On Your Own

     “Aging in place” has become the mantra of the senior crowd. Staying in your own home, where, perhaps, you raised your children or lived with your spouse, even as age stakes its claim on your strength, agility and memory, appears as an idyll of the later years to many. Membership “villages” have sprung up around the country –170 of them — intended to provide volunteer support systems for those aging in place in “naturally occurring retirement communities.” Younger neighbors helping older neighbors is part of the vision. But, like many visions, it can pale against a harsher reality. “This philosophy of remaining independent with the help of community-based services has been a little oversold,” Donna Wagner, dean at the New Mexico State University College of Health and Social Services recently told the Wall Street Journal. http://www.wsj.com/articles/communities-struggle-to-care-for-elderly-alone-at-home-1443193481 Although the Wall Street Journal story highlighted the challenges of living alone in rural areas, this is not a problem confined to the border towns of Maine. Before falling in love with the notion of aging in place – or encouraging others to embrace it – it is useful and wise to come to grips with the price not just of independence, but of hanging on to a home that serves nostalgia better than current needs.

     I should admit first that I once vowed I would never move from the home my husband and I loved and lived in for 15 years. A Classic Victorian, it had 14 rooms, including five bedrooms and two parlors, and lots of storage. The large, hillside lot was bordered by a stream and backed on to a nature conservancy. But when my husband developed Parkinson’s Disease, it became clear our years at this address, with stairs inside and stepping stones outside, were numbered. I also had begun to feel we had a house sized to accommodate our excessive belongings rather than our lives. So we took to reading real estate ads and scouting out internet sites. Then, suddenly, my husband died. The volume of the house seemed to expand and the rooms felt both empty and cluttered. I became increasingly conscious of the costs and chores associated with the house.   The pleasure in its comfort and elegance dissipated. I decided, at 68, to move to a house less than half the size of the one I had imagined living in forever, in a neighborhood across town.

     The move was physically, mentally and emotionally daunting, then exhausting – then satisfying. It was hard to choose which among decades of accumulated belongings to give away and which to pack. This would all have fallen to my children some day, had I aged in place.

     I still live independently, in my own townhouse, and the household chores and costs fall on me alone. But I can see the four walls of my home on any one floor; though still lonesome for my companion, I am not lost. I use all of the spaces, other than the guest room, every day. My cost of living has dropped with my bills for utilities, cleaning, yard work, insurance and taxes. I encounter memories, not shadows, of my husband in the art we collected and three photographs I’ve chosen. I no longer feel overwhelmed with stuff – though I could trim back more. And everything I let go was one less future burden on my children.

     These are the arguments for not “aging in place,” but they don’t address the separate problems of living alone, problems that become more numerous and intractable as we age. The risk of falling is heightened as we become more frail and less able to recover from stumbles, a risk exacerbated by stairs. Lifting and carrying groceries, laundry and trash become more burdensome. Reaching for the dish or the book on a high shelf is daunting – replacing a light bulb overhead is impossible. Planning transportation to an evening’s entertainment is challenging. And combating the isolation of life in your own house requires planning and outreach. How many of us will manage these tasks effectively when we are 80, with or without a spouse?

     In fifteen years, there will be over 70 million Americans 65 and older, twice the number of fifteen years ago. http://www.americangeratrics.org/advocacy . By 2050, the number will exceed 87 million. The population of adults 85 and over is also growing exponentially: fifteen years ago, the Census reported 4.2 million, whereas the projection for fifteen years hence is over 9.6 million. More of them will have multiple chronic medical conditions – yet more of them wish to live on their own, as I do. (Given that the median monthly rent for assisted living exceeds $3,500, it is not simply a matter of wishes for many, of course. ) How will this be possible?

     The Village is a valuable component of independent living where there is a strong corps of volunteers, capable management and enough money. It can work as a membership organization in an affluent community, though in less well-heeled neighborhoods, philanthropic dollars are essential – Elder Help in San Diego is a good example. www.elderhelpofsandiego.com But nationwide, donors have been parsimonious when it comes to supporting elder care: in 2012, only 1.2% of foundation grants went to support causes related to aging. (The Chronicle of Philanthropy points out that this is “slightly more than what went to animal welfare.” September 2015.) The prospects for massively increasing this support are not strong. State and city resources that would facilitate or support independent living are strained; aside from Social Security, federal help, even for the very poor, is de minimis. (In a booklet entitled “There’s No Place Like Home – For Growing Old”, the National Institute on Aging blithely suggests that, when it comes to personal care, “maybe a relative or friend can help.” http://www.nia.nih.gov/health/publication/caregiving) In short, living on your own is just that.

     This is most certainly not a brief for nursing homes or extended care facilities. It is a plea to put aging issues, from transportation, to housing to health, on the national agenda. When we talk about immigration, note that almost a quarter of home health aides and personal care aides are foreign-born. When we talk about job training, consider that these are the third and fourth fastest growing occupations in the U.S., increasing by 50% and 46% between 2008 and 2018. http://www.phinational.org/sites/phinational.org/files/clearinghouse/NCDCW%20Fact%20Sheet-1.pdf When we talk about education, recognize that we need 20,000 geriatricians and we have 7,300; that only 11 out of 145 medical schools have geriatric medicine departments. http://www.Changingaging.org/blog/many-geriatrics-few-geriatricians . When we talk about the needs of low-income families, remember that 10% of seniors live in poverty. When we decry Congressional paralysis, call for the reauthorization of the Older Americans Act which expired in 2011.

     And for each of us individually, it is a suggestion for a reality check. Aging in place is not a panacea; indeed, it is not a goal in itself. Well-being, as Atul Gawande points out in Being Mortal, is the goal. Can you get there aging in place? Independent living takes more than determination; a plan of action for coping with the demands and vicissitudes of daily living is essential to promote well-being. We are taught as children, Dr. Gawande notes, not to accept limitations that obstruct our ambitions, but there are nevertheless “the constraints of our biology.” As elders, we are called upon to know “[w]hen to shift from pushing against limits to making the best of them.” In this, as in all things, we must be honest with ourselves.