Mother’s last years: How we treat the very old, part I

This post got way longer than I intended, so I am going to separate it into two parts.  It is about the last 2 years of my mother’s life, and the way she died.  I believe the story illustrates aspects of the treatment of the very old that trouble me. 


My mother was the kind of woman you notice.  Her hair was black and she had a deep widow’s peak.  She stood straight, she was slim. For her time she was tall.  She cared a lot about her appearance and she spent money on clothes when she would skimp on everything else.  She was intensely intellectual.  She had a brilliant mind, she spoke and wrote well.  She was a social animal and loved to be the center of attention.


She had a Ph.D. in economics and had written a couple of books and taught college.  She continued her intellectual life into her old age.  After she retired to La Jolla, CA she spent a lot of time at the Institute for Continued Learning at UCSD. 


At the age of 95 she agreed to give a lecture on economics at the Institute. She worked hard writing it all out.  Having to read it distressed her because when she was younger she wouldn’t have had to look at her manuscript.  Nevertheless, after the lecture she told me, “A very old man [remember, she herself was 95] hobbled up to the podium and said ‘that was the best lecture on economics I ever heard’”


Besides economics and politics she had a passion for music and theater.  When I visited her she would tire me out taking me to concerts, plays, and to lunch and tea with her many friends.   


Gradually I began to see that she was slipping.  Every few months I would travel down the west coast to La Jolla to check on her.  She became more and more difficult.  She wanted to discuss her problems every minute, and she became angry if I occupied myself with anything else, like reading a book or listening to the radio.  She was aware that she was deteriorating mentally, and she hated it.


In 2004, when she was 98, it became clear to me, and to my sister as well, that she could no longer function on her own.  Up to that time she had been living in a little apartment near the sea in La Jolla. 


She was forgetting appointments, forgetting to pay bills, and her gait became a sort of shuffle (a symptom of Alzheimer’s), her spelling deteriorated, and she frequently showed signs of confusion about daily activities.  We wanted to let her stay in La Jolla, a place she loved and considered home, and where she still had a few friends living.  However, there was no facility there that would take someone with even mild dementia.  The best we could find was a place about 40 miles away. 


I persuaded her to come back to Bellingham near me.  She had tried living here for a while after she sold her pretty house in La Jolla, and I packed everything up and moved her up here in 1997.  But she pined for the warmth and familiarity of her southern California jewel of a village, and so I packed her up and moved her back again.  That was in 2000.  Now, in 2004, we were preparing to make yet another move. 


At first I thought she could still function in the retirement place she had lived in when she was here before.  We had all the papers ready, and she was to move in the next day when her best friend in that retirement place suddenly died.  She declared that the shock was too much and she couldn’t live there. 


I have a duplex here on my island that I live in one side of, and I moved her into the other apartment.  It wasn’t ideal from the point of view of social life, and she didn’t like the isolation of the island, but for a while we muddled along. 


It was difficult, though.  She was demanding and wanted me to be with her and entertain her all the time.  She really couldn’t read much any more and my attempts to find her friends among the other older people on the island were not successful.  She needed help with bathing, and I am a small person, smaller than my mother, and I was already in my 70’s.  New things were no longer easily managed.  I found I had to watch her, because she would decide to take walks and get lost.  People would pick her up along the road and bring her home.


For reasons not relevant to this account I had to go away for several months, and I arranged for people to take care of Mother full time. 


When I came home at the end of the summer my sister and one of her daughters visited briefly.  The main person who was taking care of mother was a wonderful lady named Stephanie with whom my mother had definitely bonded.  Things seemed to be going reasonably well. After I returned Stephanie continued to come part time which gave me some respite.  Fortunately, Mother had enough income to pay for all this.


I got tickets to some Shakespeare plays in Vancouver because mother was very keen to see them.  Stephanie went with us and we stayed in a hotel.  There were 3 plays.  Mother was having difficulty getting around, so we got her a wheelchair and had hearing aids for the plays.  I felt that she wasn’t getting much out of the plays – she did a lot of dozing. 


She was not doing well in Vancouver.  She had difficulty with bowel incontinence, and it was a struggle for Stephanie and me together to get her in and out of the bathtub to clean her up.  I became quite worried and wanted to take her home to the doctor, but Stephanie persuaded me to let her see the last play.


We left Vancouver and I drove her directly to the hospital where she stayed for 4 days.  She seemed to have become practically immobile, and I thought perhaps she had had a stroke.  They never determined what was wrong with her, but after the requisite amount of time for Medicare they referred her to a rehab center.  There they put her on a regular ward at first, but soon moved her to the dementia unit which had a security lock. 


She was soon able to walk again and she had various sorts of therapists.  When she was first in rehab she was having serious delusions, like thinking her feet were musical instruments, but she improved quite quickly with therapy, and by the end of her stay was no longer having bizarre thoughts.  Her bowels came under control and she was walking better.  After 6 weeks the rehab administrators declared she would not improve with more treatment (that’s Medicare’s time limit) and that she would now have to pay $6,000 per month to stay there not including any therapy


Now there was the dilemma of where she should live.  The medical opinion was that she needed institutional care and could not be at home with me.  My sister was also opposed to her living on the island.  I did not want her to stay in the rehab place.  It had a dismal look about it and it smelled bad.  Some of the other patients were in much worse shape than Mother, and could be disturbing.  One poor lady went up and down the hall continually shouting, “I want to go home.”  Another, a good looking man in his 60’s, would come up to every visitor and say, politely, “Could you tell me how to get out of here?”


We found a reasonably pleasant place where the patients were segregated according to the severity of their dementia.  Because of Medicare rules I could not get any further therapy for her.  The medical opinion was that it would not improve her condition, and she couldn’t have therapy without doctor’s orders.  I continued to have Stephanie visit with her a couple of times a week. I took her out to lunch at least twice a week and to all her doctor’s appointments.  But she hated living there, and whenever I returned her to the facility she would beg me not to make her go back.  It was hard for both of us.


There were some lighter moments.  The residents at the facility often strayed into each other’s rooms, and one day when we were having lunch at Anthony’s she complained to me repeatedly that there had been a man in her room the night before.  I told her not to worry about it and made a mental note to mention it to the caregivers.  After lunch, when I took her back, a new sign had been placed directly in front of the outside door that said “Dementia Care Unit”.  She read it and exclaimed, “Dementia Care! No wonder there was a man in my room!”


Some days her memory was pretty good, and there were other times when nothing would trigger remembrance of past events.  One day I mentioned Kitty, her step-daughter-in-law, but I couldn’t evoke a recollection of who Kitty was.  The next time I saw Mother I tried Kitty again.  “Oh, that poor woman, she works so hard and she has so little.  I wish I could do something for her,” said Mother.  She remembered Kitty perfectly.


Once as we were driving through Bellingham she looked around and said, “I used to live here, you know.  I had all my wits about me then.”


She never had a visitor she didn’t recognize.  A friend from New Zealand came once, the son of Mother’s best friend at college in New Zealand.  It had been about 10 years since she had seen him, and I warned him that she might not know him.  But she did, she was delighted to see him, and they had a good time together that day.


I have told enough of this story to make my first point about the last, difficult part of life for many of those who live to be very old. 


I believe it could be a lot better.  The facility my mother was in cost more than $5,000 per month, and it was basically custodial care only. There’s an attitude that says, “They’re old; they can’t be ‘improved’. Put them away, play them some Lawrence Welk now and then and forget them.”


I believe we shouldn’t just give up on people with Alzheimer’s, or dementia.  I saw that therapy was helping my mother and they cut it off because of Medicare regulations.  Perhaps it isn’t so much the therapy, but the intelligent attention.  It isn’t good enough for a well meaning young person with no education to say, “How are you today, Marion.”  What’s needed is a person, or persons, with some expertise, interest and intelligence to work with these folks.  I could have had my mother with me with that sort of help.  And I needed help for things like bathing.  I know in some cases bathing help is available, but it wasn’t for us because of the island location.


My mother could afford not only the care she got but also many extras like having Stephanie visit, going out to lunch frequently, and shopping for clothes, which she loved.  But many of the people in the same facility were just spending down until Medicaid took over when their money ran out.


It is inevitable that some old folks will end up without family to care for them, but there are others like my mother, who have loved ones to keep them at home if adequate help were available.  There are programs to help people with disabilities live as normal a life as possible.  Something like that is needed for the very old.  


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12 Responses to Mother’s last years: How we treat the very old, part I

  1. dale says:

    It’s very difficult. I wish we did better with it, as a people, too.

  2. Dick says:

    With my own mother’s decline through dementia towards death so recent, this account resonates strongly, Anne. As Dale says, we don’t do care in age well. In fact, alongside our profound and increasingly proactive concern for the child, the wilful neglect of the old is an international disgrace.

    I wish you and your mother as comfortable a year as can be managed, and, when the time comes, may it be peaceful and swift in passing.

  3. Old Woman says:

    Dick, she actually died 3 years ago this month. My next post is going to be about her death, because I have another point to make about how we view the death of the very old. I know it is a difficult question, but we don’t do that right either. And thanks so much for the comment. Anne

  4. Nancy Andreasen says:

    My mother died at 91. The transition was not as difficult as your mother’s, happily. I am wondering about my own future and that of my children, since I am 77. We live on 13 acres, so far without help, and my husband is severely impacted by a terrible back (3rd surgery on Monday.) He wants to live and die here. I am puzzled as to how to manage things so that my children do not have a terrible burden of care. Ah me!

  5. Old Woman says:

    Nancy, it all depends on how much work is involved in taking care of it all. I am 77 also, and live on 5 acres. But it’s mostly woods and my husband is well. I know what you mean about being a burden on your kids. Not to mention the loss of independence. There’s no easy solution, I’m afraid.

  6. Lindsay says:

    Anne, your writing touches me. I’m very glad that you stopped by The Muse Asylum and left me your comment, so that I could discover your writing. You, too, write good sentences.

    The way our society treats the old and the very old is troubling. As you wrote, in many cases, the person could be cared for by family if only there were supports available. Never mind the fact that this is better for that person and their health (all aspects, including mental), but I think it might even work out to be less expensive monetarily. Even if it is not, however, I think that those who raise us and build our communities deserve to live out their years not only with dignity, but also with interaction and activity.

    Waiting for Part II.

  7. Anne:

    Thank you for writing about your mother. Poignant, too, the way the loss of a parent so profoundly affects us. I’ll watch for Part 2.

    Rae Ellen

  8. zuleme says:

    Hi Anne,
    There is another good blog written by a woman on Cape Cod called By Bea’s Bedside. It is about the years she spent caring for her mother who lived to be, I think, 100 or close to it. Her mother has died but the blog is still up. We are caring for my husband’s parents who are now 80. They live next door in a large apartment we built with our video studio on the second floor. Right now they are both doing well and we will just deal with what comes as it comes. I can imagine that your mother was distressed to live her pretty house by the sea in CA. Gosh, if I had something like that you’d have to tear me away from it too. I think older people get very disorientated when they have to leave familiar surroundings.
    We have the two buildings on about three acres and a long driveway. My husband plows it with a tractor and a snowblower on the tractor since the road is narrow and drops on off one side. It would be close to impossible for me to live here without him if I could not do it. We talk about moving when we no longer have his folks with us but it will be tough since we built this place by hand when we were twenty.
    Some of us here talk about building a community of friends who have known each other for years. We’re all spread out and visits require cars. It would be nice to be able to walk over for tea and have someone to watch the cats. A lot of work to make it happen though. I agree that things have to change in our we care for elders. And I hope it happens before I am one.
    Two of my grandparents lived to be 100. I almost hope I don’t.

  9. Old Woman says:

    Thanks, Zuleme, for your comment. My aunt lived till the end of her life, 87, in Peterborough, NH. She had about 10 acres. Most of it was pasture and a neighbor dairy farm used it for grazing. The thing that allowed her to stay, and that allowed my mother to stay until she was 98, was that until that time both had working brains. Help is available in most places if you have the time, the good sense, and the money to get it. My aunt never learned to drive a car, but neighbors, or sometimes the red cross volunteers would take her shopping or to the doctor. It is when dementia sets that these sad changes have to happen, and the elderly lose control over their lives in such a tragic way.

  10. I am in the thick of this now with my 97-year old mom. She is still lucid, but her body is failing her, little by little. At least her assisted living home is cozy and staffed by great people who have good activities for the residents. Ah well.

  11. Old Woman says:

    Bozette, I think that the worst is when the body is strong (my mother’s case) and the brain fails. She knew that her brain was failing, but she couldn’t bear to relinquish control of her life, even though she couldn’t manage it. For people with dementia group activities don’t seem to work very well. They need intelligent individualized attention, and that’s almost impossible to come by. Thanks for the comment.

  12. btchakir says:

    I Drink a lot of coffee… Now the Swedes say that could prevent Alzheimer’s

    I was happy to read a Yahoo article in which a Swedish study showed that folks who drink five or six cups of coffee a day in middle age reduce their chances of getting Alzheimer’s disease in their later years.

    As I approach my later years, already with enough medical problems to make me wince, Alzheimer’s is something I really hope to avoid. Now all the coffee drinking I’ve done (and still do) seems to have a reward.

    The few times in my life when I’ve given up coffee for a number of months at a time are behind me. My praises to caffeine.

    Under The LobsterScope

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