New York Times, August 19, 2017, Page B1 :
Your Money
Hard-Won Advice in Books on Aging and Elder Care
Longevity
is generally better than its alternative. But when the body or
especially the mind wears out, caring for yourself or finding someone
else to do it for you can impoverish you in short order.
We
fail to plan for it at our peril. So when it seemed that Republicans in
Washington were close to passing legislation that could fundamentally
change Medicaid, I wrote five straight columns
about the program. Already, the majority of Americans need Medicaid to
pay for at least some of their nursing home costs or care at home
because they’ve run out of money. Proposed caps on Medicaid, which have
not come to pass for now, had the potential to cause enormous problems.
In
the wake of those articles, you wrote in, hundreds of you, with
harrowing stories and hard-won advice, more of which I intend to present
in future columns. But a smaller number of people wrote in unprompted
to assign me homework — books that they found useful as they were
navigating their own changing conditions or those of spouses, close
friends or other family members.
This
week, I read all four books that came up at least twice in your
correspondence. I don’t recommend you do the same, for if you’re more
empathetic than average or prone to anxiety, you’ll finish the reading
sprint, as I did, emotionally wrung out and worried sick.
Still,
these books are all in their own way utterly essential reading. Few of
us are prepared for the financial and emotional complexities of managing
the last several years of our lives. But as we live longer, drain what
may prove to be inadequate retirement savings and lean harder on already
strained government programs, we’ll probably find ourselves facing ever
more challenging questions and unfortunate compromises.
We may as well know what’s coming. Here’s what I learned.
“Being Mortal,” by Atul Gawande
I
started here, with this book by a New Yorker writer and physician who
aims to help readers avoid what he calls a “warehoused oblivion,” even
if none of us will win the ultimate battle.
The
book is a good introductory text in part because of the sobering
statistics. By age 85, 40 percent of people have some form of dementia.
There are 350,000 falls each year that lead to broken hips. Once you’ve
got a fracture there, there’s a 40 percent chance you’ll end up in a
nursing home and a 20 percent chance you’ll never walk again.
A
good geriatrician, one hopes, will school you in stability to lessen
the chance of taking a spill. But good luck finding one, since their
numbers have declined even as studies show that people do better over
all under their care. Think your family will be there to steady you or
at least check in? According to Dr. Gawande, half of the very old among
us live without a spouse, and we’re having fewer children than ever
before.
He
writes movingly of his own father’s death, and I felt the lump rising
in my throat five times over 263 pages. But it is the chapter titled
“Letting Go” that I found most useful. There, he discusses the powerful
effect of frequent, concerted conversations about goals and wishes at
the end of life — not just bland, advanced medical directives in writing
but continuing talks out loud.
“It
is not death that the very old tell me they fear,” he writes. “It is
what happens short of death.” But we don’t think about it enough, and we
talk about it even less. Having read this book, I won’t make that
mistake or let anyone close to me make it either.
“The 36-Hour Day,” by Nancy L. Mace and Peter V. Rabins
The
title is a sympathetic nod to what it feels like to care for someone
with Alzheimer’s, other dementias or memory loss, and it could take
nearly that long to read this book and absorb.
Still,
its value is in its encyclopedic nature, including detours into
necessary but often uncomfortable topics like adult diapering and
masturbation. These authors have clearly heard and seen it all.
The
tips in Chapter 16 for people shopping for long-term care residences of
various sorts are particularly comprehensive. You’ll finish thinking
that this is a selection process that shouldn’t happen within 24 hours
of a hospital discharge but should instead unfold over weeks, and you’ll
be right.
“A Bittersweet Season,” by Jane Gross
The
reward for living a reasonably long life, according to Jane Gross’s
mother, was getting to “rot to death” rather than merely dying. As a
physician Ms. Gross quotes later in her book confirms, this “inching
toward oblivion” is no longer bad luck but a “generalizable phenomenon.”
With
that bit of foreboding as a baseline, Ms. Gross takes us on a
no-holds-barred tour through the years that she and her brother spent
caring for their late mother. The author, a former New York Times
reporter whom I’ve never met save for a few encounters on social media,
is unafraid to admit all the mistakes she made out of sheer ignorance
and how often even the most high-functioning adult children simply do
not know what they do not know.
The
book explains the financial side of her mother’s care — including her
eventual qualification for Medicaid — plain as day. I also picked up
even more tips for a list I’ll eventually publish of questions to ask
before picking a nursing home or assisted living facility.
As
someone with a sister and two sisters-in-law, I found the book most
useful as a sort of post-mortem meditation on gender. Women often lose
out twice or more in the aging derby, first when they take on
disproportionate responsibility for their aging parents and then again
when they outlive their spouses in old age. Ms. Gross’s raw honesty
about her feelings about all of this — often fair and sometimes not, by
her own admission — makes this book mandatory reading for any man with a
sister who wants to be thoughtful about planning for aging parents.
“Being My Mom’s Mom,” by Loretta Anne Woodward Veney
There
is no sugarcoating the number of physical and emotional challenges that
come with aging, so it’s clear why Ms. Veney’s upbeat memoir of the
years she has spent caring for her mother, Doris Woodward, who has
dementia, is so appealing.
Ms.
Veney’s steadfast focus on her own mental health is something others
will want to mimic. Her aim is tranquillity and patience, with an
emphasis on reprogramming her reactions, like her frustration with being
late.
She’s
also practical about doing whatever works to make her mother happy.
While Ms. Woodward had no taste for McDonald’s in her younger years, she
found it soothing for whatever reason once her decline began. Often,
the two of them would stay there for hours.
Finally,
Ms. Veney devotes a chapter to humor. Laughing with someone afflicted
with dementia can, in her view, be life-affirming in a period when joy
may be elusive. So we hear of her mother’s confusion over her new memory
foam slippers. How was something on her feet going to help her brain?
she wondered.
At
the end of one particularly challenging day out, the pair stopped for
dessert. When they arrived back at her mother’s group home where she had
lived for more than a year, she did not recognize it though she did
thank her daughter for the treat. “I just don’t remember where I live,”
Ms. Woodward told her daughter. “But of course I remember the ice
cream.”
Paying for the Nursing Home: Tell Us Your Story
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A version of this article appears in print on August 19, 2017, on Page B1 of the New York edition with the headline: Facing Dread Of ‘Inching Toward Oblivion’.
