Looking for a Senior Living spot for a parent or friend – maybe even for yourself? Here are a few tips to speed the process, in these upside down times when you can’t simply go visiting.
Where to start? There are almost as many varieties of Senior Living as there are seniors on park benches. Or there were, when people could go to parks. The site to which I’ve directed more geezer friends than I can count is A Place for Mom. (Why is it always mom? Well, sorry dads, but we seem to outlive you by a long shot.) This site, though, has a wealth of short-form information to help you home in on the sort of place you’re looking for.
After the basics – cost, location, availability etc – all you need to consider are the three F-words. The promotional stuff really doesn’t tell you about the F-words. In essential order of importance they are:
Food. Interest in food increases exponentially with age. At my own geezer house (call these places what you will, I call mine the geezer house) we have a four-star chef. Presumably the salary and benefits here are good, because the job has to be about as much fun as being a Trump appointee. Somebody wants ethnic, somebody wants more garlic, somebody else wants bland and tasteless. Too much spice! Not enough dessert variety! More light choices! You get the picture. So ask about the food. Ask whether there’s an onsite chef or an outside food service. If meals are contracted to a supplier, you or your geezer friend/relative may not love the food. Weekly entrées repeated throughout the month? Not wonderful. Get specific with your food questions.
Frivolity. Almost everywhere promises eternal happiness through crossword puzzles and arts-&-crafts. Almost everywhere advertises elegant-looking dancing couples. Don’t believe it. Ask for pictures of the onsite library. Ask about the fit with what you or your geezer enjoy: Symphony & opera – assuming we eventually get those chances? Find out if the facility has regular transportation to such events. Nature walks? Find out if there are arrangements for hikes or offsite exercise. Socialization? Find out what the real opportunities are, not what the pretty pictures in the brochures suggest. Preferences about all of these don’t magically change on moving from a regular neighborhood to a “senior community.”
Fire drills. Every city or county has safety regulations. Equal parts important and invasive. Once you move into a geezer house your safety is in its hands, and it’s not always pretty. Ask for details. Some places (mine included) have unannounced fire drills. As far as I know, no one has ever died of a heart attack by being blasted awake from a nap by the most god-awful shrieking noise you’ve ever heard, generally followed by instructions to remain calm. But I’ve come close enough that we now have an agreement that they alert me ahead of time so I can arrange not to be at home. Try to find out what invasive procedures are in place for staff to enter an apartment without prior permission. It may well be necessary (Is Mrs. Jones OK? She hasn’t been seen today . . ) but it’s one more major change to face, and geezers don’t do change any better than the next person.
Here’s to the day when we all emerge from virus hell, and explorations in real time render a focus on the Senior Housing F-words unnecessary.
“Six die, 53 ill at nursing home,” reads the San Francisco Chronicle headline. It follows a similar, recent headline, “Coronavirus: 27 test positive at Orinda nursing home,” and seemingly endless others: “New cases in Alameda County facility,” “Another death at Gateway Manor”. . . These are the sorts of headlines that the management of my particular senior housing community most fears, and that strike a little dread in the aging hearts of my neighbors and myself. I live in a 12-story assisted living building near downtown San Francisco. It includes some 90 apartments housing singles and a few couples with a median age of, say, 87. That is a random number, chosen only because it puts me in the younger half. I generally refer to our place as the Geezer House, but the marketing materials use slightly more refined wordage. Those materials do not lie: this is not the ritziest senior living place in town, but it would fall in the “upscale” category.
There are hundreds of senior living facilities in the San Francisco Bay Area, ranging from minimum-care to rehab to lifecare to nursing home; all of us are, to one degree or another, the scariest target populations for COVID-19’s quiver of poison arrows. At the center are the nursing homes, source of the horror stories that seem to increase daily; my community is somewhere around the second ring out from the bullseye. Though we are somewhat less vulnerable than nursing homes, if one COVID-19 virus particle managed to sneak into our building it would be Katie-bar-the-door. We’ve had practice runs, with flu or norovirus, but those moved in slowly, two or three new cases per day until the mini-epidemic retreated. With COVID-19 we’re staring down a mystery virus that, in neighboring senior facilities at least, seems to move in and take over in a blinding flash.
Extreme measures are underway to prevent that from happening in my building. Think San Quentin, but with better food. We began with Mayor London Breed’s shelter-in-place decree on March 16; this being San Francisco, Mayor Breed got a three-day jump on Governor Gavin Newsom’s March 19 statewide order. Life in geezer houses took a sharp turn toward confinement at that point. I encountered the new reality head-on when innocently heading out to drop some mail in the box across the street. “If you step out that door,” my friend the concierge remarked, “you must first sign this document.” He handed me a paper declaring that I “understand that by departing (the facility) I am violating Public Health Order No. C19-09, enforced by the San Francisco Police Department” and that I “may be excluded from (the facility) and not re-admitted.” I thought better of mailing my letters.
There is a stillness here. Sometimes it’s eerily pleasant, the silence broken by birdsong in nearby trees. But often it is ominous. Having worked as a hospice volunteer and with other end-of-life organizations, I know the sudden stillness that is death, and others here have experienced it when losing a loved one. So here we are, in a place where most of us have come planning to stay until we die – and we’d just prefer not to be thinking about it in the middle of a pandemic. Listening to the stillness, watching the quiet streets no longer bustling with cars and people – manages to equate with death and become just a tiny bit stressful.
Life in confinement turns out to be something for which many of us were remarkably ill prepared, and there’s little comfort in knowing we share that woeful lack with millions of fellow citizens and certainly the Trump administration. Comfort is in short supply under social distance guidelines. Most of us here were children during World War II, memories of which have a certain nostalgia: there was shared sacrifice then too, but it felt noble rather than resentful. And there were Mr. Roosevelt’s fireside chats.
I don’t remember the first of these, which was given a few months before I was born, but I well remember some of the last, during the war, when we’d gather around the big Philco radio to hear that deep, cultured voice. Grammatically perfect, unfailingly calm and reassuring. It’s hard not to yearn for such a voice when listening to our current president’s egotistical bombast and vulgar, vicious divisiveness. I think the memories of very different times accentuate the vague feeling among residents of senior living facilities that we are imprisoned against our will.
On the upside for my fellow inmates here and me, our fortress is pretty posh. Three good meals delivered daily in compostable containers, creature comforts like views of the San Bruno mountains to the south, or the San Francisco sunsets from our west windows. On the downside, it is possible to spend days at a time without seeing another human being, other than the masked person who shows up every day to take your temperature. For those of us still mobile there are decidedly other upsides: a small exercise room with treadmill, weights etc, and an outdoor terrace on the second floor (barred gate at the bottom of its stairs.) Walking from one end of the terrace to the other requires 180 steps. The exercise room being too small to accommodate more than one socially-distanced person, I get my best exercise walking from the 7th floor to the 3rd to see if anyone is on the treadmill. Eight or ten of us are also known to go walking at the same time, appropriately distanced, and thereafter to hang out for also distanced but at least human-to-human, conversation – though it does include frequent remarks in the “Did you see who that gurney came for?” category. Some of us are more obsessive than others about checking the case/death numbers posted every morning at 9 by the San Francisco Department of Public Health; everyone talks less and less about when the country may “open up.” Or about politics at all, for that matter. Political discussions pretty much begin and end with “What about Trump saying . . .” This place is not a bastion of conservatism.
What’s not heard a lot? Complaints. If we chafe at confinement, we’re grateful to wake up without a fever. Most of us have friends or family in New York, Atlanta, New Orleans or Seattle and we worry about them far more than they need worry about us. All of us have friends or family who are doctors, nurses, first responders and others on the front lines. Somehow, gratitude seems to edge out the fear in our geezerly hearts.
This essay also appears on Medium.com, a fine site committed to the exchange of ideas, knowledge and perspectives, on which I’ll be posting in the future. But I’ll still be holding forth right here on franjohns.net. So stick around!
Disappearing from cyberspace is a little like being a tree that falls in the forest. A very small tree. Having disappeared from cyberspace myself for a couple of weeks, I am comforted by the fact that the forest is very large.
It’s not that this space disappeared, just that Boomers and Beyond disappeared. Boomers and Beyond is a blog primarily about issues critical to over-50 generations, and it came to pass on True/Slant.com a couple of years ago. It dealt with health care and fitness and housing choices and brain exercises and driving safety, and often diverted into rants about gay rights and abortion rights and gun control and other miscellany — because the True/Slant folks were a free-wheeling bunch and why should anybody quit worrying about rights and justice when they turn 50? All those profound words are archived in this nifty blog (this WordPress one right here) created by incredible friend-of-B&B-&-this space Mary Trigiani, so that if anyone stumbles into the forest and wants to study a small bush those twigs — OK, enough with the metaphor — are there to be read.
True/Slant didn’t actually disappear; it got bought by Forbes, and is gradually reappearing (as a New And Improved Forbes blogsite) there. Boomers & Beyond is reportedly going to reappear thereon, as soon as a contract appears. In the interim, it is just sitting there inert, and after several watchful readers noticed its inertia (posting anything new isn’t an option at True/Slant any more) I decided to venture once more into cyberspace.
It’s pleasant to meet you here. I hope we’ll meet again soon.
“The best thing? Well, there are only three rooms to look for my glasses in.” Nearing the end of her first year after a final move, my sister reports a whole bunch of pluses and only a couple of minuses in her housing choice.
Like millions of other older Americans, my sister Helen and her husband Clare faced the multitude of questions that come with aging in this country: where to live, how to stay active and independent, how to get necessary health care, how to finance it all. After a lifetime in academics and music, they had good friends at home and around the globe, but were beginning to feel isolated in their 4th floor Boston condominium because of limited mobility (Clare has Parkinson’s; they had long since sold the car…) and knew that changes had to be made.
First issue: Housing. Staying in their home was not a good option; though it had plenty of spare room, no family member was available to move in and help. They were far from needing (or being able to afford, for that matter) regular in-home help. Their children were scattered across four states, with families of their own.
The answer for Helen and Clare was Kendal at Ithaca, one of a growing number of retirement communities offering “lifetime” or “continuing community care” in almost every part of the U.S. and many other countries. They chose a two-bedroom, two-bath “cottage” within an easy walking distance of the main facility and its dining room (they have one meal a day there), fitness room, crafts room, library (a large and very well-stocked area where Clare spends most of his disposable time), swimming pool and meeting rooms (where Helen quickly found ways to be useful on multiple committees.) They made the move eight months ago (as reported on this page along with a running bunch of posts on senior housing choices then and since then); I visited again this weekend to see how things are working out. Pretty well. The winter wasn’t all that bad, though April in Ithaca seemed about as cold and ominous as June in San Francisco to this San Franciscan, and they have had no second thoughts.
The bad point: they miss their Boston friends. The good? Not having to worry about home care or upkeep, having a regular cleaning/household helper whom they greatly like, door-to-door transportation to cultural events at nearby Cornell University, Ithaca College and elsewhere, plenty of activities and new good friends, good food (“the desserts are desperately attractive,” Helen says) and health care (mostly right there on the premises.) On this last point, Clare lists one great attraction he sees: “They can’t throw me out.” The crowning bonus, for this fairly happily aging couple, is the proximity of their physician daughter and her husband, who relocated from the west coast to be near their parents, and who are in daily communication and assistance.
Kendal communities are not cheap. Nor are most of the others that offer independent living, assisted living and nursing care in assorted facilities, along the can’t-throw-you-out principle. Helen and Clare paid a hefty lump sum (being able to sell a home you’ve had for decades is the way most people swing this) and their monthly fee, which covers meals, transportation, doctors visits, drugs, etc, etc and etc, is also substantial. They are, though, a good choice for many. One college friend now in such a spot refers to her South Carolina retirement home as “our little corner of paradise;” another very close friend is delighted with her Virginia apartment in a community where her husband now lives in a “memory unit” a few steps away.
If you Google “retirement communities” or “continuing care communities” or similar phrases, literally hundreds of choices pop up. The managers of those facilities can spell out the costs and the benefits; for the pitfalls, it’s a good idea to talk with those who live there or whose loved ones are/have been there.
Years ago when my grandmother was dying — a process that seemed to consume her for a very long time — her children took turns having their semi-invalid mother live with them for a period of months. Grandmother was not an easy patient. She spent most of her days talking about how everyone she loved was dead — which used to make me wonder where my sisters, my long-suffering mother and I stood with her. But Grandmother’s decline was before technology complicated such events, and pretty much all that was needed was to put a borrowed bed somewhere, try to keep her comfortable and entertained and call the doctor if she needed anything. Most of her six children had at least one at-home family member who could handle Grandmother’s care for a few months without straining the family budget or everyone’s patience and good humor.
Caring for aging family members today is not so simple. Few families have a stay-at-home member able to juggle regular routine with patient care, such care now often calls for high-tech equipment and/or high-cost drugs and interventions, and doctors don’t make house calls every other night.
In an informative and enlightening ‘Encore’ feature, Wall Street Journal writer Anne Tergesen follows the adventures of several families wherein siblings have become caregivers to aging parents.
Family cohesiveness is a tall order at any time of life. But as parents grow frail, brothers and sisters often encounter new obstacles to togetherness—at precisely the time they most need to rely on one another. Sibling rivalry can emerge or intensify as adult children vie, one last time, for a parent’s love or financial support. And even as parents grow dependent on children, the desire to cling to old, familiar roles can create a dysfunctional mess.
Today, with the economy and household finances in disrepair, such strains are more pronounced. According to a recent report by the National Alliance for Caregiving and AARP, about 43.5 million Americans look after someone 50 or older, 28% more than in 2004. In comparison with 2004, a smaller percentage—41% versus 46%—are hiring help. And more—70% versus 59%—are reaching out to unpaid help, such as family and friends.
Experts say it’s crucial that families figure out ways to work together, to work through their differences, for the common goal of caring for a parent. If they don’t, their parents will suffer—and so will they.
“Family caregivers are the backbone of the long-term-care system in this country,” says Francine Russo, author of a new book about how siblings can cope with aging parents, “They’re Your Parents, Too!” Siblings who work together, she adds, can help preserve not just one another’s health and sanity but also a “last link to their first family.”
There is, fortunately, a lot of support for family caregivers, through sources listed above, the Family Caregiver Alliance and other local or national groups. There are also helpful tips, many of which are outlined in Tergesen’s article: use new technologies, seek help, be flexible, keep lists, and laugh a lot.
The latter was what saved my family from collapse during Grandmother’s stays in our home. Grandmother would today be easily identified as clinically, chronically, severely depressed. My sister Mimi and I devised a game, after the first few days of jockeying for position as the one not to have to spend the afternoon with Grandmother. Whoever came up with the most hilarious joke to tell and see if we could make her laugh, or the most bizarre question (“Did Uncle James really go to jail, like we’ve heard?”) to prompt a family story, would win. I don’t know if this technique has real merit but it worked for us. We laughed a great deal, and Grandmother got to tell a LOT of previously untold family stories. Some of them were even true.
With the over-5o population expected to grow from 100 million this year to 130 million in 2030, the question of how and where to house these older adults is one that’s not going away. And it is not just a question of quantity and variety — enough houses, apartments, retirement communities — it’s how to ensure that needed services will be accessible to all.
All of these Boomers, who are now beginning to swell the ranks of the Seriously Senior, have specific wish lists: independence, security, and above all avoidance of the N-word — the dreaded nursing home. The wish lists change almost by the day, but some things stay the same.
“With the population of older adults on the rise, this report helps to identify the essential housing policy strategies that can help them to balance their increasing needs with a desire to continue to stay closely connected to their families, communities and society,” said Center for Housing Policy Chair John K. McIlwain, senior resident fellow and the J. Ronald Terwilliger chair for housing at the Urban Land Institute.
According to Susan Reinhard, AARP Senior Vice President and Director of the AARP Public Policy Institute, “These resources will be invaluable for policymakers at the state and local levels as they adapt to the changing needs of an aging population.”
If you, or your parents or grandparents, are over 50, chances are you have already had The Talk. Where in the world will Mom and Dad go, and how in the world will they stay there? What’s going to be comfortable? How will we afford it?
Nine fact sheets accompanying the newly released report are divided into three sections. It all makes the task of plowing through the talk a little easier, especially if local and state policy makers are paying attention at the same time.
This space will be looking at the different points over the coming weeks. Your comments and personal stories are welcome.
Waiting lines at the bathroom? Overflow in the kitchen cabinets? Welcome to the suddenly multi-generational family home.
Yesterday a friend of mine was alternately laughing and crying (I mean, literally) over the tales of her once comfortable, now overstuffed home. Her daughter and son-in-law, both unemployed for an extended time and overwhelmed by mounting debt and loss of health insurance, recently moved in with the older generation. With them came three grandchildren, ages 3, 8 and 11. It could make a great sitcom pilot. “My husband was so desperate to get into one of our two and a half bathrooms the other day,” she said, “that he suggested getting one of those take-a-number things they have in hospital waiting areas. The kids put labels on their snack bar boxes, but now I can’t even find which shelf the boxes got stuffed into or what they’re hiding behind.”
Welcome to the brave new world of extended-family housing.
The extended family is making something of a comeback, thanks to delayed marriage, immigration and recession-induced job losses and foreclosures that have forced people to double-up under one roof, an analysis of Census Bureau figures has found.
“The Waltons are back,” said Paul Taylor, executive vice president of the Pew Research Center, which conducted the analysis.
Multigenerational families, which accounted for 25 percent of the population in 1940 but only 12 percent by 1980, inched up to 16 percent in 2008, according to the analysis.
For the rapidly growing 65+ segment of the population, there’s good news and bad news in this. Loneliness is often cited as a great fear among the aged. At talks and workshops this writer often does on end-of-life issues (advance directives, end-of-life choices, etc.) the response to any “What do you fear most?” question is never “death,” almost always “pain,” “isolation” or “loneliness.” When younger generations move in, loneliness is unlikely, but other problems may well take its place.
The analysis also found that the proportion of people 65 and older who live alone, which had been rising steeply for nearly a century — from 6 percent in 1900 to 29 percent in 1990 — declined slightly, to 27 percent.
At the same time, the share of older people living in multigenerational families, which plummeted to 17 percent in 1980 from 57 percent in 1900, rose to 20 percent.
While the pre-World War II extended family may have been idealized as a nurturing cocoon, the latest manifestation is too recent and a result of too many factors, positive and negative, to be romanticized.
“It calls to mind one of the famous lines in American poetry, from Robert Frost: ‘Home is the place where, when you have to go there, they have to take you in,’ ” Mr. Taylor said. “I don’t know that I can offer a value judgment of whether it’s good or bad. It reflects our time.”
The decline of extended families coincided with an exodus to the suburbs, where many young adults preferred to raise their children, and the enactment of Social Security and Medicare, which made older adults more financially independent.
A lot of factors combine to create the more than 49 million adults currently living in multi-generational homes, the census figures show. We’re living longer, getting married later, getting divorced more often, losing jobs and losing homes. One ray of good news is that the homes now housing multiple generations tend to be larger than a generation ago. Two and a half bathrooms for three generations still beats the olden days of one bathroom for a family of five. But not many families get along as well as the Waltons did. “We love the kids and the grandchidren,” remarked my stressed-out friend mentioned above, “but my son-in-law’s first paycheck is going to go for the down payment on a new apartment.”
What about moms and dads who really don’t want to move?
The problem of where to go and what to do about housing in the sometimes not-so-golden years has an assortment of solutions for those who prefer (and can afford) the retirement community or any of the multitude of assisted living communities around. But for those who are bound and determined to stay put in the old house or the long-familiar apartment? A collection of obstacles begins to accumulate.
Enter the village.
Swiftly catching on around the country, aging-in-place “villages” are designed to help members overcome those obstacles by providing a variety of programs and services – while the members stay put. The prototype was Boston’s Beacon Hill Village, founded in 2001, which offers “groceries to Tai Chi to cultural and social activities to home care.” Others have popped up in states ranging from Colorado to New York, Florida to Nebraska, Massachussetts to Hawaii.
San Francisco Village was the second, after Avenidas in Palo Alto, to get off the drawing boards and into action in California. Although each Village differs from others, SFV illustrates many of the attractions that are drawing in the stay-put crowd. The organization began with some local grants and individual donations, and is sustained now by annual membership fees.
Sarah Goldman agreed, after a good bit of arm-twisting, to be a poster girl for SFV in upcoming stories for the neighborhood’s New Fillmore newspaper. Sarah was among the first to join the organization, and in many ways typifies the village member-enthusiast: fit, active and fiercely independent at 80, she plans to stay that way as long as humanly possible. Her first move, as a Village member, was in support of someone older still and desperately in need of help: her landlady. Goldman could see that the landlady, who also lived alone, was becoming forgetful and increasingly unkempt – the distress signals that often propel seniors into care facilities. So she began by talking the landlady into joining also. This paved the way for calling in, with the landlady’s approval, a wide-ranging group of service providers: house cleaners, organizers, financial assistance people, personal care helpers. All had been vetted by SFV. Their help has now enabled both landlady and tenant to keep right on aging in place.
Goldman also quickly started a program patterned after one she had organized when working with an assisted living community. SFV’s play-reading group was an immediate hit among those seeking socialization and intellectual stimulation. Three necessities of life — social, physical and mental fitness — added to issues such as those dealt with by the landlady, add up to the heart of the Village. Members hope that by accessing things like this while staying on familiar turf their golden years may indeed stay shiny.
This one hopes that SFV membership will help keep the contributions of this space emanating from this laptop on this Sacramento Street kitchen counter for a very long time to come.