in the ‘home’ she just gave up.
      This tale of woe involves people with some assets to use in combating the ravages of ageing. I fear for all those who have no assets, which number is growing, both in raw numbers and in percentage of the population.
      So, yes, do indeed cultivate the interests of your neighbors. It will save someone’s life, and make living more interesting and worthwhile.

      1. ambrit

        I find myself in the curious situation of being a “Poster Child” for early Alzheimer’s symptoms.
        Looking over my comment above, Phyllis remarks that I have conflated two separate incidents involving Elizabeth next door.
        The first incident, she says I did indeed ‘break into’ the house, but, since the sons were so far away, Ed said to call 911. So, Elizabeth did indeed go to the Emergency Room in an ambulance. The sons ended up footing the bills for the co-pays and deductibles.
        The second incident, both being falls, Elizabeth was “all there” and herself refused to have 911 called. When Ed arrived, an hour later, the “drama” of the Family Physician’s admitting staff happened.
        Phyl’s judgement on this contretemps; “You are in sad shape. Better double your intake of B-12 and ginko biloba.”
        My take away from this; We never know when the decline sets in.
        Thank’s for your indulgence.

        1. pretzelattack

          just for another perspective, our memories are sort of stories we tell ourselves, and the older we get the more stories we have to keep track of–that’s what i tell myself anyway! . probably many of us are living lives of quiet desperation, i guess that’s inevitable in our society. i hope for the best for you and phyllis.

          1. ambrit

            Back at ya! “Quiet desperation” is code for low level depression I think. As I commented just above, community is a sovereign remedy for depression. Even physiological depression can be ‘blunted’ by friendly input from others.
            The human mind and body are still mainly mysteries. Add in the interface between the two, and we come up with complexity squared.

  16. Calvin

    It seems that two problems could help cancel each other out in certain circumstances:
    The elderly who are alone, weak and without resources,in houses that are too large to occupy or maintain, combined with the young who are gregarious, strong and without the financial ability to buy or rent homes.

    A young family moving in to a large home, maintaining it with physical labor, or construction skills, running errands, providing company and paying a modest rent, in cash of course, can be a godsend for some older people.

    Distant relatives might pay more attention to their parents when they realize that they *might not inherit the house* when the occupant finally dies.

    1. Wyoming

      Perhaps that solution might work out sometimes. But the potential for abuse or no actual care being provided in such situations would be very high. Who is going to be checking independently on the elderly in these situations to try and keep that abuse down to some ‘acceptable’ level? There is no doubt that the social services agencies cannot come close to taking care of needs now so there would be a big tax increase and govt hiring need to make any attempt to manage such types of arrangements.

      An additional issue would be that few young people in today’s world have the basic skills to maintain homes, the time, money, physical ability, or any desire whatsoever to be taking care of such kinds of elderly people.

      1. pretzelattack

        taking care of people in such circumstances is a thankless task indeed, and requires a social core of values i don’t think we possess, and a respect and admiration for the people who are caretakers, a social value to the role. lacking that, we pay people minimum wage to be responsible for taking care of the immediate needs of 10 or more patients, people they have no real emotional connection to. in the day there may be enough nurses, at night one nurse per locked dementia ward. religion in its day provided some incentive; i suppose across some groups it still does.

  17. newcatty

    Agree, Wyoming. Except, not quite clear on the necessary scenario of “big tax increases” as being so simple a solution for funding of extended social service agencies management. Reminds me of the talking points against M4All. To put in stark economic terms: how much is it going to cost to continue with the present methods to warehouse older adults in “care facilities”? If not of higher income means…why is forcing older adults on to Medicaid a solution? Why not be “smart” and include long term care, adult centers, home health care and good quality “assisted living” homes in a comprehensive health plan for all Americans?

    Another point that is often not discussed: Not all elderly adults, who need care or assistance, make it easy for their family members and friends to be caretakers in a live-in situation. IMO, its not realistic, kind or caring to ask an adult, whose parent was literally physically abusive or verbally, to care for the parent. The reality is that the adult child will often sacrifice their own mental and physical health when in those circumstances. Often, the abusive elderly parent will be a charming person to others, or will be lead to understand that abusive and disrespectful behaviors are not tolerated by staff. No way is any harmful behavior by staff the way to deal with the patient. In a world where so many of us are harmed by “life” , or others , then miserable elders may not be so.; until that is so, then there are complex factors to consider.

    1. CMF

      Yeah, that’s the boat I’m in. Mom was verbally and emotionally abusive for years. We’re heading into that final lap, she’s still in her own apartment, but 1000 miles away. People look in on her, she’s got a good support system, and a friend of my late brother has taken her on.
      But when it gets really bad, and she alienates everyone again, it’s going to be on my shoulders. And I’m afraid it’s probably going to be a nursing home on Medicaid. I’m determined to do what I can, but I also have to protect the life I’ve built from someone who would take it all/ruin what she could just out of spite and anger.

  18. fnx

    It certainly doesn’t help that there are no organizations willing to help with routine household chores rather than things like personal hygiene – or at least the kind that are supposed to exist for the low income and poor anyway. There are always companies you can hire if you have the money to spend. And when children live several states away, there is no way to coordinate all the different tasks involved with assuring someone is being taken care of properly.

    It’s not just the elderly that have this problem as many disabled people may have lost some support systems when they had to stop working. If you live in a large urban area where there are a lot of apartments and people don’t know their neighbors and you can’t get anywhere without being able to drive, you’re pretty much stuck.

  19. clarky90

    Years ago, at a dance class, I learned that my physical body, is my only home. (my only real estate investment, investment portfolio, house, retirement nest egg……)

    I am 70ish now. Many of my friends are obsessed with other things (not the physical/spiritual/emotional health of their bodies). They have “suicide” up their sleeves if their health becomes “unacceptable”. They brag about their plan, to all that will listen. (My 75 year old potbellied, millionaire friend (a wonderful person), confided to me, yesterday during our walk together, that he would take a chair on top of our local hill, and as the sun rose……blah blah blah. (Jack, give-up being a gourmand, and get rid of your huge pot belly before contemplating your grisly self-murder?). I will miss him if he does it.

    Over my lifetime, I have cycled through different dietary regimes; vegetarianism, fasting plus raw vegetables, gluten free, Atkins, SAD, Paleo, Keto, intermittent fasting and now, carnivore. I am always looking for a regimen that “works better”.

    So far so good. I am drug free and go to the gym for sauna, weightlifting and yoga, 5 or 6 days a week. (I am isolating from the gym right now, until more is known about the novel corona virus)

    Getting healthier is straight forward in this n=1, internet era. Fast for a week, or go carnivore (no plant poisons such as “Oxalates!” for a month (ruminant meat, salt and water), then add one new food every day while keeping detailed notes. If the addition of spinach (or dairy, beans, chicken, soy…..) results in your bone aching or your depression returning; don’t eat spinach……

    I do not plan to go into care. The “suicide” rubbish being normalized on discussion groups, is sad and disgraceful. No other creatures kill themselves and others, and then call it “kindness”. Everyone/being has their own appointed time to be born and then to die.

    1. pretzelattack

      nobody plans to go into care, they think they will be self sustaining forever. as one who has seen what happens to people on dementia wards, some of them lasting for years, i have no interest in going to those places. i am not convinced that somebody sinking into dementia, that can’t feed themselves or wipe themselves or remember their names and relative, is somehow better off living. add in abusive nursing home personnel in some instances, or simply neglectful ones, and families that don’t care. all the healthy food in the world won’t protect you against eventual deterioration, and there’s nothing that says that deterioration will be either quick or merciful.

      1. Joe Well

        Serious question: what is your plan then?

        I am trying to just maintain my health and hope I live until technological and societal improvements make aging more dignified. Or the world catches fire and it makes the whole thing moot.

        1. clarky90

          Hi Joe. My plan, when the inevitable starts knocking on my door, is fasting. One step further is short term dry fasting (no water). Our bodies can break down body fat into endogenous water. Much wonderful autophagy ensues!

          Autophagy is a concept that every old person should be a master practitioner of.

          Animals fast when they get unwell.

  20. RBHoughton

    I believe one danger that is not listed in the analysis is loss of the will to live. Pursuing that thought, a viable means of rehabilitating the elderly loner might be to do the student thing – facilitate his sharing accommodation with 3-4 others in a similar situation. Long ago, the British comedy author Kingsley Amis wrote a book of just such a group called “Ending Up” which probed the concept very fully and amusingly.

  21. Kaleberg

    This is a pretty old problem. In the 1920s, people proposed requiring adult children to take care of their parents. We got Social Security instead which is great if you don’ have any living children with resources to take care of you.

    It might have been easier when everyone lived on a farm, but that only worked for those who had kin who owned a farm. Tough luck farmhands, blacksmiths and so on. The usual recourse in the 18th and 19th centuries was the poorhouse, usually for profit and rather horrible. The family solution was sometimes like the one in Like Water For Chocolate, where the tragic heroine was the designated caregiver.

    Maybe we need more and better paid home health care aides. Maybe we need communities where one can survive without being able to drive a car. We actually can afford this, despite the usual billionaire whining.

  22. Joe Well

    >>as I pointed out with my example from Italy, even things like public community centers for seniors would be a great help, but we don’t do that in individualistic/privatized America.

    I am totally confused by this. How would “public community centers for seniors” be different from senior centers? There are over 10,000 in the US. At least here in Massachusetts, every town over a certain modest size seems to have one.

  23. Joe Well

    Talking with voters, it has astounded me that voters over 60 almost never have elder care, Social Security, and Medicare+Medicaid among their very top priorities. They are in denial.

    1. neo-realist

      I have a mother in law in a nice gold plated retirement facility in a suburban area who happens to be a bit of a lefty. She talks to many of her fellow retirees and finds that many of them support Trump and don’t believe that social security and medicare are under threat, yet many of them aren’t voting (good).

      That being said, your discovery is also quite shocking. Are these elderly well to do, with cushy pensions and or savings from having been at a good paying job w/o a layoff for decades? Jeez, I’m in that neighborhood age-wise and those issues concern me greatly; then again, I’m not wealthy.

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