August 15, 2012

Best Place and Best Way To Die: My Secret Strategy

Most of us oldsters would prefer to stay at home until we're carted off. The ideal scenario: do this surrounded by loving, caring family and friends. But all too often, this set-up isn't possible. (I've found a way that I think may work, which I'll get to shortly.)

In our mobile society, family members are usually scattered all over the world. Even if they aren't (and I'm one of the fortunate few with all my family still in the area), our kids and grandkids are having a hard enough time struggling with the lousy economic hand we've dealt them (I'll have more to say about THAT in another post). Most of us don't want to make their lives more difficult by burdening them with caring for us.

I was surprised to read in the Washington Post this morning that only four percent of the 65-plus population go to nursing homes. Of course, many more go to senior residences or move in with relatives. Most of us try to remain at home. The article in the Post, titled "Aging in Place," was based on an interview with Henry Cisneros, the four-term mayor of San Antonio and former secretary of the Department of Housing and Urban Development. He is co-editor of a new book, Independent for Life: Homes and Neighborhoods for an Aging America," a collection of papers authored by more than a dozen experts in aging and housing.

At the start of the interview, Cisneros talks about his elderly mother, whom he calls a "classic case of a person aging in place," still living in the home his parents bought in 1945 in a lower-middle-class San Antonio neighborhood. "I don't think there's a tractor strong enough to pull her from that house," Cisneros says.

Home Alone Is Not Easy
Based on his mother's experience, Cisneros gives this description of the problems associated with "aging in place":
Seniors fear being unable to communicate, being lonely, feeling insecure. Especially people who all their lives have had other people around them -- family, neighbors -- and now they go entire days and never see anybody.
Imagine being older, a step slower, a bit more fragile. Add to that being lonely, edging to depression and unsure about how you're going to get everything done that you used to do. But wanting above all to stay in your own home and keep on being independent. That's hard.
This description sums up why many seniors -- as much as they want to stay at home -- end up deciding to move in with relatives or into a senior residence, often under pressure from concerned family members.

My Now Not-So-Secret Strategy
One option to deal with seniors' living-alone issues described so well by Cisneros is to hire home care workers. But many elderly people are reluctant to have strangers in their houses. Home care can be very expensive, too, particularly if it's around-the-clock.

So, what's my secret strategy? Truth be told, it wasn't planned. It just emerged, a happy accident. Here's what I suggest, based on my experience:
  • In your late 60s and 70s, while you're in good health, pick a country you like in the developing world. It should be one where many young people want to come to the U.S. to study or work.
  • Start visiting that country each year, ideally a couple times a year. Perhaps a trip in the spring and another in the fall.
  • Make friends with the locals and become more than a tourist.
  • Help the most promising of your new friends get their student visas or green cards.
  • When they get to the U.S., give them as much advice and support as possible.
  • If they find jobs or schools in your area, offer to let them stay at your house for as long as they want.
Let's assume you've been able to do all of the above when you appear to be strong and independent. Then, when (as in my case) you learn you have Parkinson's or some other progressively debilitating disease, your resident is probably going to feel compelled to continue keeping you company and helping around the house -- from love, economic necessity, or guilt. Love would be best.

This development may require spending some money adapting your house to changing circumstances, e.g., your resident decides to go home, get married, and bring his bride back here with him. But it's so worth it, particularly if you end up with two care-givers whom you love having around.

My friends and family know that this "secret strategy" just sort of happened. There was no plan. Once again, so often the case in my life, serendipity blessed me. My many trips to Nepal -- and all the friendships I formed there -- have enriched my life immeasurably this past decade. Many of my Nepali friends have emigrated to America. I described in an earlier post my good fortune to be surrounded by three families -- my Schappi family, my Kathmandu family, and my Pokhara family.

While my situation is unique, I would urge any senior who has his or her own home to consider ways of sharing it with young people. My next door neighbor takes in young German interns who come here to work or study several months at a time. Another neighbor employed two young men, one from Nepal, the other from the Philippines, to help care for her husband during his final years with Parkinson's. After his death, the Filipino continued working for her, and he and his young family have become a second family for her.

There are ways to deal with the "home alone" issues described by Cisneros. Opening your house to young people is a great option. 


Hugh Yarrington said...

As always, John, thanks for sharing your always enlightening and entertaining life with all of us who follow your blog. Your solution is a great one for you. And, I am delighted to say that from the perspective of one who has had the pleasure of meeting the couple currently living at your home. I suspect that this solution would be a difficult one for most to pull off, however. Be that as it may, it certainly gives all of us something to think about.

The past year has given me much to think about on the subject of how, where, and when to die. With some considerable effort, those who choose to control all of that can now do so. Still, as was discussed here recently in another of your posts, none of us can really say what we will do until the time comes. Many say they will do one thing and end up doing another. I think the best we can do is to arrange things in a way that preserves our options and then hope we have our minds intact long enough to make our own decisions.

gleeson1929 said...

Thanks Hugh. Your last sentence sums it up nicely. I'd add that we also need to try to remain flexible and open to considering options that will involve change. That becomes more difficult as we age. I've seen elderly friends who appear (to me) overly locked into remaining where they are when (again, to me) their quality of life suffers from the risks and loneliness that Cisneros describes and would be happier and safer giving up their homes in exchange for independent living in a senior residence.
Of course, I have to remind myself that I nearly made an awful decision over 3 years ago to make this change because I'm overly inclined to go charging after something
new and different. (Our friend Bill hated giving me the required annual performance review but the most he could do was fault me -- rightly -- for my tendency to "shoot from the hip" without sufficiently thinking things through.) -- John

Susan Carhart said...

I LOVE this idea. I'm thinking of a domestic variation -- foster children "aging out" of the system who continue to need life skills and guidance, not to mention a place to live that they can afford. And who can't afford free? I actually plan to charge a modest rent, which I will put aside for them and convey when they leave as the start of a savings account and/or nest egg.