Margarete Hicken tries to keep her voice chipper as she talks to her friend on the phone. "Oh," she says, "I'm just lolling about." Lolling, indeed. She is lying under the table in her tiny breakfast nook, unable to get up.
A half-hour ago, trying to throw something in the wastebasket, she lost her balance, then lost her grip on her walker as she fell. She wasn't hurt, but she couldn't bend her legs to get vertical again. So she inched her way toward the breakfast nook, hoping to get a grip on the table legs to pull herself up. She was lying there, pondering her options, when the phone rang.
When you're 101 and you don't answer the phone at night, well-meaning folks and busybodies alike start to worry. They summon ambulances and rescue crews that may take you to the hospital and then to rehab and then maybe move you into a nursing home. They set things in motion that you might not be able to undo.
So she pulls the phone off the table and answers with a bright, "Hello." She will see who it is and decide what to do. Can that voice be trusted not to jump to the conclusion that she should no longer live alone in the home she loves?
She's not sure, so she makes small talk. Later she scootches herself through her dining room to the stairs, hoping she can pull herself up by holding onto the bannister. It is now well past midnight, and she is still flat on her back. Finally, at two in the morning, she decides to push the button on the emergency alert bracelet she wears on her wrist, the same button that could have brought help hours ago.Of all the snapshots of Utah as it ages, perhaps Margarete lying in her front hall at 2 a.m. is the most telling. It's the image of a woman fighting hard to control her future, full of gusto but frail. And caught, like Utah itself, in that gray area, not quite willing to accept what's coming, not quite sure what's inevitable and what's not.
"To live independently and then die suddenly that's what everybody in geriatrics prays for," admits Dr. Steve Fehlauer, a Salt Lake geriatrician who has overseen care of hundreds of Alzheimer's patients at local nursing homes.
"Aging in place" is the buzzword the ability to grow old in your own home and your own town, or at least in a senior apartment with your own pictures on the walls. It's partly an effort to keep costs down, partly a human need to be near what is familiar. At its core is also an unnamed fear: of ending up aging in another place, at the mercy of family or strangers.
Utah certainly has aging success stories like 96-year-old Lennox Tierney, who tomorrow will lead a group of Utahns on a tour of Japan. He's a museum curator in California, teaches Japanese flower arranging in Utah and still shovels his driveway every winter.
But the people on the front lines of aging outreach workers, first responders who answer 911 calls, home health workers, the elderly themselves all have stories of old people afraid to reveal the extent of their frailties, fearful that someone will remove them from their homes. Afraid they'll be "doomed," as Peter Hebertson, director of outreach for Salt Lake County Aging Services, puts it.
There was the woman who fell at the bottom of the basement stairs on her way to her laundry room and then crawled all the way back up the stairs without using her emergency alert necklace to call for help. There's the woman who masks her dementia by always talking about the more reliable and accessible very long ago instead of what happened this morning. There are spouses who hide each other's frailties, and there are neighbors at senior apartments who cover for friends who are failing, so those friends won't be asked to move out.
There's the man at the Friendly Neighbor senior high rise in Salt Lake City who refused to get into an ambulance after falling, afraid he might never return to his apartment. He had promised his children he wouldn't spend their inheritance on long-term care.
"I see a lot of people covering for themselves," says Heather Bittinger, a social worker with Millcreek Home Health and Hospice. Asked if they need help with bathing, for example, they'll insist they're fine an exaggeration uncovered when Bittinger sees dust in the bathtub.
Not long ago, an 85-year-old widow's house was robbed and vandalized. She told her friends but was afraid to tell her children for fear they would try to persuade her to move out of state to be closer to them. In fact, when she did decide to tell them, that's exactly what happened. Now she's a thousand miles away in a town she doesn't know, safe but sorry.
It's not craziness that motivates the evasiveness and the denial, says Maureen Henry, director of the Utah Commission on Aging. "They're in a desperate self-preservation mode." They're often stripped of their independence and self-determination in the name of safety, by children who love them.
There's a lot of wheedling and wooing "You'll see the grandkids every day, Mom" and pressure. One daughter of an elderly man recalled "hammering away until he gave in to shut me up. That's how Dad went to a nursing home."But he didn't have to. Ultimately, every adult has the right to decide for himself unless a court rules that he's incompetent to make decisions. Barring that, dementia or a family's good intentions don't matter.
But what do you do with someone who is fiercely independent yet unwilling to take steps to ensure that independence? A local Mormon bishop tells of a woman who repeatedly called neighbors in the middle of the night when she fell and couldn't get up but was unwilling to make changes simple grab bars in the bathroom that might allow her to stay in her home more safely.
The elderly are sometimes even reluctant to use the kinds of services designed to let them stay in their homes longer. Some are afraid it will label them incompetent, worried that, as Salt Lake County firefighter Dominic Burchett notes, "some van will take them away."
Burchett is a paramedic whose area includes the neighborhoods above 2300 East that are full of elderly residents who have truly aged in place, still living in homes they first moved to with young families decades ago.
Paramedic Barry Makarewicz says his fire station in Sugar House also gets lots of calls from and about old people. Sometimes the calls come in from old folks who are simply lonely for a visitor at midnight. More often it's a call from an old person who has fallen and can't get back up or can't get pulled back up by an elderly spouse. Often the calls are repeats, from a person or a couple unwilling to admit they can no longer live alone without some kind of help.
Families, too, are often in denial or too busy to figure it out, Makarewicz says. "Sometimes the younger part of the family doesn't want to get involved, they don't want to take care of their parents; it's going to cramp their style and cost them money." He says that when paramedics and police say someone can't take care of himself any more, "then family will finally do something. They just didn't want to face the reality of it."
Makarewicz's sister, Salt Lake County Aging Services outreach caseworker Paula Pinkham, has made it her mission to visit every fire station in the county to alert first responders about Aging Services programs, so they can pass the word along to seniors and their families. There is help out there, she wants them to know: There are programs that provide caregiver support, help with transportation and household chores and "activities of daily living."
On the other hand there are also waiting lists for these services and sometimes income requirements that exclude people who make a little too much money to label them officially poor. The programs are more apt to be available in cities than in rural or frontier areas. Vaughn Call, director of the gerontology program at Brigham Young University, says the availability of programs that help the elderly "varies dramatically by community size."
Seventy percent of us are figuring we'll live the rest of our lives in the homes we're living in now, according to a survey conducted by Dan Jones and Associates for the CareSource Foundation. Asked how worried we are that we might not have the physical health to take care of these homes as we age, the answer on a scale of 1 to 7 is a moderately concerned 3.6. We're fairly sanguine that things will work out fine for us even though 44 percent of us think, erroneously, that if we ever need long-term in-home care, Medicare will pay for it.
And although long-term care insurance can help pay for home care, no one knows how many Utahns over 55 have actually bought a policy. The number that's floated nationally is about 5 percent.
Boomers are in denial about their future, says Lorna Koci, services director with Utah Food Bank Services. "All you have to do is look at their savings and spending habits." They just don't get it, she says, although recent economic events have slowed spending and made people more cautious.
We expect, perhaps, that our families will come to the rescue, which they often do. We figure we'll call our neighbors and church members for rides and meals and help getting out of the bathtub when we fall. It takes a village to keep the old-old "independent," but often the villagers wear out trying. And will there be enough neighbors and caregivers to help? Utah has far fewer working-age adults to take care of and financially support its young and its old. We have one of the worst "dependency ratios" in the country.Experts worry that voluntarism itself is changing, and not for the better. Boomers seem to have a shorter attention span, observes Salt Lake County Aging Services director Shauna O'Neil. They want to come in and do more one-time, splashy projects. "They don't want to run the gift shop, do the grunt work, show up every Wednesday morning."
"If you think the oil crisis is bad, just wait," says Bill Farley, director of the W.D. Goodwill Initiatives on Aging in the College of Social Work at the University of Utah. "I think as a state we're in denial about the problems that are coming."
As a whole, Utahns are living longer (an average 79.35 years for women, 76.38 for men), and many people in their 80s, 90s and even 100s are thriving. But the conditions that no longer kill us are making us frailer as we age. We're living longer with arthritis, Parkinson's and the after-effects of stroke, leaving us with mobility and safety issues.
Sixteen years ago, when Hebertson began his job with Salt Lake County Aging, his clients were much less frail and sick than his clients now. And in the future, he says, "we're all going to be dealing with more and more frail people."
To live long is expensive, and if individuals aren't prepared, warns Aging Commission director Henry, the burden on safety-net programs, from Meals on Wheels to Medicaid, will increase. Our communities will be faced with providing better transportation for the old-old, more money to help with home chores and personal care, and housing that will accommodate wheelchairs and walkers.
In the weeks ahead, the Deseret News will explore what's coming and look more closely at what's happening now. As a society, we tend to look past the elderly, drawn instead to the vibrant young and our own concerns. We boast about being a young state. But we're also becoming an old state.
Millions of aging baby boomers will force us out of denial, predicts Scott Wright. Wright is director of the Gerontology Interdisciplinary Program at the U. and is upbeat about the future. With the first boomers poised to hit 65 just two years from now beginning a trajectory that may eventually include walkers as well as early bird specials the motivation will be there to change how aging looks, is accepted and is planned for.
The sheer numbers of boomers will either break the bank and overwhelm the system or be a catalyst for change.
And, already, there is much to be hopeful about. The story of aging is a story about decline and loss, but also the story of Margarete Hicken, who's a little embarrassed about the night she spent on the floor.
She's the oldest surviving member of the Mormon Tabernacle Choir and turned 102 earlier this month. At her birthday party she good-naturedly let a friend talk her into doing the "chicken dance" before a hundred or so of her dearest friends. She still cooks for herself and her frequent overnight guests, still makes the trip up and down the stairs between her basement laundry room and upstairs bedrooms, still loves to crack a joke.Opening a fortune cookie one night with friends, she was delighted to read: "Always respect your elders." She laughed at the thought. "Elders? I don't think I have any of those."