The Third Third

An Assist for Assisted Living

An assisted living facility is nothing more than “a goddam rest home,” according to my father, who, clearly under duress, moved into a really very lovely place in May.   I’ve been trying to look at it through his eyes since that little outburst and I’ll give him this: even a very lovely place is depressing, inhabited, as it is, exclusively by human beings in various stages of deterioration and disrepair.  Wheel chairs, walkers, oxygen tanks, and vacant stares traffic the hallways, and while fresh flowers, a friendly, competent staff, generously-sized, immaculately clean accommodations, bright, sunny public spaces, and an impressive number of well-cooked  menu options are mitigating factors, my father wishes they wouldn’t waste his money on most of them. He cannot shake the belief that he has come to this new place to die.  He rejects the entire evolution of the elder care industry over the last 50 years --  from warehousing the dying to assisting the living; it’s marketing word play to him. Thus, albeit irrationally, he rejects all assistance -- even the oxygen his doctor prescribed to palliate his end-stage COPD, and particularly, help with the daily living tasks that otherwise deplete his limited supplies of oxygen and energy.   “Bullshit,” he says when my sisters and I try to explain that accepting assistance from the facility staff and/or from us could improve (although not necessarily increase) his days.  It would be easier to travel across town to his bridge games; his mind would stay clearer at the bridge table; we could have him in our homes more often, more easily, and with less concern about his well-being “off the reservation.”  He says it’s easy enough now, and to his credit, he keeps going. In fact, he has made a remarkable adjustment.  We were prepared for much worse.  But just in case we might fool ourselves into thinking he’s actually relieved to be in a safer place closer to us and sometimes even a little bit happy about it and our attention, he regularly threatens to move out and talks as if his being consigned to an assisted living facility is simply all a huge mistake, one that he will remedy as soon as he is able.  He insists he doesn’t belong there with all those broken people. In his 89th year, in a significantly weakened state, he is making Denial a senior art form. I’m not going to change his mind.  So I am turning my attention to the assisted living facility itself, and to things it might do differently -- not to appease people like my father (that simply is not going to happen), but to give him fewer reasons to resent being there.  There isn’t much any of us can do when our bodies betray us; but that betrayal seems to be compounded when the people who’ve taken control of our care appear to betray us, too.   For example, he is signed up for services that include transportation to any place in a 10-mile radius of his apartment home, services without which our taking away his car would have been a lethal blow to his independence.  He has been pleased that there’s a driver to take him to  his bridge games, or for a haircut, that he doesn’t have to depend on us to get around.  But when the driver arbitrarily cancels a standing appointment because of some other residents’ request to go out to lunch, it undermines the confidence he needs to have in his support system.  Alternative transportation was arranged eventually, but no one communicated directly with him about it, again rendering his autonomy weaker than he needs it to be. Then there are the finances.  There’s no getting around the fact that quality assisted living accommodations are expensive. My father derives no pride from being able to afford them.  A child of the Depression, like all his remaining peers, he has no stomach for wasting money, and he is utterly convinced he is wasting money paying rent at all, much less such an exorbitant rent, and wasting even more money by having to pay for three meals a day when sometimes he doesn’t eat all three, and paying for assistance he swears he doesn’t need.  We have gone over all the numbers with him and run spread sheets on this and other options, and we’ve shown him he can pay the price and still preserve his investment capital, and his broker has concurred, but the arrival of the monthly bill enrages him every time.  What makes it worse is that the bill has so far never been calculated correctly, and it would almost take an M.B.A. or a C. P. A. to understand the mysterious credits and debits arranged on the pages in the smallest of print.  I can find the mistakes, and the business office has been happy to make the necessary adjustments each month, but again, it would be so much easier if the accounting were accurate, and the management more sensitive to an old man’s fears of running out of money or being cheated.   He assumes they assume he isn’t sharp enough to know what’s going on, and rightly and deeply resents it.  It chips away at his sense of self and dignity, which, let’s face it, some days, when the legs are weak and breath is short and they’re serving tuna melt in the dining room, is all you feel you have left. With two sisters sharing my commitment to Dad’s care and well-being, we can take turns mollifying him and watchdog-ing the facility.  One of us can even entertain his queries about where else he could live for less money, showing him places that are older, dingier, sometimes smellier, but, indeed, cheaper, though none of us will move him.  This month, according to my sister, I need to be the Bad Cop to her Good Guy -- with the facility, and get the bill straightened out.  And we’ve decided to request two invoices each month:  one to him for the fixed rate he’s signed up for -- one number covering rent, meals, assistance, and phone; and another to me with the details and any extra charges. The problem is, this place knows how to keep me happy.  They know I appreciate the fresh flowers at the reception desk and on the tables in the dining room; they know it makes me feel better to have Dad in a place that’s really very nice and safe; they know they’re selling peace of mind, and that that’s what I am buying.  Where they need to improve is in their dealings with my father.  On balance, they’re quite good; they provide quality care and they are generally respectful of his feelings and his demands.  But they could be better at treating the person and not just the patient, at recognizing the emotional as well as the financial costs of moving into assisted living and actively seeking and developing new ways to uphold every last shred of his human dignity, strength of character, and independence.  Otherwise, according to my father, life isn’t worth living.  And no further assistance will be required.
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