Getting Old in the New West

By Marjorie Smith, 12-19-06

It is certainly not news that the U.S. is facing a crisis in care of the elderly. Since the oldest of the baby-boomers hit 60 this year, it stands to reason that the demographics spell problems ahead. But it’s possible that many folks living in the New West – especially those newly settled in this wonderland of outdoor activity – may believe it’s a problem for other regions of the country, not here.

I beg to differ.

In the past year, three of my close friends have left town, people with whom I used to spend a great deal of time indulging our mutual passion for live community theatre. In all three cases, they left to help look after ailing parents.

Meanwhile, all around me, the parents of our vital, grabbing-life-with-both-hands residents are following their kids here, attracted, to be sure, by Montana’s beauty and recreational opportunities, but also wanting to be close to kids and grandkids as they enter their “golden years.” And when those years turn out not to be all rounds of golf, mountain hikes and games of mah jongg, but include debilitating illness, their children are discovering that elder care can put a severe crimp in their personal lives. Or as one lifestyle emigrant was quoted as saying recently, “We came to hike and ski and now we’re taking care of Mom.”

Six weeks or so ago I was talking to a friend who was running his labor-intensive business without his business partner who was in the Midwest indefinitely dealing with the impending death of his father. “I’m pinning my hopes on PBS,” my friend said. “They’re airing a program on November 21 about the aging crisis. Maybe we can figure things out from that.”

So I put the “Frontline” program on my calendar and dutifully watched it. It stated the problem dramatically: our extended life spans mean that millions of us will live into our dotages – but what will those last years be like? And how will we fund the intensive care required for these hordes of oldsters?

The problem is clearly bigger than my absent theatre playmates, or my concern for another dear friend who dedicated two years to hands-on care of her invalid mother and seems to have narrowly avoided a total breakdown herself.

Once again, I turned to the one friend I have who is doing something about the care of the elderly: Marian Steffes, founder and director of Bozeman’s Bear Creek Respite Care Center.

I say “again” because 13 years ago, when Marian was first establishing her business, she was a beacon of hope to me and my mother. At the time my father, who in the space of six years had endured open heart surgery, prostate surgery and uncounted small strokes, had become a major concern to my siblings and me and especially to my mother. He was increasingly vague and had an obsession with pills, often forgetting that he had just taken the days’ medication. The knowledge that someone was opening a center just a half mile away where someone like my father could stay for a few days while my mother went on a trip, or that would offer daycare for people who shouldn’t be left alone – this was a major tonic to my mother’s morale.

Marian and her then-husband bought a single family home in the same neighborhood where I grew up and where my parents still lived and after extensive renovation, opened it with six bedrooms for residents plus facilities to accommodate as many as eight adult day-care clients. It’s such a pleasant setting, down a long driveway off one of Bozeman’s busy boulevards but with trees and fabulous views over the valley, and immediately Marian, a registered nurse who specialized in acute care in graduate school, was besieged with requests that she provide full-time live-in care at Bear Creek. But because of her goal of providing respite for family caregivers, she has held firm and kept at least two beds available for temporary clients. It’s a kind of care that is still difficult to find in the Gallatin Valley, although some of the new assisted-living centers that have opened over the past dozen years are edging toward providing respite care.

It seems obvious that anyone will be happier and better off if they can stay in their own home rather than being moved into an institution. In fact, 20 years ago, my Japanese friends liked to tell me that elder care was superior in their country because “we refuse to warehouse our parents in old age homes.” At the time I could see the other side of the equation – the women whose lives segued almost immediately from intense mothering of their children to almost slave-like dedication to their parents-in-law in their declining years. Now, as more and more Japanese women have careers (and frequently decide against getting married because they don’t want to go into full-time care of other people) things have changed and retirement homes are being constructed throughout Japan.

How do the infirm elderly stay in their own homes? Either with hands-on care from a relative, like my friend who had the near-nervous breakdown after two years in her mother’s home, or like my other friend who supervises the round-the-clock hired caregivers who care for his parents. This sort of solution is not a panacea, even if the family can afford it: my friend has been so frustrated with the quality of caregivers the agency has been able to provide, and so overwhelmed by the financial situation his parents had reached before anyone realized they needed help, that after ten months in his new role, he suffered a heart attack.

It can’t be right for people in their most productive years to give up the rest of their lives indefinitely so they can look after their parents, I have frequently ranted, even while realizing that I have been – so far – extremely lucky. My father never got to sample the respite care at Bear Creek – he died of a sudden heart attack shortly after Marian opened her center. And my mother, relieved of her caregiver responsibilities before they overwhelmed her, has thoroughly enjoyed the past 12 years, traveling to all the corners of the world she hadn’t been able to visit with my father who had grown too timid to travel outside the United States. At 86, she remains in good health, managing her own home and garden and doing almost all the work in both (it’s very difficult to hire someone to help her who will live up to her standards, especially where weeding flowerbeds is concerned). Almost every time I stop by she sends me home with home-made soups and baked treats, and she is still signing up for a couple of international trips each year. I try to remind myself that if and when she becomes unable to manage on her own, I might have to move into her house for awhile. I can’t imagine her in an assisted-living facility. For one thing, they probably wouldn’t let her bring her three cats and I’m not sure she could survive without them.

I’m trying to learn from my friends’ caregiving experiences in case I need to assume that role at some point. Marian Steffes agrees that it’s often the open-ended status of long time care that grinds the caregivers down. There’s a tremendous amount of stress in putting on theatrical productions, for instance – but there is always an end in sight: by opening night the lines are all learned, the costumes and props all located. After the final performance, the set is struck and everything is carted back to the storage unit. But with elder care – there are no scheduled closing nights. And trudging through the days waiting for a loved one to die has got to be about the most spiritually debilitating way to live a person could have.

Caregivers need to recognize their own need for respite, Marian says, admitting that early on in her business she had trouble taking necessary breaks herself. “That idea that I had to be there for the clients all the time was certainly the main cause of my divorce,” she says. “People over-commit – we all do that. And for the elderly, it’s an extremely stressful situation. Americans have a sense of independence built in, I think, and it’s very difficult to be dependent on others, so that people are not always at their happiest when they are in care.”

Marian insists, “I like end-of-life care. It’s good to make life good at the end.” But like all caregivers must, she has learned to take her breaks. Last year she turned Bear Creek over to her staff and took a full month off to go hiking in the Peruvian Andes. “It was a wonderful experience,” she says, and not just the South American part. Before she left, she notified all the families of the Bear Creek residents about her plans and suggested their visits would be even more welcome while she was gone. “The families came to help the staff while I was gone. It was a wonderful response.”

Marian takes her residents and the daycare clients on outings whenever possible. “You’ve got to keep people involved with life,” she says. “There should be variety instead of endless routine. And the residents need to know they belong to a community and see things like the new library.”

She takes the clients to lunch once a week in local restaurants and acknowledges that their reception as they arrive with walking frames and wheelchairs has varied widely. “I always try to tip generously,” she says, “but some servers really earn those tips by making my people feel welcome and as important as any other client.”

Having just survived a major milestone birthday myself, I’m a little grumpy on the whole subject of aging this month. I’m not at all confident that our society has figured out how to deal with the entire issue of staffing and financing elder care or even focused sufficient attention on it. But it’s awfully reassuring to know that someone like Marian Steffes is hard at work trying to make a difference in one small corner of Montana.



[End of article]