Assisted Living is Often the Best Choice- That Might Indicate a Problem.

Recently an older family member of mine had a health crisis and decided they could no longer live independently. In their words “the work of daily living” (cooking, managing medication, doctors visits, and errands) was just too much for them to do any of the things they actually enjoyed about living (socializing, going for walks, reading). So, they chose to give up their apartment and move to an assisted living facility.

I have no doubt that this was the best choice for them. But, I also have no doubt that that fact is an indicator of a bigger problem- our society is not equipped for helping people age at home. We’re not even talking about the challenges independent living brings to people as the age.

These past two months have taught me that we as a society need to confront the myth that it’s easily possible for people to die at home. If for no other reason than it’s nearly impossible for people to age at home.

There is an unnavigable gap between when aging people start to need extra help and imminent dying.

1. To be eligible for hospice a doctor must feel its reasonable to expect a person to die within the next 6 months. (And, even then hospice itself is not enough for any person to die at home).

2. There are few to no support programs for help with aging before a person is eligible for Hospice.

3. Most palliative care programs require an acute diagnosis. “Getting old” doesn’t count.

4. As people become more and more dependent on their care-giving community, members of those communities most balance their ability to be there with managing their own lives, the lack of paid leave from work, and the knowledge that once death is imminent they’ll be even more needed.

5. As the tasks of daily living become overwhelming aging people must take on the additional burden of coordinating their care, including any home support services via private pay or medicare, food delivery, medication delivery, and housekeeping. All these things are designed to help people stay independent, but the reality is they are exhausting and often expensive to organize.

I’ve said before that a #DeathPositive Movement (normalizing talking about dying and designing how to meet the needs of the dying) should be concurrent with a #AgingPositive Movement (normalizing talking about aging and designing how to meet the needs of the aging).

The #SilverTsumani is almost upon us, when 65 million people in the United States will be over the age of 65. We’re talking about being ready to support them as they die. When will we start talking about how to support them as the age?




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