In Sickness and in Health - For several years, the professor and his wife, who has Parkinson’s disease, managed in their house in Cambridge, Mass. But two years ago, finding living on their own too difficult, they moved together into an assisted living facility.
The professor, retired from M.I.T., was in good health and didn’t need personal care. So I wondered: Why not move just his wife, whose mobility would deteriorate, and visit her regularly from his own home?
He sounded puzzled at the question. Live apart? “That never occurred to me,” he said. “She’s my wife.”
As is often the case, though, assisted living proved only a temporary solution. His wife developed intensifying dementia and needed more care than the facility could provide. In November, at 85, she moved to another facility in a neighboring town. The professor stayed behind in assisted living. Now 87, he is living alone for the first time in 55 years. (He asked that I protect his wife’s privacy by not identifying them further.)
He spends a good part of each day traveling to his wife’s residence on public transportation; they eat lunch together, walk outside in good weather, try to have conversations. “I still haven’t quite adjusted,” he confessed. “I realize she’s not going to get well and move back in with me. But in my head, I haven’t quite grasped it.” He sounded very sad.
“These are the hardest kind of situations we deal with,” said Emily Saltz of Elder Resources, a veteran geriatric care manager in greater Boston. “We don’t have good options for couples with differing health status.”
Yet almost every elderly couple will eventually fall into that category, she pointed out. Who ages at exactly the same rate?
It’s yet another quandary caused by lengthening life spans; more people over 60 are married, remarried or cohabiting than decades ago, when more were widowed. Ms. Saltz finds it no longer uncommon to work with couples in their 90s. Most want very much to continue living together. But it’s not easy.
Questions of how and where to live are complicated by the conviction that one spouse should shoulder the burden, sometimes the entire burden, of caring for the other. They see that as a duty, even as research repeatedly underscores the risks.
“I’ve seen so many cases in which one goes under, their own health fails as a result of the stress and strain,” said Ms. Saltz. As spouses struggle to hold onto their roles as caregivers, “they hurt themselves lifting. Their blood pressure goes sky-high. They fall.”
Hiring home care is the least disruptive solution, if clients will accept it, but it can also be isolating for the healthier partner. And as the more disabled partner needs more care, round-the-clock home aides can become as expensive as a facility, or more so.
Even when a couple and their children agree that a move makes sense, however, finding a residence that works for both spouses can prove difficult. Select a place with enough personal or medical care for the sicker one, and the healthier one can feel out of place. Judith Parnes, a geriatric care manager who directs Elder Life Management in central New Jersey, had a client couple try assisted living together. “There were sacrifices” for the wife, who was more able, Ms. Parnes said. “The activities in most assisted living centers aren’t at the level an independent adult wants. She really didn’t see herself fitting in.”
But a facility that suits the well spouse can also pose problems if it doesn’t provide enough care for the ailing one. “It leaves the healthy spouse in that caregiving role,” Ms. Saltz said. “If she can never leave the apartment because she’s responsible for him, what have we accomplished?”
She often steers clients to a continuing care retirement community, where individuals can move to a higher level of care as needed and still remain on the same campus or in the same building. One couple, clients in their mid-80s — he’s in fine health, she’s disabled by a stroke — moved into separate wings of a C.C.R.C. in Dedham, Mass., the husband in independent living, the wife in the nursing home. “She gets a lot of hands-on assistance; he gets somewhat of a life,” Ms. Saltz reported. “They’re together every day.” But as with the professor and his wife, it’s a “bittersweet” solution, she added. “This isn’t what they envisioned for their retirement.”
Moreover, C.C.R.C.’s can thwart such arrangements by rejecting applicants with serious health problems, like Parkinson’s or Alzheimer’s. They prefer healthier adults in their 60s or 70s; it isn’t financially feasible to offer lifetime care if residents need help very soon after moving in.
In some cases, communities will be flexible and allow the independent partner to participate in lifetime care while the less healthy one enters on a pay-as-you-go basis. C.C.R.C.’s are already an expensive option, however; paying two sets of fees makes them even more so.
Some couples probably shouldn’t strive to live together, Ms. Saltz noted. Severe dementia can make cohabiting nearly impossible. And some relationships were miserable even when both spouses were healthy. “Sometimes we encounter couples with terrible conflicts, and illness just makes it worse,” Ms. Saltz said.
But a great majority of those who’ve spent their lives together want to continue; they took those vows seriously. And finding ways to make that happen takes thoughtful planning and a creative approach.
If you’ve coped with this issue, I’d like to hear what you and your parents decided and how they fared. ( nytimes.com )
The professor, retired from M.I.T., was in good health and didn’t need personal care. So I wondered: Why not move just his wife, whose mobility would deteriorate, and visit her regularly from his own home?
He sounded puzzled at the question. Live apart? “That never occurred to me,” he said. “She’s my wife.”
As is often the case, though, assisted living proved only a temporary solution. His wife developed intensifying dementia and needed more care than the facility could provide. In November, at 85, she moved to another facility in a neighboring town. The professor stayed behind in assisted living. Now 87, he is living alone for the first time in 55 years. (He asked that I protect his wife’s privacy by not identifying them further.)
He spends a good part of each day traveling to his wife’s residence on public transportation; they eat lunch together, walk outside in good weather, try to have conversations. “I still haven’t quite adjusted,” he confessed. “I realize she’s not going to get well and move back in with me. But in my head, I haven’t quite grasped it.” He sounded very sad.
“These are the hardest kind of situations we deal with,” said Emily Saltz of Elder Resources, a veteran geriatric care manager in greater Boston. “We don’t have good options for couples with differing health status.”
Yet almost every elderly couple will eventually fall into that category, she pointed out. Who ages at exactly the same rate?
It’s yet another quandary caused by lengthening life spans; more people over 60 are married, remarried or cohabiting than decades ago, when more were widowed. Ms. Saltz finds it no longer uncommon to work with couples in their 90s. Most want very much to continue living together. But it’s not easy.
Questions of how and where to live are complicated by the conviction that one spouse should shoulder the burden, sometimes the entire burden, of caring for the other. They see that as a duty, even as research repeatedly underscores the risks.
“I’ve seen so many cases in which one goes under, their own health fails as a result of the stress and strain,” said Ms. Saltz. As spouses struggle to hold onto their roles as caregivers, “they hurt themselves lifting. Their blood pressure goes sky-high. They fall.”
Hiring home care is the least disruptive solution, if clients will accept it, but it can also be isolating for the healthier partner. And as the more disabled partner needs more care, round-the-clock home aides can become as expensive as a facility, or more so.
Even when a couple and their children agree that a move makes sense, however, finding a residence that works for both spouses can prove difficult. Select a place with enough personal or medical care for the sicker one, and the healthier one can feel out of place. Judith Parnes, a geriatric care manager who directs Elder Life Management in central New Jersey, had a client couple try assisted living together. “There were sacrifices” for the wife, who was more able, Ms. Parnes said. “The activities in most assisted living centers aren’t at the level an independent adult wants. She really didn’t see herself fitting in.”
But a facility that suits the well spouse can also pose problems if it doesn’t provide enough care for the ailing one. “It leaves the healthy spouse in that caregiving role,” Ms. Saltz said. “If she can never leave the apartment because she’s responsible for him, what have we accomplished?”
She often steers clients to a continuing care retirement community, where individuals can move to a higher level of care as needed and still remain on the same campus or in the same building. One couple, clients in their mid-80s — he’s in fine health, she’s disabled by a stroke — moved into separate wings of a C.C.R.C. in Dedham, Mass., the husband in independent living, the wife in the nursing home. “She gets a lot of hands-on assistance; he gets somewhat of a life,” Ms. Saltz reported. “They’re together every day.” But as with the professor and his wife, it’s a “bittersweet” solution, she added. “This isn’t what they envisioned for their retirement.”
Moreover, C.C.R.C.’s can thwart such arrangements by rejecting applicants with serious health problems, like Parkinson’s or Alzheimer’s. They prefer healthier adults in their 60s or 70s; it isn’t financially feasible to offer lifetime care if residents need help very soon after moving in.
In some cases, communities will be flexible and allow the independent partner to participate in lifetime care while the less healthy one enters on a pay-as-you-go basis. C.C.R.C.’s are already an expensive option, however; paying two sets of fees makes them even more so.
Some couples probably shouldn’t strive to live together, Ms. Saltz noted. Severe dementia can make cohabiting nearly impossible. And some relationships were miserable even when both spouses were healthy. “Sometimes we encounter couples with terrible conflicts, and illness just makes it worse,” Ms. Saltz said.
But a great majority of those who’ve spent their lives together want to continue; they took those vows seriously. And finding ways to make that happen takes thoughtful planning and a creative approach.
If you’ve coped with this issue, I’d like to hear what you and your parents decided and how they fared. ( nytimes.com )
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