Assisted Living: An Insider's View

Assisted Living: An Insider’s View

Carol Netzer

Smashwords Edition

Copyright 2013 Carol Netzer

Smashwords Edition, License Notes

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Table of Contents

Preface

Chapter 1: A Letter To My Doctor

Chapter 2: Self Management With Assistance

Definition

The Building

The Staff

Philosophy of Assisted Living

The Difference Between Nursing Homes and Assisted Living

Chapter 3: Background

Personal Introduction

Introduction To Aging

Successful Aging

The Reasons Not To Change

Chapter 4: My First Residence: Cadbury Commons

Making The Rounds

Cadbury Commons

Reception As A Newcomer

Meeting And Greeting

Food

Transportation And Its Sorrow

Failure To Thrive

Some Of The Residents And Their Ways

Assorted Journal Entries From My Days At Cadbury Commons5

Farewell, Cadbury Commons

Chapter 5: Socializing At The Hallmark

The Dining Room

What Is Assisted Living Like?

Leaving Home

Friends

Taking Initiative/Avoiding Isolation

The Elevators

Friends And False Starts

Inside/Outside

Death And Dying

Chapter 6: Activities At The Hallmark

Activities

The Hallmark Kind

Tuesdays At Four

Chapter 7: The Pull Towards Regression

The Psychological Side of Aging

Reasons For Regression

Falling Out Of Life

Foreknowing

The Role Of The Retirement Home In Regression

Who Are These People?

Infantalization

Chapter 8: The Defenses of Old Age, or Coping With Change

Reticence

Institutional Inertia

Denial And Aggression

Shutting Down

Repression Aids Regression

Regression in the Environment, Regression in the Self

Regression In The Self

Passive Aggression or Wheedling Consent

Resilience

Chapter 9: The Old Old

Introduction To Aging

The Old Old

The Secret Of Longevity

Centenarians

The Lively Old

Hostility Toward The Old

The Charms of Old Age

Chapter 10: What You Won’t Find In Brochures

Failure To Thrive

Mitzi

Henry And David

Marie

Aggie B

Failure To Thrive

Alfred

Roslyn

Marjorie

Treatment For Failure To Thrive

Chapter 11: Making The Transition

Asking The Necessary Questions

Hands-On-Support

The Transition Experience

The Deciding Moment

A Poor Transition

Emotional Issues

Making Friends As A Newcomer

Summary

Chapter 12: Making Friends: Lively Minds in Old Bodies

Finding Like-Minded People

Obstacles To Making Friends

Lively Minds in Old Bodies

False Starts

My Higgledy-Piggledy Friend

Chapter 13: Exercise: The One Good Addiction

Exercise For Seniors

How To Convince The Sedentary?

Prescription for Staying Active: Exercise and Brain Power

Why Does Exercise Build Brain Power?

Learning as Exercise

Developing Endurance

Never Stop Learning

Strength Training

Stretching

Balance

How To Keep Active

Exercise Can Even Improve Your Brain!

Short List of Benefits

A Further Benefit

Chapter 14: The Benefits and Drawbacks of Assisted Living

The Neglected

How People Manage

The Drawbacks and Benefits of Assisted Living

Other Questions to Ask The Staff Before Signing On

Endnotes

About the Author

Preface

Shortly after I moved into assisted living I started to write down my feelings about it in order to get comfortable with the move. That led me to consider the nature of assisted living itself and how other people adjust to it. I began to make inquiries. I discovered that many books and journals have been written about the residents and staff of retirement communities by professionals, but that there were few day-to-day accounts from residents themselves. The subjective experience, how it feels to live in assisted living, are few. Nor is there much information about the actual performance and practices of these facilities available to the public. A resident’s eye is needed.

As I was in the thick of living it, I thought it might be useful to report on what I observed in my new situation, the ways I found to adapt to it and, finally, my contentment and modest pleasure at living in an assisted living facility today.

I must say at the outset that the retirement communities I have lived in, Cadbury Commons and The Hallmark, are both of high quality. Still, the transition was difficult. I hope that reporting on my own experience will serve as a guide for those considering the move, be of help to those now in residence who are still coming to terms with some puzzling aspects of their new and different lives, and provide useful information and insight for those advising the move (i.e., adult children, physicians, friends, etc.).

In my early eighties, I moved to Cambridge, Massachusetts to be near my daughter, Jenny, and lived at Cadbury Commons for a year. I then spent a trial month at The Hallmark in New York City, liked it, and signed on. Cadbury was small and compact, with only 75 residents. The Hallmark, where I am now, has two hundred residents on fourteen floors.

Assisted living is the name for a community of diverse older people who live under the same roof and who, owing to age or disability, have given over most of their former responsibilities to others. Food, shelter, some medical care, entertainment and transportation are provided in many of these facilities, but they are not nursing homes. They are designed to accommodate independent living. Most residents are still mobile, enjoy socializing, look forward to dinner with others in the communal dining room, and go out with old friends whenever they wish. They go their own way. The great advantage of residences like these is that the vexations of ordinary life are taken care of. Residents are free to do as they please. Life moves at a slower pace. The halting ways of the elderly are not overrun by the fast-paced city dweller.

Although both residences I’ve lived in are stable and well-regulated, relations among residents are transitory, more like living in a good apartment hotel with medical facilities than living next door to a family in your hometown. In real life, you have a stake in the community through school, work or neighborhood. In assisted living, the occupants come from various backgrounds, in various degrees of health, and it takes time to find company. One woman, Jan Slepian, 88, described her arrival this way: I remember feeling as though I had landed on another planet. It took some getting used to. ¹

I know what she means. My own transition to assisted living was in some ways blind, improvised and unsure. Scheduled events in the residence and the proximity to others help people to socialize, but you have to find agreeable companions on your own.

Taking that initiative makes for a more interesting life in a bland community. After trial-and-error at Cadbury Commons, I learned some new ways to socialize and made two good friends. By the time I got to The Hallmark, a bigger place, I found friends and a place for myself with greater ease. I was helped in both places by friendly residents who looked out for me. In this book, I will pass on some of the lessons I learned and hope that they’ll be as useful to others as they’ve been for me.

My daughter, Jenny, did the initial scouting. We both read a number of brochures before the first move, and together we visited five or six different places in the Boston area. The brochures stress the ease, comfort and safety of the residences, describing them as nurturing places to shelter the aging and disabled. We talked to current residents, and in each facility the manager showed us comfortable apartments of different sizes, toted up the cost and pointed out the advantages of the locale. We were left to think it over.

Cost, and who pays it, is a major consideration. I pay my own way, but when adult children pay the bill for the parent there is role reversal (perhaps not for the first time). In either case, cost should be discussed in advance, because this dependency might influence the quality of the transition. The parent’s comfort about making the change is what matters most.

The price, whatever it is, cannot include the emotional cost of making a major change in life at an advanced age. Only the individual experiencing this change can speak to those feelings. He or she may be hesitant to do so because she has conflicting feelings about a decision that seems so final. Her adult children should be aware that she may want to stay where she is rather than risk the unknown in assisted living. Or that she secretly wants to live with one of her children but has not been asked. Or that she would rather die rather than live with any of her children. She may also be reticent about revealing what she prefers if her children are paying the bill. Above all else, she is protective of her children: she does not want to cause trouble. She does not want to be a burden.

She might not use those words, but she’ll act on them nevertheless. This protective feeling is lifelong in most parents, and so strong that she still doesn’t want the kids to worry. Kids who are in their forties or fifties, have already had to make many hard decisions and are fully capable of helping her with her own.

Moving into a residence, even for independent living, is a big change, so it’s better to speak up beforehand than to arrive at the new door unhappy and resentful. However she comes to this decision, the facts of her life demand a change. Her husband has died. The house is too big, too isolated. She has chronic health problems. The friends she has left have all moved to Florida. A retirement home may come to seem to be the best way to grow old close to family.

I was uneasy about leaving New York City and moving to Cambridge. But I knew that among gerontologists, close to family trumps all other concerns, so it wasn’t hard to quiet any doubts as we prepared for the move. Also, I was genuinely happy with the prospect of living near one of my daughters, neither of whom had lived at home since leaving for college.

For me, the major reason for accepting the change was loneliness. I needed daily contact, even transient contact, with responsive people to make me feel less isolated. In my eighties, I also knew that I would grow frail and need help sometime soon, and I wanted to be in a place where someone knew my medical history. Only later did I fully realize that living in an unfamiliar place in an unfamiliar state would be more of a source of conflict than I could foresee. I was too preoccupied by the physical move and the emotional upheaval that goes with it. I put any doubts I might have felt onto a back burner.

As the rooms of my house emptied, I was sometimes uneasy, but then I’d vigorously pack up another box for Goodwill and return to the task at hand. I was confident that my loving daughters were protective of me and would be immensely relieved to know that I would be safe.

And I didn’t want to be a burden.

The first evening at Cadbury, Jenny had dinner with me. The resident manager had thoughtfully seated us with two congenial people, Helen and Harvey, who became good friends. That was good luck. The next morning, however, when I came downstairs on my own, no one was around, and I felt alone and unsure.

At that time I was still walking well, so I began to explore the neighborhood around Cadbury Commons to get my bearings, and when I came back I spoke to whoever was around. People were formal at first, but gradually I found friends.

There was some mild hand-wringing by the staff about my long walks because I didn’t carry a phone. But it was a liberal place that generally applauded initiative. I was physically able and needed the exercise and the feeling of being in charge of myself. The absence of responsibility in assisted living created a vacuum in my life, but no sense of freedom. It was like the old joke about the child playing on the monkey bars who asks his mother, Mom, do I still have to do what I want to do? He needs to direct himself to the swings!

My walks provided the sense of purpose I needed. I was afraid that the canes, the walkers, the debilitated, the intellectually impaired and the lack of vitality around me would immobilize me as well. I had to keep reminding myself to keep moving, as this was just a preview. I was looking at my shrunken self next week, next month, next year.

I regretted not having been resourceful enough to live out my years in the world like a normal person. My ideal was someone like Hazel Miller, who at the age of 100 lived alone and said, I don’t need help with anything. I just pass the time reading, painting, going out. I have a lot of friends I visit with. I eat out two or three times a week. So the time passes. In fact, I flit around doing a lot of things when I should be painting.²

What a role model!

I met some people in both residences who were over 85 and made the transition better than I. They enjoyed the experience from the start. Others were stoic and endured it. Still others were depressed and withdrawn, and never fully recovered from this, their last move.

I believe that preparing for the change emotionally can decrease the number of the depressed old considerably. In this book I offer some suggestions on prevention.

I admire many of the people I’ve met for their courage and resilience in moving gracefully into life’s last stage without my doubts and jeremiads. The two aforementioned good friends I made at Cadbury, for example, who filled me with awe. Both have spouses with Alzheimer’s. Harvey lives in the Alzheimer’s unit (called Morningside) to be with his wife. Helen, who has a serious illness of her own, is matter-of-fact and calm about her husband’s long-term dementia, lives in an apartment with him, and competently manages his care.

There are many quiet heroes like them in assisted living.

Chapter 1

A Letter To My Doctor

CAROL NETZER

66 Sherman Street, Cambridge, Mass., 02140

617-945-1595

E-mail: carolnetzer@gmail.com

May 21, 2009

Dear Dr. Papp,

I thought that you might be interested in what life is like in Assisted Living, and how I’m faring living this way, and so I’m writing you this letter. My account is subjective in every way, but here goes: There are about 75 residents in Cadbury Commons. The ones who come to meals, lectures and activities are in the majority, I think. There is a separate Alzheimer Unit called Morningside, some of whose residents are taken out to the garden by aides. They attend activities like baking in a bright and sunny activities room that is down the hall from our main gathering room. One of them is a lady with a dog (as in Chekhov’s story) and in another life she must have been a grand dame as she wears pretty whirling skirts and retains a haughty manner. She appears for lectures and travelogues but not for meals and then disappears into the Alzheimer Unit, I think.

Before I left New York I may have told you that I had heard that Cadbury Commons was full of Harvard professors, and so it is. One of them greeted me quite kindly when I came (not usual—many of the old and/or infirm barely relate) is said to be ninety, a former professor in the Business School. He walks to Harvard Square and back most days, a distance of a little over a mile each way. A neighbor who is distinguished looking and reads the New York Times intently every morning at breakfast is aloof even from his former colleagues, which may be because his wife in a wheelchair can cause a ruckus when displeased. He wrote that famous book on negotiation, Getting to Yes. Professor Fisher is stoical and silent at his wife’s outbursts but attentive to her when she needs something although she can also whip around in her wheelchair on her own and demand whatever it is from whoever is doing her in. No negotiation there! He seems resigned and dutiful but committed. There are two other valiant men here who are devoted to their demented wives who are constantly attentive and tender and this is very touching to see.

I am friendly with a couple named Helen and Hugh. Helen has a serious physical illness—leukemia, but Hugh has Alzheimer’s and is almost completely silent and it is never clear whether he understands what’s going on around him. He and I are in a play-reading group and the other day we were reading Ionesco (only in Cambridge! ) and Hugh read off several paragraphs from his assigned part loud and clear How can that be? It was like the musical autistics Oliver Sachs writes about. The other day Helen took Hugh to Brigham and Women’s for an appointment and she collapsed in the waiting room. I ate dinner with Hugh that night and he said to me, Lucky we were in the right place. He also knew where Helen kept their address book when I went with him to try and call their son. Otherwise, he ate heartily and indicated silently that he liked the food (which is god-awful). His affect is flat but he smiles and is very endearing.

I am also friendly with a child psychiatrist who can be offbeat in the way I am. He is deaf, but I don’t know what other deficit brought him here. I think that he shows signs of the deadening and despair that is all around us and that can undermine adjustment, or maybe he’s just making the most of it while he can—it’s hard to tell. Every morning he has pancakes, bacon, eggs, and syrup for breakfast which I envy but would never eat as a regular thing because I’m still consciously trying to stay fit and stave off despair. So, in my friend’s case, is his breakfast Living Large or a cry for help?

Now we come to me: I‘ve been living here for two and a half months and still find the adjustment hard. Institutional life is very different from everyday home life. Meals are early (5:30 pm for dinner) and at regular intervals. (Dinner, especially, is terrible–bland, overcooked, without seasoning.) The doors are locked at 9:00 pm, which means a whole rigamarole about rousing the night person on duty when I come in after nine from Jenny’s house. I have a panicky feeling while waiting as though I am being imprisoned but I also feel as though I have been locked out of my prison home as well! When we go on trips in the Cadbury Commons van, we ride around the area but do not get out in deference to those on the trip who have walkers, difficulty walking, or are easily confused. Walden Pond is an example where I felt the difference between Real Life and life here. We drove right up to the pond, but not getting out of it to walk around it or see Thoreau’s cabin as I have done in real life makes me feel keenly that I am outside of everyday life forever. (I am saved by knowing that Jenny would be delighted by my request to go there and would drive to Concord any weekend).

For the rest I think there is a subliminal downer effect in constantly seeing so many disabled people, many of them in various stages of dementia. This is so although I get along very well with them and have a special feeling for them as I did when I worked at an Outpatient Clinic for South Beach years ago. They speak to the Id in me.

I counter the experience of being here by long walks although the major square, Harvard Square, for example, is a little over a mile away as are the other centers of urban life. I miss the everyday