November 28, 2019 by Jean
Since I last posted here about my friend with the degenerative illness, my life has been taken over by a health care crisis that she has fallen into (literally: she seems to have fallen out of bed). My involvement began when I got a phone call from the hospital ER on Halloween morning. Hours of imaging and evaluations revealed no injuries that would warrant hospitalization, but her level of cognitive confusion and physical deterioration argued against discharging her home. In the end, the hospital kept her overnight “for observation,” while I worked with the social worker there to arrange a temporary placement as a private-pay patient in a rehab facility until more permanent arrangements could be made. I am now hard at work on trying to get her accepted to and moved into an assisted living apartment before the serious winter weather sets in.
One of the advantages of being a teacher is that you can find a silver lining in just about any crisis by treating it as a “learning experience.” Here is what I’ve learned in the past month about the challenges of aging alone:
- Those who are aging alone have a special responsibility to plan ahead; we cannot afford the luxury of denial. When I expressed my frustration that in the several years since my friend’s diagnosis with a disease that was surely going to get worse, she had done nothing to plan for the day when she wouldn’t be able to manage alone at home, she said “Well, it was hard to wrap my brain around the reality of it.” She had some vague idea that she would be able to continue living alone in her big two-story house with the help of aides, but she never took a clear-eyed look at the costs (about $250,000 a year for aides 24-7).
- Health care organizations and providers are largely oblivious to the constraints and needs of those aging alone. If you are aging alone, you need to repeatedly bring this to the attention of your health care providers. At one point, the ER doctor was planning to discharge my friend home, and I had to dig in my heels and insist that this was not a workable plan. I think they assumed that there was a family member who could drop everything to take her home or move in with her and provide care. On several occasions, providers who were speaking with me on the phone (the hospital social worker, a nurse at the doctor’s office) referred to my friend as “your mom” or “your mother.” There seems to be a widespread assumption in health care that every elderly person has a daughter who will do the heavy lifting when care arrangements need to be made.
- It is very difficult for someone who is not normally involved in the details of your financial life to step in and take care of getting bills paid. Although I have my friend’s Durable Power of Attorney, it has still been difficult to get information about what her normal bills are and how she pays them. After a particularly frustrating day spent trying to get a handle on this, I sat down at my computer and typed up a single page of “essential financial information” for my younger sister (who is my emergency contact). It includes the password to my computer (where all my financial records are kept), a list of institutions where I have accounts, a list of my regular sources of income and when and how I receive them, and a list of my regular bills with information about when and how I normally pay them. I’ll print this out and put it in an envelope with a key to my house to give to my sister when I travel south to visit family over the holidays.
- There are limits to friendship as a support system for those aging alone. Regular readers of this blog know that I am a strong advocate of developing and maintaining a rich and extensive friendship network that you can call on for help in times of need. My friend did this for most of her adult life; she was outgoing and generous in her willingness to help others, and she made friends easily. But as her illness progressed, that friendship network shriveled. Once she stopped driving (about five years ago), her ability to maintain friendships by getting out and doing things with people declined; this took a toll especially on newer and more casual friendships. But older friends also had difficulty hanging in there. Some, I think, were not ready to face the intimations of their own mortality in my friend’s situation. Her tendency toward negativity also made her an increasingly difficult person to be around. As my friend’s cognitive abilities deteriorated, she also declined invitations and isolated herself as a way of hiding that deterioration. In recent years, as she made greater demands on the friends who were left, some stopped returning her calls. By the time we reached this crisis, there were only two of us left to pitch in and help – a devoted friend who has been going to her house every day for the past month to care for her elderly cat, and me.
Of the lessons I’ve taken away from my friend’s situation, this last one about the limits of friendship has been the hardest one for me to take on board. Developing and nurturing an extensive friendship network has been my primary insurance against the vicissitudes of aging without a life partner or children or family nearby. I need to do some hard thinking about how to create a safety net for myself when that network is not enough. Until then, I remain thankful for my friends and committed to trying to create a world that is supportive of those aging alone.