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  • Dr. Patricia A. Farrell

Home Alone or Not: Elderly in the America of the Future


©Christophe Faugere

A walk on the sidewalk near my home would prove to be more than just a refreshing day out of doors. I’d walked around this area many times before, but today would be different. Today I would stumble across disturbing information. An innocent talk about a shopping cart took off in ways I or the stranger never intended.


The stranger was, in fact, a woman who lived in this large apartment complex and stopped to ask about a shopping cart she had seen me use. Then the conversation opened up into another area; an elderly 94-year-old woman in the area. Marish was her name.


I’d seen her walking in the roadway, literally half bent over from severe spinal problems, pushing a small cart containing her meager groceries. Moved by the troubling sight, I stepped into the roadway and offered to help her up onto the sidewalk.


Abruptly, she turned to me and without a trace of a smile or a word of thanks, pushed me away, cursing in a low voice and swinging her tattered handbag in my direction. Stunned, I stood there in disbelief. Questioning myself, I thought perhaps I had not been gentle enough or had chosen the wrong words, but that wasn’t the case at all. The woman valued her independence, no matter her disability, and she scorned help as a sign she would not tolerate.


No Thank You But a Clear Message


I learned to hold my thoughts of helping in check when I saw her after that as, once or twice, she came across my path. Frankly, it tugged at my heartstrings, however; I understood and I honored her wishes. But I would be alone in that wish to honor her independence. Her health and her ability to contain her anger were declining.


The months went by, neighbors complained of an odor of gas in the building from her apartment. Marish had forgotten that she left the jets on. Too many times, they called security to her small apartment and the security personnel’s tolerance wore thin. They had her gas shut off.

Nights were even worse for the neighbors now. Marish remained active all night long, banging around her home and playing her radio loudly because of her hearing impairment. There was no civility, no agreement with her regarding her need to move about more quietly.


Neighbors alerted management that water was constantly running; they could hear it. Inspections of her apartment revealed that she hadn’t properly shut the water off in her tub. The water overflowed, swamping the bathroom floor, flowing out into the living room and seeping down into the apartments beneath her’s.


Not a “Move” But a Mandate


The time had come for more muscular measures; she would move to a supervised living situation. Marish protested more than verbally. She filled nights with even louder noises, slamming closet doors and shattering walls with pans, throwing her heavy metal apartment door open and closed throughout the night as she vented her anger.


The authorities were insistent; she could not live alone and she could not remain in her apartment. They would move her with or without her consent. The posted notice was swift and undeniable. The physical move would come the following day.


After reading it intently through half-closed eyes and her broken glasses, the plan was clear and she prepared her response. Dressing carefully in her finest silk dress, a gift many years ago, she ran a warm bath. She did not turn the water faucets off.


Neighbors would, within hours, quickly call the maintenance office when, during the early morning hours, the water came pouring from their apartment ceilings.


They found her there, in the tub where she struggled to straighten out her small, crooked body as she slid slowly beneath the mounting water. Old tubs held so much water there would be no question she would realize her goal.


Sitting with her arms across her chest, her head beneath the water, her white hair floating in gossamer wisps around her wrinkled face she looked at peace. Closed lids covered the pale blue eyes, the small opal ring on her left hand reflected in the glow of the flashlights aimed in her direction.


Independence was her only reason for living and, if she could not have that, there was no reason to live. Her fate was in her frail, gnarled hands. The hands that had scrubbed the clothes on that board, cooked over a small stove in their run-down home where the chickens scratched the ground outside the kitchen window and now the hands that opened the taps fully.


All of that was in the past. She was in America now. Everyone had died. Only she remained.


A Return to Multigenerational Living


The bleakness imagined by Marish is a mismatch with what is and will come to be in the United States. The aging of American is fast coming on and the financial demands are more-than-obvious. What does the future look like for us and for the elderly who will not want to go willingly into that good night of assisted care?


Family units were no longer the dependable lifelines for the elderly starting in the 1950–1980s but a sea change has taken place. Housing developers, building multi-generational homes or homes with an attached unit for the grandparents are, once again, seeing an increased interest in their products.


According to a report from The Pew Research Center, “A record 64 million Americans live in multigenerational households.” This represents an upswing from 1970 when there were 25.8 million of these households.


The population of the world and of the United States, according to The National Institute on Aging, will experience a “predictable very large increase in disability caused by increases in age-related chronic diseases in all regions of the world.” Elderly disabilities are burgeoning because people are living longer thanks to improved healthcare, but this presents a new series of challenges for those left to care for them.


A 2014 survey by The Pew Research Center also found that Marish wasn’t alone in her wish to remain in her apartment. “Overall, women still make up a majority of the 12.1 million older U.S. adults living alone, but their share has fallen over the past quarter-century — from 79% in 1990 to 69% in 2014.


“… findings (of the survey) underline the extent to which older adults value their independence and wish to live in their own home, even when they can no longer care for themselves.” The survey also revealed that 61% of those 65 and older say that, while they would wish to live in their own home, they would have someone care for them there and 17% indicated they would move into either an assisted living facility, while 8% said they would live with a family member in those intergenerational homes that are being built.


In 2016, both young and older adults, live in multigenerational homes. One factor for the increase is cultural with Hispanic and Asian populations preferring such an arrangement.

Independence, in one form or another, remains a primary wish for many older adults. The emphasis is on physical and financial independence, but that may not be possible in an age of increasing costs and decreasing benefits.


Also, the factor of social isolation must be considered for the elderly, despite local senior centers which may not appeal to the vast majority of seniors living independently. Some have termed it a form of “daycare” to which they do not subscribe.


Home Design and Healthcare Jobs


Living independently may not be as easy as some might assume. Structural considerations in a home for a person who ages significantly or has some physical disability is only one factor. There is also the question of cost for the redesign of the home and care workers being brought in on an assigned schedule.


An AARP study completed in 2017, found that 90% of the people in their sample who were over the age of 65 showed they’d rather live in their home and not a nursing home or assisted living facility. The study also addressed the matter of construction and redesign of residences in order to make it more comfortable, convenient and safer for older individuals. Often, this must be on a limited budget in a retrofitting aspect and there is the matter of finance.


Seven key universal design elements need to be incorporated into the re-design. They are:

1. non-slip flooring

2. slip-resistant shower and tub surfaces

3. shower and tub design (which can cost up to $1000)

4. wide doorways to accommodate walkers or wheelchairs

5. lever door handles replacing doorknobs for easier access

6. one-step entrance. However, they did not recommend removing stairs from the home entirely since this can be exercise. The front-step entrance modification can cost anywhere from $1,000-$4000.

7. signage is an often-overlooked aspect of the home redesign for the elderly. The house number must be large and bright enough for emergency medical personnel to see from the street. Mailbox numbers should be visible at night. This is a relatively inexpensive change, however.


Co-housing Alternatives from Denmark


New forms of housing pioneered by in Denmark in the 1960s such as cohousing may be a tantalizing answer to independence, finances and socialization.


Cohousing, which was seen in the United States during the 1970s and 1980s when seniors needed to share their homes with either younger college students or other seniors, is now coming into play. Not only seniors are seeing its merit but young families who want to share the cost of childcare and housework in a pooled-resources type of arrangement.


Several groups are addressing this new style of living and they include Co-Housing Solutions, PDX Commons and a group that is running yearly training programs called 500 Communities. Intergenerational home sharing with seniors and college-age persons is also attractive and Generations United is active in promoting this idea.


In this intergeneration model of a living arrangement, the young person could help with chores around the home like making meals or walking the dog. Several cities are looking at these proposals as viable alternatives to reducing not only elderly isolation but environmental impact; their carbon footprint.


Job Prospects for Senior Care


The estimates regarding the senior living industry, in whatever form it may take, indicate it will require over 1.2 million workers by the year 2025. This industry will create 34,700 new jobs by that year which will raise industry personnel requirements. One study estimated that in the next 10 years, in order to replace workers who will leave, there will be 900,000 positions open.


The Occupational Outlook Handbook has estimated the need for home health aides. The growth will be a “projected percent change in employment from 2016 to 2026…(of) 7 percent.”


Marish would have had opportunities that would have maintained her independence if only she had known about them and had the personality to accept it.

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DR. PATRICIA A. FARRELL