Wasn’t it just yesterday that I chatted with friends, talking about holiday preparation, what the grandkids were doing, golf scores and the weather? Today when we chat, it is about doctor’s appointments and which friend just had a colonoscopy or is about to go into chemotherapy or has broken her wrist in a fall or has decided to stop driving. Increasingly we discuss what we thought of an obituary. This is happening so fast.
I have always been precocious. True to form, it makes sense that I am getting to my death ahead of time. As a result of divorces, my two kids currently have six parents (biological and step) age eighty or more in their circle of love. I am determined to prepare as much as possible to make things easy for them as I approach all the nasty possibilities that come with aging. I live alone and currently I live 4300 kilometres away from them.
Because of the urgency of climate change and the persistence of Marie Kondo in reminding me to declutter, I must address my demise. Accumulating stuff is hurting the planet. It is not possible to throw something ”away.” There is no ”away.” I am accosted by startling pictures of unimaginable volumes of plastic clogging our rivers and oceans. With hope, I am about to wash my hair with a bar of shampoo that I purchased in a cardboard box.
When my mother and dad gave up their family home, my elder siblings came in with a U-Haul truck and just put everything in it and it went ‘away’ to the dump. I was a very much younger sib and I remember my terrible distress. I was learning, brutally, the lesson of impermanence. My siblings did not want what was in the house. Their own houses were already full. I was too young to have a house and all the things that had made me feel safe were flying away to the dump. The wooden mincemeat bowl is gone forever.
Now I have a house and I have stuff and lucky me, I have Marie Kondo on Netflix in my den. I must keep only what gives me joy and all else must go, hopefully to be recycled. How did I get so much stuff? Out with a friend recently, I purchased a new skirt. She remarked, and kindly, that I must have twenty-five skirts! I was shocked by the possible truth of what she was saying. In fits and starts, I declutter. My son has told me I am getting there, as he says that he and his sister could empty my house in less than a day. Yet it is hard to cope with such a small imprint. Of course, I am more than my stuff but so many items give me joy or are my friends filled with memories. They tell me to take a photo. While it is not the same, I remind myself that I do like looking at photos and that this might work.
I have this problem that I animate things with spirit. That broken damaged silver sugar shaker is so sad that it has never been repaired and that its days of usefulness are over. I feel guilty that I never fixed it. My children loved it into its present state of disrepair. Maybe sugar shakers have disappeared forever into nutrition eviction? This business of animation that I inherited from my ancestors makes it hard to let go.
I am thinking about giving up buying plastic altogether. Margaret Atwood did it for a year, I am told. I don’t think she is the cheating sort. I think I would have to cheat.
I drive a car very little and I ride in planes very often. So much energy goes into contemplating options. Can I truly be a less selfish “older”? My grandchildren have been inspired by the activism of Greta Thunberg to fly less often. We went on a driving holiday this Christmas into the heart of winter in Quebec City. Brilliant, I think. I accept, if I live, that when the time demands it, I will move back to Ontario and so flying to be with family will be over for me.
I did decide to get cremated and where to have the urn buried. I did not want to reside in my children’s closets because they did not know what to do with my remains. I really wanted my body to be shrouded and buried in the ground. I like compost. However cremation seemed like the best choice for me, if not the climate, as I live a long way from the cemetery where I have arranged to be interred. Nothing seems easy or simple. I had to get written permission from my entire living family to have the privilege of being buried on top of the bodies of my grandparents and my two infant children. Apparently they also had rights. Burying my ashes was acceptable but not my shrouded body. There is always red tape.
I made a list of all my possessions that I might like to have a particular destination, and I update it and send it to my children from time to time. I told them about what kind of a “funeral” I would like and who to ask to do it. I am blessed to have a lot of friends who are younger and who are clergy people.
My will and other legal affairs are all set up. My lawyer tells me I need one more signature regarding the sale of my house, which I keep forgetting to get. 2020 will not happen before this is done! Ah, but it did.
My daughter says I deserve a “blue ribbon,” so I know I am doing not too badly. I may even be rolling right along. It is a time-consuming job, I am finding, this getting ready to die responsibly as a single person.
What I was not doing was figuring out what would happen if I got sick or my mind began to fail. I do keep up to date with MAiD (Medical Assistance in Dying) and have begun talking to my children about this. I think I am good with final case scenarios but not so great at the time that precedes such a decision.
Keeping in mind the “before time” (too sick to manage on my own but not sick enough to die), I began a research project. The results are the basis of the rest of this essay. I visited twelve possible retirement home options in four different cities. I have a young voice and at times when I was arranging tours on the telephone I was asked if it was for my mother or my father? Cynical me thought perhaps this was flattery, but even if it was, it worked. Do we ever feel ready for this option?
Two projects were co-housing projects. I was swept up in this possibility. If only I wanted to live in Sooke, BC and was about sixty-five years old with the money to retire. I would have to love hiking and biking and boating and be adept at a least one of them. I knew I would like to live in such an intentional community. The units hang over the Pacific; the eagles soar and the boats bob in the sunlight on the good days. On the wet days the fog swoops in, the mist hangs on the giant cedars and everything is glossy green. While I was visiting, another investigator like myself entered a master bedroom, saw the view and her jaw literally dropped! The owners were such delightful people. I just knew that in a lot of ways they would be my tribe. But I am also a very urban person who likes to holiday abroad, not live in places like Sooke. I felt I was welcome, even as I knew I would be the eldest among them.
I came away from this research feeling happy that courageous people were finding ways of aging while doing the work of forming deep connections. These projects respect our desires to have meaningful and appropriate levels of control and at the same time profoundly share our lives. Now, they are happening in other parts of Canada. The philosophy was right for me but I had waited too long.
Then I began to research private retirement homes. I seem to be just wealthy enough that this is a better option for me than public options. I am discovering that retirement homes are big business. Some are part of huge conglomerates that have franchises all over North America. Others are very much smaller, with under five facilities.
The ones I visited all had reasonably distinctive characteristics within a somewhat generic frame. They tend to be conservative in appearance and furniture. I have heard of one I did not visit that is entirely Scandinavian modern in design. This appeals, but I was told that such furniture might challenge my knees and hips! Some had phenomenal dining rooms with great views and one had exceptional food with a view of freeways in the midst of downtown Ottawa. Each had distinctive services. One, for example, was situated between three major hospitals and specialized in folk needing a lot of medical care. Two on university campuses offered a lot of interaction between town and gown.
All had a system of levels/neighbourhoods; think gated community/golf course/retreat centre. The fully-independent living was either in a separate condo building or in townhouses on streets. These surround the central facility commonly referred to as “The Big House,” which is where as many as five remaining levels are housed. These levels range from some meals and minimal care, to full-time nursing to “memory care” for people with dementia who wander and need the safety of a locked facility.
As in any system, there is a vocabulary. Are you ready?
Cueing: This is a service if you need to be reminded to take your pills or to come to meals or any form of reminding.
Portering: This is the service where you have to be helped to get somewhere because you are not steady on your feet or with your walker or wheel chair.
Touches: You can count the contacts the resident has with the staff and these are called touches. Some places charge per touch.
Memory Care: This is the neighbourhood for those with dementia in various forms. The important definition here is that it is a locked facility. I discovered folks with various levels of dementia in the other neighbourhoods but they did not wander. It is also important to know that private retirement homes are not equipped to deal with violent residents in any of the levels. This is when the public option must be sought. I visited several such “hoods” or memory care residences. I was impressed by those with a big, outdoor, safe terrace. I came away thinking everyone I saw was clean, dressed and being spoken to kindly and regularly. The rooms were spacious, the decor was homey and the residents did not seem drugged beyond alertness. Several spoke to me and told me stories with different levels of logic. One person was very sure I knew her brother. We had an easy chat that I think she enjoyed. I did. It felt like a gentle place. I appreciated that most residents had good use of their bodies.
I thought about “what ifs” and choices we hope we never have to make. My mother was deaf for almost all of her life and she always played the “what if” game and was certain it was better to be deaf than blind. Would I rather have full body function and declining mind function or the other way around? I had those thoughts as I visited. I surprised myself by leaning toward the former.
Private retirement homes offer a lot of services. Some had a resident GP with an office on site. Most had foot care and eye care and access to dental care. They had hair salons and barber shops, pubs and bistros and private dining rooms for parties. Residences were pet friendly. There were shuttle buses and easily-accessible walking paths. I was impressed that many staff members had been with the facility over an extended period of time and that they had benefits. I knew that remaining in your own home and hiring help was no easy task and that regular certified care would matter.
In one home, just after breakfast, I noted three women in animated conversation. Suddenly a full-throated rendition of an Italian operatic aria rose in the air and filled the vast room where we sat chatting with the tour guide. She was delighted and shared that this was the third solo by the woman singing. The soloist had moved in some months before and found two other Italian women who were residents. Their daily chatting was growing at exuberant speed.
Private retirement homes specialize in helping you figure out whether you can afford them or not. The big conglomerates have excellent tools for this. Chartwell’s is available online. They seem to cost between $4000 and $8000 a month. This is very dependent on the level of care you require and the size of apartment you desire. As you require more care, your living space gets smaller. One facility I visited had up to 3000 square feet of luxurious living space if you required no care. A state of the art living with dementia home, The Village Langley, has been built in BC and the cost is $8000 a month. If you are entitled to government care, I discovered that one can bring this with you into the retirement home just as you can into your own home. Several of the homes I visited also had units for sale. Resale might be difficult as the potential buyers would be more limited than on the open market. The homes also help with inter-provincial moves and the relocation of your heath care. They also help with downsizing your current living place and will help you choose what to bring. As in the wider world, the units give testimony to individuality in decor. A studio can be made into a very creative and inviting space and I saw a stunning example of this.
I immediately became curious as to why a person or a couple would choose to pay $5000 a month or more to rent an albeit luxurious townhome or condo in a city where you could just rent a comparable accommodation for $2000 or so less. Here are the reasons. In most cases you have access to all the services and activities of “The Big House.” The rent is inclusive of almost everything. You have a community that is built in. You are in the queue to move up (or down as you view it) in the system. Some people with good pensions simply have the money and like the security of having all decisions made. Frequently one or another of a couple has become more in need of care and the other spouse likes to know this care is close at hand. Sometimes a spouse has died. Perhaps another reason is a fear of waiting lists that will be too long. My experience at private facilities gave me the assurance that while there are waiting lists, they are not excessive. There is also the option of respite care. This means that you could decide to enter the system as a resident for a limited time because of a special need for extra care and then return to your own home.
At one facility, I met Dan and Ann. They had moved into a completely independent townhouse and were very buoyant in their enjoyment. I met them in the library in The Big House where they volunteered. They were in charge of an extensive library. They were emptying out 200 books for a city-wide book sale the following day. I also learned that Dan ran an extensive gardening program in the good months for all the residents. They were definitely outgoing and easily shared their pleasure with me at having decided to become residents. As I prepared to leave, Dan came over to me to offer his inside scoop on aging. In a conspiratorial air, he confessed to me that the secret of aging is, “You must have a purpose. Every day I have a great reason to get up and get going. The library and the garden need me.” Dan and I are cut from the same cloth. I share his sentiment exactly.
My sister spent several years of her life in Australia in an assisted living space. In several ways it was modest compared to the levels of elegance I had been experiencing in my touring. It was operated as the outreach of a church. I knew such places existed in Canada. One such place, run by the Unitarian Church, was recommended to me. Its location in Ottawa is ideal. It sits on the edge of the footpath along the Ottawa River, close to one of Ottawa’s trendy neighbourhoods, Westboro. It is also where my daughter lives. It is small, friendly and quite delightful. It has fully independent living apartments that house 80-90 people. They are registered under the Affordable Care Act, and a one bedroom apartment costs $990 a month. Alas, there is a ten year waiting list that is completely full. My brother, at 92, is still living independently in his home but sadly his wife has just moved into assisted living care. I thought, well, if the waiting list opens up I will definitely put my name on that list. Genes may be on my side.
The assisted care side of this complex offers a studio with private bath. It has multiple services and more can be added from the community. It costs, at this moment, $3400 a month. It houses fifty people from their late seventies to age 102. This waiting list has sixteen names and moves quickly. There is a down-to-earth vibe to the place as you approach and when you enter.
Life in the other neighbourhoods (levels) would have its little challenges. I like a bathtub, and the apartments do not them because they are considered too dangerous. One friend who made the tour with me found herself struggling to imagine how her furniture would fit in the apartment we were in. Of course, the very friendly salesperson made sure that I knew that wanting to make this move made it significantly easier to relax and enjoy the transition. A very friendly person at one of the homes told me exactly this. “I was tired of making meals and living alone. I wish I had come earlier.”
The average size of a retirement home seemed to be about 200 residents. The average age in the homes I visited was 85. 25% were couples and of the remaining 75 % at least 60% were single women. However, I visited one facility where in addition to husbands almost half of the remaining residents were single men. I observed these men engaged in a number of male only activities. I am sure they felt they had lucked out and were forming friends they had not had since boyhood when they shared a tree fort. I felt really happy for them.
It struck me that so many of the activities provided were for a younger and more fit cohort. Several had unused swimming pools and bicycle racks. What does this mean? I also thought that it would be good preparation for this period of life to know how to play bridge, do jigsaws, sing in a choir, play an instrument and be in a book club. Skill with crafts would also be good preparation. One, on a university campus, had a full curriculum available in fall and winter semesters taught within the building, by university professors
I visited homes in British Columbia where I live. I visited homes in Guelph where my son and his family live, and in Ottawa where my daughter and her family live. I am glad they came with me. It made for very interesting conversation afterwards. Something about it all made us just a tad uncomfortable in different ways. I know I had not thought that at the end of my life I would be going away to camp fulltime. I have a friend who reframes it as a country club. I could see paying visits, but then I would want to come home, as I would after any group excursion.
My daughter was overwhelmed by the fact that residents were all white. It is true that in twelve residences I did not see a single resident of colour. Very white people with very white hair were being cared for by a staff of every colour and ethnicity. Why is that, we mused? Several of the complexes were owned and run by people of colour. It became very obvious that families of colour do not expect that their “olders” will live anywhere other than the family home. Is this a phenomenon that will soon change? Is this reality also true of publicly-funded facilities?
Recently I spoke with a friend that had just spent time in a retirement facility to receive respite care after surgery. She was taken by the upstairs /downstairs reality. The staff had their own world and their own dynamics. She became very aware of the differences. When we live in our own homes we are more protected from this reality. Currently, care in a communal setting puts this reality squarely in our faces.
We are now in the midst of the COVID 19 pandemic. Retirement homes may emerge as hot spots as have nursing homes. The population post 60 is vulnerable. It makes the home I visited that was surrounded by three hospitals look very attractive. The pandemic is raising not anticipated realities for us all.
I am left thinking that we have yet to discover what works as a way to care for ourselves as we age. I think we can do better. In all likelihood the aging baby boomers will figure this out. Once upon a time, villages took care of their seniors. I grew up in such a home. My grandparents first lived next door and then, as they aged, they moved in with my parents. The church down the street held us all together.
I think of the movie called Quartet. In this, movie a group of musicians rent or purchase a house and move in together. More such movies are being made and books written about such experiments. I experienced something approximating this while in Queensland, Australia recently. A classical orchestra retired and were living in a community. They all lived close to each other and met regularly to play and also to perform. They truly loved and cared for each other. I got to attend their annual Melbourne Cup extravaganza. In hats and gloves, they betted and then watched the famous race. I was completely outsmarted in all the horsey games played. Retired clergy have created a community in Marin County, California. Is heterogeneity what we crave as we age? One residence I visited in Ottawa was very downtown. Cars whizzed by the windows. The local street was alive with shoppers. It was one of the oldest facilities I visited and it was, I think, by far the cleanest. All were clean but this place sparkled. Maybe it had just been renovated. The independent unit there housed all ages including families with babies. There were many units rented by that cadre of young people under thirty who serve in the offices of the government officials. It was the only heterogeneous community I visited.
At the end of this research can I make a decision? Not yet, but I am thinking and reading and asking questions. MAiD is in my mind more powerfully as an option. If I need memory care, I can now tell my children a place in each of their cities where I could live and they could feel I made the choice. I know that if I need the safety of a locked ward then I want to be in one where there is a large outdoor space that is attached and safe. I want to know that I can access the out of doors every day, even if I don’t know it. I hope this decision never has to be made, but if it does, then the city doesn’t matter to me. I want to be where one or the other of my kids can visit me and watch over my care easily. I hope my children would choose based on their life circumstances at that time.
If I do not need memory care but I do need assistance, then from the group of twelve homes I visited (with two more to be considered), I can make a choice. I know what to expect. I can see having to update this research from time to time. I am profoundly glad I made such a thorough run at it with all my wits and health around me.
I have made progress preparing for the externals actions that will surround my demise. Alas, the harder and most courageous work of internal preparation beckons. I now know more clearly what I will miss from my present life. Every day each of the special things about my home and my life in it are more precious than ever. I am grateful that as I sit here, I can watch the lights on Cypress ski hill shine in the night sky. I am thankful for the filet of wild spring salmon that will be my dinner. For now, I am most blessed and a little more prepared for what tomorrow inevitably brings.