In the assisted living facility where my mother would like to live, a grandfather clock stands beside the lobby elevators. The hands on the clock don't move. Though this may just be an oversight by the maintenance staff, the frozen clock also serves as an apt metaphor for old age in America. That is, after a certain age, or level of irreversible decrepitude, time slows to a crawl. If it moves at all, it moves backward into memories the elderly often keep to themselves rather than risk boring or annoying representatives of America's “forever young” culture.
As we wait in the lobby for a marketing person to give us a tour of the facility, I feel the way my mother must have felt when she used to take me as a boy to pre-school or summer camp. Like her then, I now try to put the best face on the experience. After all, the assisted living facility has the aura of a resort hotel, and I point out the amenities to her: solid furniture, thick carpet, polite and pleasant staff, hair salon, pharmacy, a Hilton-quality dining room and Starbucks-quality coffee shop (open 24/7!), activities pavilion, busy activities schedule, well-maintained grounds. In short, this is not some hellish snake pit of soiled, deranged people like the nursing home where my father died. Indeed, some of the residents who pass us in the lobby have springs in their step, Dr. Laura-approved smiles (though their eyes can't hide the fear), places to go, people to see, etc.
Naturally, then, this facility has a waiting list. And, of course, the only vacancies here occur when a resident becomes helpless to do the simplest tasks, or they die. The unstated question: which of those two prospects is the more appealing? After all, when you leave a place like this, you're not headed anywhere nicer. In her new book, Never Say Die, Susan Jacoby examines “the myth and marketing of the new old age.” Contrary to all the pipedreams about “extending life,” Jacoby offers a dose of reality: “By the time men and women reach their 80s and 90s, not the best but the worst years of their lives generally lie ahead.”
Dr. Ira Rosofsky, a New Haven-based psychologist, agrees. Author of the provocative Nasty, Brutish & Long: Adventures in Eldercare, a finalist for the Connecticut Book Award last year, Rosofsky has counseled nursing home residents in Connecticut for the past 30 years. In that time, he's heard and seen just about every nuance of growing old in America.
“People have this magical notion that something called assisted living will take care of all your needs,” says Rosofsky. “I often say assisted living is the halfway house between the family home and the nursing home. But then, many people in nursing homes are getting way more medical care than they need or use, but it's paid for by Medicaid. The government will pay for nursing home care but not for assisted living, even though the cost for assisted living is half what a nursing home costs and many residents in the latter could easily get along in the former.”
Rosofsky warns that the monthly fee of assisted living facilities covers just a base fare and that, depending on the level of care your parent needs, you end up paying for a lot of extra things a la carte.
“Say you pay $2,000 per month, plus a la carte charges for any extra care,” he says. “This can add up quickly and because all the costs of a nursing home are covered by Medicaid, the pressure builds on some families to get the parent into one of those as soon as possible, to save money.”
The “gold standard,” Rosofsky says, is “to find the least restrictive environment for the older person.” If your parent already knows people in a particular facility, that may be the right place for them. “Being with friends in a safe environment is not the worst thing your mother could face,” says Rosofsky, though he also warns that moving is stressful, especially for someone who, like my mother, is moving from a house where she has lived for 50 years.
“Ask yourself, ‘How will the new environment be different from the old?'” he advises. If the differences are more positive than negative, it may be time for that final move.