What does a couple do when one wants or needs to move into a senior facility and the other does not? Several recent emails were on this topic. One example. “I am 78 and my husband is 82. I am ‘frailing,’ as you said you were, Dr. Heins, but he is strong and takes no pills. He scoffs when I bring up the subject: ‘We don’t need it!’ How can I talk effectively to a person who is in denial of the concerns of his less healthy partner?”
A contemporary dilemma. In days of old, families took care of aging kin at home until they died or became so feeble they needed nursing home care. Nursing homes like hospitals had wards with several or many patients. Care was suboptimal. Wards smelled and little attempt was made to provide stimulation or comfort, just minimum care of bedridden patients.
Out-of-home care for the elderly was started in the early 19th century by religious groups and fraternal organizations. We have come a long way. Today Continuing Care Retirement Communities with accommodations for independent living, assisted living, and nursing home care are designed to provide residents a continuum of care.
In Anne Tyler’s “Ladder of Years” an aging grandfather describes his retirement home, Senior City, “We’re organized on the vertical. Feebler we get, higher up we live … strikes me as symbolic.” He goes on to say he pictures life as a “ladder on playground slides, a ladder of years where you climb, you fall over the top and others move up.”
The continuum approach to aging is designed to accommodate the changing needs of the elderly. Advantages include being able to stay in one location for the duration of your life, having less anxiety about what is next to come, being with one’s own age group, having activities on site, and not becoming dependent on one’s children. Disadvantages include cost, giving up one’s “nest,” and downsizing, which means parting with some of the possessions we all accumulate.
I became familiar with today’s senior living from my friends and have seen many of the local facilities when I visited them. I helped one couple I had known for years make their decision, choose a facility, and move in. I watched them both ascend the “ladder of years” as chronic illness in one worsened and a stroke felled the other.
I am not an expert in aging like a geriatrician or gerontologist. But we all can learn from our friends and our experiences.
After listening to and observing many friends and colleagues I know this is not an easy decision. I frequently heard “We should have done this earlier;” “I didn’t realize how much running a home on my own was stressing me;” “I wish I had faced what loneliness was doing to me. I kept trying to suck it up!”
I never heard one person say, “We did this too early.” The challenge of aging is to accept our old selves. We ain’t what we used to be! And we’ll never will be that person again because age and time each go in only one direction. Age goes up, the time left to us goes down.
I once wrote that the decision should be made 1) Sooner rather than later 2) Early enough so you can move as a couple. 3) Early enough so you make the decision of where you want to spend the rest of your life, not your children!
I have known couples that were not “balanced.” One was independent, while the other needed more care. One couple told me they were grateful the facility enabled them to stay together. One man confessed he would never have survived alone in the house after his wife was gone. Another man said that, when his wife died, he was grateful they had made the move. He could visit her every day by just walking over to the memory care unit. She was in a familiar place. And he had friends on site to help him deal with his grief.
A dear friend said she was very fortunate to be able to manage her husband in their independent apartment with part-time help for showering and getting him to the doctor. “Because I didn’t have to cook or shop I had the strength to just be with my beloved. We held hands and watched old sitcoms or movies. Friends dropped in. One lady bought her dog to visit every day.”
Today’s letter writer has an “imbalance” problem. She feels ready, he does not. My answer: Talking with, instead of to your husband, is the way to start. Tell your doctor you are worried about your health and ask what is likely to happen as you age. Tell your husband how you feel and why. Ask him how he feels and why. Use “I messages” instead of accusatory messages like, “You never listen to me!”
Gather information about local facilities. Look online. Ask friends as it is likely friends in your age group are thinking about their future, too. Most important, visit facilities together. Have lunch there to get a sense of the ambience. Talk to the residents.
The visit has two purposes. 1) To show both of what contemporary facilities are like and how different they are from the nursing homes of old. 2) To decide which one best suits you in terms of location, amenities, and cost.
Don’t fight over this or despair. Instead try to convince your husband that this will be an adventure like deciding what island you two want to visit in Hawaii! Encourage him to be grateful for his good health. Explain you want to stay together but do not want to burden him. Rather, you want to give him a chance to maintain his independence even when you must climb to the next rung on the ladder.
