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Senility and Disability: Your Plans?

As a full-time caretaker for a senile old woman, I’ve come to realize that there are some very important questions which everyone should ask… and which very few do ask.

It all boils down to this single question: What do you want out of your elder years?

I’ve noticed a tendency among people from a variety of backgrounds to treat elderly persons with fading minds much as they would treat toddlers. Essentially, the person’s individual free will is not respected to the same extent as tha…

  1. Aaron Miller
    Crow’s Nest

    But I do think at a certain point, a person ceases to be productive in the simple sense, and becomes instead contemplative. To be productive through one’s contemplation is a great and fruitful achievement in those years where other capacities wane, provided one is fortunate enough to retain one’s mental health and enough physical strength to convey contemplations.

    Ever more people live until they can neither move nor think. It is certainly difficult to know what to do near and around such circumstances.

    Yet I am given pause by the fact that no loving parents would throw away their newborn babe’s months of helpless and unproductive life even if they knew the baby would not survive beyond those precious months. They love the child not just for who he or she might become but for who that child already is, even without any self-awareness or communication.

    Life and love are truly mysteries.

  2. Aaron Miller

    I almost forgot. Everyone should also consider their expectations of privacy in old age. There might come a time when your caretakers want to keep an eye on you via a baby monitor. Or they might just call you night and day to check up on you. Is that acceptable?

    I moved in to take care of my grandma after she took a fall, broke a hip, and was not discovered — in pain and helpless on the floor — until many hours later Her sons swore she would never be left unattended again. 

    When you are old, would you accept occasional experiences like that — painful, helpless, embarrassing — in exchange for general independence and privacy?

  3. raycon and lindacon

    We have always talked openly about the eventuality of death to our son and daughter.  They have both been raised with the understanding that they will be responsible for our daily care should that ever be necessary.

    Our son lives here in Colorado, and is in our life frequently.  His wife requires care because of her medical condition, and his marrying her and committing his life to her care is our evidence that he has learned well.

    Our daughter is a trained care giver for the mentally failing elderly, and her husband is a pastor.  They live in New York, but speak often about relocating back to Colorado should we ever need them.  We, ourselves, spend some of our days with elderly people reaching the end stages of their lives.  So much of our lives are lived as an example to our children that we are confident that we will not want of care if ever needed.

    Our children are very aware that quantity of years is not a measure of a person’s life.  It is the quality we bring to our lives now, that is the evidence to our children of our expectations in those last years.

  4. raycon and lindacon

    Aaron;  You have honored God by your commitment to your grandmother’s care.  We have sought to also honor God in the same way, and our children understand the significance of this goal in our lives.

    As for the questions regarding the intimate care giving decisions that they may someday face, we expect to be treated with the same dignity that we display in our own lives.

  5. Nanda Panjandrum

    Awed and uplifted by this, Aaron!  You seem to have struck a beautiful balance here…I, too, am blessed with caregivers who *respect* and *expect of* me…Sirach/Ecclesiasticus [Chapter 3] has much to offer here.  Prayers for you and your grandmother!  God bless you both!

  6. civil westman

    A wistful and yet hopeful essay. In our times, memento mori is insufficient. We must also be aware, as Aaron reminds us, that many of us are likely to spend substantial time at the end of life dependent and inescapably aware of our personal powerlessness.

    As a medical student, an ethics lecturer told us that with age and disease individuals and their values change. Self-centered, young and healthy, I could not understand. I thought that who I was was immutable. Now, at 68, I do understand. Situations once unacceptable in my mind have become a new baseline for living.

    The discussion reminds me of the wisdom of extended families living together. This allowed for elderly and infirm members to have the full-time presence of loved ones; to be and feel useful; to live in one’s generational season. Modernity and the dissolution of families, for the moment, have made that a rarity. Perhaps new economic realities will reawaken the wisdom and humanity of such extended families.

    “Time, like an ever rolling stream, Bears all its sons away; They fly, forgotten, as a dream Dies at the opening day.” -Isaac Watts (Psalm 90)

    Only love can answer the questions.

  7. 3rd angle projection

    This is an important topic and is only revealed to those in the middle of it. I didn’t think about until my dad died in July 2011. My mom has a touch of Parkinson’s and can’t really live alone. Fortunately, I was in the position to move in with her and look after her.

    Long term care coverage is important. My parents started paying for it in the early 2000′s.

    Before you get there, you will need to understand that it will be hard. Mentally and physically.

    As I see it, once there, you will need to understand that your life is no longer your life. You will need a strong faith and spiritual life. You will know humility.You will become dependent on someone for most everything. You will need to work hard to keep any physical abilities. You will need to take the joy out of small things. You will need family to be around for company and laughs. You will need someone you can trust for financial management.

    For those with elderly parents, you will need to understand the phrase, “Honor your mother and your father.”

    The mortar for these bricks is love.

  8. Tom Lindholtz

    Aaron, your encouragement to think about this and develop a plan is very wise advice that all should heed.  Perhaps my parents’ greatest material gift to my siblings and I was their decision in their early 70s to sell their home of 48 years and move into a “continuum of care” retirement community in their home town.  They considered a similar place in a VERY nice setting — Santa Barbara, for those who are familiar — but opted wisely to remain in more accessible and familiar surroundings.

    Mom broke her leg and was dead in two months.  But she simply moved into the skilled nursing area and Dad could walk over to see her each day.  Dad’s heart began to fail — a 17-year old valve job stopped working — and he, too, moved into skilled nursing and was gone in a month.

    In each case we knew that they were very well cared for.  We could visit them easily each day.  But we could also take care of responsibilities to our own families without worrying about either parents or children being neglected.  When you plan to execute such things is optional.  That you plan is not….for love’s sake.

  9. Mama Toad

    Beautiful post, Aaron.

    Another thing to consider in terms of elder care is religious practice and community.

    My parish church is very close to a nursing home, and volunteers from the Legion of Mary frequently take residents to Mass and the priests and deacons visit regularly on a rotating basis, but the opportunity for many patients with dementia and other long-term care issues to worship in community is sadly lacking.

    We do what we can towards bringing Catholic culture in — my family comes weekly to say the Rosary. The residents don’t just love praying the old familiar and comforting prayers of the Rosary, they eat up the children with their eyes, especially my youngest, who hops around the room, scootches across the floor on her tush, shows off her lovely umbrella, or sings a song with her older brother.

  10. Aaron Miller

    Another option for dealing with one’s own old age is to share one’s home with a friend or family member of a similar age. But, like so many aspects of old age, this requires humility and tolerance. You must be willing to relinquish some privacy and control over your home.

  11. skipsul

    My grandparents are the perfect case study of what NOT to do.  Early retirement on a pension + SS as the only income, wiped out savings, clinging to stubborn independence long after they lost the ability to care for themselves, never discussing the inevitable with their children.  Also open hostility to offers of aid and support, coupled with continued exacerbation of old wounds and hurt feelings.

    My parents and aunts sacrificed much to soften the closing years, little of it appreciated.  The old house had deteriorated to wrack and ruin by the time they had to be moved to a nursing home.

  12. DocJay

    Good advice.  

    I’ve pulled three drivers licenses this year.  Joy.  Men handle this much more poorly than women, some so poorly that you must make sure they don’t suspect their spouse was complicit.  

    Our senior drivers should have mandatory driving exams past 80, maybe 75.  

  13. Foxman

    I plan to … uhm. What was the question?

  14. Amy Schley
    skipsul: My grandparents are the perfect case study of what NOT to do.  Early retirement on a pension + SS as the only income, wiped out savings…  The old house had deteriorated to wrack and ruin by the time they had to be moved to a nursing home. · 12 minutes ago

    One of the saddest things I do in looking at real estate appraisals are the ones for reverse mortgages.  Essentially, the “borrower” sells their free-and-clear house to the bank in exchange for a monthly check.  So often you can see the accouterments of a life well lived, but also the long deferred maintenance as they’ve simply been unable to keep up the place on their retirement income.

    One recently really broke my heart … a small house in Alabama.  The appraiser couldn’t complete the appraisal on his first trip because the house, though clearly occupied, didn’t have power or water.  She was hoping for a “loan” of $75K; the house appraised for $30.

  15. Aaron Miller

    Doc, I hear of a woman in my area who is practically blind and still driving. I have tried my darndest to impress upon her caretaker that they must take her license by force (legally, or by destroying her license) and not defer to her will, because the lives of others are at stake. The caretaker reminds me that she would be furious. So what!!

    This old lady also lives in filth —  not just dirt, but soiled clothes and scattered garbage. Yet the daughter, who has the power of attorney, will not take the necessary step of forcing her mother into managed care. There must be options for the poor in such circumstances, right?

    Thanks for sharing, skipsul.

    That my grandma has a cheerful, meek and self-deprecating personality makes care of her much easier than it might be otherwise. I don’t assume that my capacity to endure these challenges with her means I am strong enough to endure them with anyone else.

  16. DocJay

    Aaron, you can report her to the DMV. Clearly the caretaker/daughter is more concerned with other issues than public safety. This is a common issue.

  17. Joseph Paquette
    DocJay: Good advice.  

    I’ve pulled three drivers licenses this year.  Joy.  Men handle this much more poorly than women, some so poorly that you must make sure they don’t suspect their spouse was complicit.  

    Our senior drivers should have mandatory driving exams past 80, maybe 75.   · 1 hour ago

    Self driving cars (e.g. Google car) will solve this one problem before you or I need to have our license pulled.   The automony of still being able to get around will be a luxury. 

  18. Joseph Paquette
    Aaron Miller: Doc, I hear of a woman in my area who is practically blind and still driving. I have tried my darndest to impress upon her caretaker that they must take her license by force (legally, or by destroying her license) and not defer to her will, because the lives of others are at stake. The caretaker reminds me that she would be furious. So what!!

    This old lady also lives in filth —  not just dirt, but soiled clothes and scattered garbage. Yet the daughter, who has the power of attorney, will not take the necessary step of forcing her mother into managed care. There must be options for the poor in such circumstances, right?

    Thanks for sharing, skipsul.

    That my grandma has a cheerful, meek and self-deprecating personality makes care of her much easier than it might be otherwise. I don’t assume that my capacity to endure these challenges with her means I am strong enough to endure them with anyone else. · 23 minutes ago

    Most states have a Department of Public Safety that allows anyone to register a concern with senior drivers, check the web for your state. 

  19. BTConservative

    Thanks for sharing this.  It’s a tricky situation which we are in with our grandparents now.  I completely respect and understand giving adults their independence and dignity, but that’s hard when you worry about the safety and fragility of their day to day business.  Our grandparents are determined to stay in their home, and continually say, “we don’t want to be a burden” without asking for what they need from us.  One thing I learned from them, though, is to make sure that in home care/long term care coverage is a part of the insurance package, if that’s something you foresee.

  20. Very neat post.  It reminds me of the joys of being young — when these insoluble challenges were someone else’s problem.  But each of our turns comes in time.

    In my case, I’ve observed the decline and death of my grandparents, with a generation ahead of me to bear most of that burden and soften the blow, and my parents’ day is coming.  Not now, but not so far away that I can no longer see or imagine it.

    Happily they can too and it is my good fortune that they have developed the wisdom to at least discuss their views and their wishes with their children, to begin to share information about their assets, insurance policies, etc., but most importantly to share views of what they consider a life worth preserving and how they hope we will respond when they are in extremis.  Ultimately mortality will catch us all, so that is all we can really ask of them.

    Again, beautiful post.  A subject always worth spending some time dwelling on.

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