Is Home Always So Sweet?
By Paula Span
Let me tell you about a couple of elders I happened to meet recently. Both lived in Washington, D.C., and both were insistent, like so many of their peers, on remaining in their homes even as their health declined.
One was a 95-year-old woman still reigning over the small brick colonial she and her husband had bought more than 40 years ago. Staying at home required a platoon of hired caregivers: a morning aide, an afternoon aide, a Tuesday helper with a van for doctors’ appointments, eventually an overnight aide. Her 74-year-old daughter, coordinating this demanding (and expensive) mission, was fraying under the strain.
But the woman relished her books, her daily newspaper and a stream of visitors: fellow church deaconesses, neighbors, friends and family.
She suffered from heart failure but resisted hospitalization, and in September she died at home, as she’d wished, a day shy of her 96th birthday.
Across town, a broad-shouldered former cab driver lived in a basement rec-room-turned-bedroom in his son’s house. He used a wheelchair and a walker, and he had Alzheimer’s disease, but I found him good-natured, chatty and gregarious. The problem: there was rarely anyone around to chat with.
His son worked long hours; other relatives called but could rarely visit. Aside from his home aide, who came three hours each weekday, he was usually alone. He seemed a good candidate for the activities and communal meals of a well-run assisted living facility, but to his son’s frustration, he was adamant about staying with family, even if that meant long hours of watching televangelists on a large-screen TV.
The contrast in these two elders’ lives raised a tough question. Research repeatedly confirms that most older people want to remain at home, with services brought to them in the places they choose. Government and social policies are moving, belatedly, in that direction. But is living at home always the wisest solution?
Not every senior can have that option. “Sometimes, the family can’t sustain the burden,” said Suzanne Modigliani, a veteran geriatric care manager in Brookline, Mass. Most family members caring for seniors also are trying to keep jobs; while many manage to juggle eldercare and employment in the earlier stages of caregiving, they may be unable to continue when the demands increase.
Hiring home help can present its own difficulties, depending on a senior’s condition and personality. If dementia has made an elderly person aggressive, caregivers will have trouble employing and keeping home care aides.
“A big factor in whether it will work or it won’t is affordability,” added Peter Notarstefano, director of home and community-based services for the American Association of Homes and Services for the Aging. When a parent can’t transfer from bed to chair to toilet, and is too heavy for one caregiver to safely lift and move, or when he needs help around the clock, the cost of multiple aides may surpass the price tag for a nursing home, the only other option that provides that level of care.
But when staying at home does represent a viable option for a senior, can the preference for home be so reflexive that families ignore its drawbacks? Or overlook the benefits that congregant living sometimes provides? The familiarity of home is a comfort, but maybe it shouldn’t be the only consideration.
“People who see nobody from day to day, or see only their caretakers, can become incredibly isolated,” Ms. Modigliani pointed out. “We know that can lead to depression. Seniors’ cognitive skills decline if they have less interaction with people.”
Ms. Modigliani also has found that seniors living at home tend to neglect nutrition; they don’t eat well. “I’ve seen time after time that people who go to assisted living tend to gain weight,” she said.
To move or not to move: it’s a daunting decision that may pit an older person’s preference against his safety and health. It’s not always clear which should prevail, where quality of life really lies.
I was glad that the 95-year-old’s family was able to help her to live and die in the house she loved. But I wished that the cab driver’s son could have persuaded him at least to visit a couple of assisted living facilities. They might not have been as scary as he envisioned. They might have been better than the basement.
Paula Span is the author of “When the Time Comes: Families with Aging Parents Share Their Struggles and Solutions,” to be published on June 10 by Grand Central Publishing.