A TALL, ALERT WOMAN WITH STEELY GRAY hair and skin as thin as parchment, Cécile Donalson, 95, is one of the lucky ones- a prototype for the way most of us would like to be cared for in old age. She lives in her own home on Belfort Street in the Park Cities, and she surrounds herself with people who interest her.
She walks with the aid of a cane these days, but with a steadiness that’s unusual for people her age. Sometimes she seems frail, but Cécile has no persistent health problems and she takes no medications.
Best of all, Cécile knows she is not a burden to the few family members she has who are still living. She has enough money to hire someone to cook, clean, and handle the everyday household and personal chores that she simply doesn’t want to do-or is unable to do-anymore. Visitors are for warm discussions and trips to the symphony.
“CEcile’s an inspiration,” says Jere Reiser, a geriatric care manager who hires Cécile ’s live-in help and handles her business affairs. “This woman is sharper than you or me. even at her age.”
Like most elderly people, her life is rooted in the past. While Reiser discusses her schedule, which includes a hairdresser s appointment and a visit to the doctor, she talks about her life.
Cécile was a career woman before the term was popular, working for a Dallas insurance company. She never married, but instead has spent much of her life traveling. Her eyesight is failing now, and she is much too frail to travel long distances. But she recalls Paris and [he other capitals of Europe. The cafes, the ancient architecture, the beautiful countryside, they are all indelibly marked in her memory, Reiser listens intently.
Cécile Donalson is among two of the fastest growing groups of Americans-the oldest old, people 85 and older-and those who have never married. The 85-plussers are a tiny percentage of the total population, but their numbers have increased by 232 percent over the past 35 years. And that segment of the population will triple again by 2030. Those who have never married now number almost 20 percent of all U.S. adults. These two groups form the core of those who will increasingly need care over the coming years.
By 2030, for the first time in our history, there will be more elderly than school-age young people (22 percent of 65-plus, 21 percent of those under 18). This trend illustrates the dramatic increase this century in the number of years spent in retirement. In 1900. the average man lived 46.3 years and spent only 1.2 years in retirement. In 1987, he spent 13.9 years of h is 70-year life span retired. And those numbers will go up in the next century as the life span increases.
Statistics describe the march of baby boomers through life-that “pig in the python” we’ve heard about. This vast number of aging citizens inspired one of the lesser-known items in the House Republicans’ Contract With America. A portion of the Personal Responsibility Act seeks to mandate that family members, not the government, must be financially responsible for care of the elderly. This codicil may never become law, but what’s clear is the trend toward defining the responsibility of family members to care for aging relatives.
Seven million Americans provide help to older family members. The vast majority of the caregivers and those being cared for are women. In fact, family members are the sole source of care for an older person in 70 percent of the cases. An entire industry of elder-care alternatives has developed to aid this effort. The “old-folks home” of old has segmented into retirement communities and nursing homes.
Many retirement facilities offer a continuum of care that begins with a perfectly healthy, active senior citizen and continues through the progression of declining levels of health to the grave. Some specialize in light personal care for those who can do some things for themselves. Others offer skilled nursing care for those who need constant medical attention.
Some retirement communities have special wings for people with Alzheimer’s disease or other forms of dementia. In these units, rooms are not identified by numbers. Instead, boxes with familiar items from the older person’s past-a scarf or a picture of a long-gone loved one-a re affixed to the entry doors. These pictorial representations of a life before the disease tell the patient this is his or her place of residence.
Institutional care is expensive, ranging in cost from $2,400 to $4,500 a month, depending on the needs of the resident. Facing such costs, an increasing number of older people are choosing to remain in their own homes. Social service agencies such as Senior Citizens of Greater Dallas and the Alzheimer’s Association provide companions for home-based elderly and support groups for families coping with caregiving responsibilities. In addition, the senior citizens group operates a nursing home ombudsman program that works to improve nursing home conditions for the residents.
“The truth is that people want to stay out of nursing homes,” says Molly Bogen, executive director of Senior Citizens of Greater Dallas. “Everybody wants to age in place. But nursing homes are necessary, and many of us will live in one someday. Because they are needed, the best thing we can do is work to make nursing homes better.”
For people with the resources to afford private caregivers, these services overlay those of the institutions and support the efforts of people trying to continue living at home, For fees ranging from $60 to $100 per hour, a geriatric care manager like Jere Reiser serves as a clearinghouse of information about caregiving sources, pays the bills, and hires household help for people like Cécile Donalson. A home companion, who prepares meals and does light chores, will charge from $6 to $15 per hour. A home health aide gets up to $16 per hour to assist the older person with bathing, dressing, and other physical chores. A licensed vocational or registered nurse (LVN or RN) will cost $20 to $40 per hour. Live-in help charges as much as $2,500 per month.
“The biggest questions are what to do with grandma and when,” Reiser says. “People struggle with the idea of moving her to a home or trying to keep her with the family or in her own home.”
Most of the time, Reisers real clients are the children-often busy, two-wage-earner families, many of them hundreds or thousands of miles away from their aging parents. They worry about mom or dad, but they can’t leave their own families and take care of that parent around the clock. In cities around the country, geriatric care managers take care of these details and report back to the kids.
Reiser began his service after earning a degree in gerontology from UT Southwestern Medical School in 1990. “At that time,” he says, “there were only 225 GCMs across the country. Now there are more than 800, and I get calls every day from people who want to do this work.”
Some of Reiser’s duties will never find their way onto a list of services. For instance, he helped one local man “kidnap” his aunt, who suffers from severe dementia. She had a habit of wandering off from her cabin beside a raging river in a rural area of Indiana. With no relatives nearby, neighbors were certain she would eventually harm herself. They alerted the man that his aunt was in grave danger.
Reiser worked with state and local authorities to gain the necessary legal papers so the law would not try to stop him. Because the aunt said she didn’t want to go, the man wondered if he was doing the right thing. But doctors who examined her said she had no real concept of free will anymore and convinced the man that he was acting in her best interest. He simply showed up in Indiana one day and asked his aunt if they could go for a ride. On the trip back to Dallas, the aunt slipped away from him at a truck stop and told travelers she was being held against her will. There were a few tense moments, but she was so obviously delusional that no one tried to stop them.
Reiser worked with the man to select a nursing home in the Dallas area. After adjusting to this new situation, his aunt is doing well and the man realizes he did the best thing for her.
Often private caregivers supplement the assistance older adults get in retirement communities. Faye Crittenden lives in a private apartment on the fourth floor of a personal care facility off Central Expressway in the Park Cities. She ambles down the hallways behind a walker. Faye doesn’t move nimbly anymore, but she is good at formulating opinions.
“People here don’t like me because I tell them what’s what,” Faye says. The 88-year-old macron with the acid tongue often has a new joke for a visitor. Faye provides a lot of her own entertainment these days. She says her son in Houston rarely comes to see her. “He doesn’t really want to worry with me,” she claims. It’s the grandkids who usually visit. She is proud of the wheelchair her grandson gave her. “Wetraded,”sheexplains, “He gave me this wheelchair and I gave him my automobile.” Considering their stages in life, it made perfect sense to her.
Faye hired Jere Reiser to handle her finances when she began to believe that people were taking advantage of her. On a pleasant spring afternoon, they meet in the sitting area just down from her private room. “This is your rent check,” Reiser says, speaking loudly. Because Faye is legally blind, Reiser had special checks printed with large type and raised lettering. It takes all of her concentration to sign on the correct line. “There,” she says, as she finishes the scrawled signature. “This really is tor my rent, isn’t it?”
Critics of private caregiving contend that the “rent-a-relative” approach is a sorry substitute for the care family members can give. Reiser agrees that the ideal situation is for kids to take care of grandma. “Everywhere I come in, it’s to fill a void,” he explains. “Sometimes you have sensitive issues between family members that make it hard for the kids to spend much time with their parents. There are resentments that may be decades old. And then you have the guilt; people wanting to take care of their older loved ones but feeling that they are just not able to handle them and all their other duties.”
NO FAMILY ANIMOSITIES PREVENTED SHERRY Stallone from deciding to care for her grandmother three years ago. Sherry is a classic caregiver of the “sandwich generation,” people in their 30s and 40s-mostly women-whose lives are sandwiched between elderly relatives and their own children. A 36-year-old single mother with two children at home. Sherry is employed as a bank manager. When her grandmother, Marita Pietzker, was diagnosed with Alzheimer’s disease, Sherry was the only one of several grand-kids who stepped forward.
“Basically, she was starving herself,” Sherry recalls. “She would forget to eat, She was having hallucinations of bugs on the floor and of people coming into her house and trying to steal her wedding ring.”
Marita, a diminutive woman known to her “kids” as Little Mama, sits next to her granddaughter and smiles. At first glance, the older woman seems completely at ease, as if she is ready to take part in the conversation. But as Sherry talks about her, its obvious she is not aware that she is the subject of an interview.
“I love my kids,” says Marita, “and they love me. There’s no bad feeling in my family.” Sherry rolls her eyes at this one. Her family, like many others, has experienced its share of severe disagreements over the years. But she’s content to let her grandmother live with the fiction.
Now 87, Marita raised her granddaughter while Sherry’s own mother had her problems, including a series of bad marriages. The older woman provided much -needed stability in the granddaughter’s young life.
“We’re best friends,” Sherry says. “All my life, I’ve been able to talk to her about everything-even about boyfriends, even sex. She’s the most positive person I’ve ever known. When I couldn’t talk to my mother, Little Mama was always there.”
So when Marita Pietzker fell victim to Alzheimer’s, it was time to return all that love. She moved into Sherry’s two-story home in Richardson. The family had planned to convert the garage into a “grandma” suite, complete with a full bath. But they soon found the cost of construction was too high. So each time her grandmother needed a bath, Sherry and the kids had to engage in a precarious ballet of sorts, moving Marita awkwardly upstairs to the bathroom. Sherry’s daughter, Tonya, now 8, was afraid of Little Mama at first. She worried that the older woman would die while they were in the house together. But she pitched in and helped. And Jeremy, now a 16-year-old high school junior, even took charge of his great-grandmother’s care during summer vacation.
Besides providing the care, Sherry saw this as a life lesson for her children in respect for their loved ones. “And who knows?” she says, “When it comes time to take care of me, maybe my kids will remember how important it was to take care of Little Mama.”
Often, Sherry took off work or would sneak home from work during lunch time to check on her grandmother. She even paid her own mother and sister to come into her home and help. The arrangement worked fine at first, but as the Alzheimer’s disease reached a more advanced stage, the family’s caregiving system broke down.
“My mother had brain surgery and my sister had some health problems, and they weren’t able to help,” Sherry says. “My grandmother couldn’t be alone for a minute. I was struggling to keep all of this together, but it wasn’t working.”
With the money left from her husband’s death 10 years ago, Little Mama was moved into a residential care home, a private residence in a North Dallas neighborhood with a nursing staff that cares for eight elderly residents. She pays $ 1,500 a month for a room she shares with another woman, her meals, and care. The first couple of months were difficult for her. She wanted to stay with her “kids.” Now, however, she is content at the home. For one thing, there are people around to talk about the old days. Reminiscence is a valuable part of aging, and young people arc in too big a hurry.
“I used to feel so bad,” Sherry remembers. “When I got home, I was rushing around, getting clothes washed and fixing dinner. I did not have the time to sit down with her. The people at Alzheimer’s tell me how important it is for people to sit and talk about the past. It helps them hold on to their minds.”
Now, Little Mama spends weekends with her. There is time to talk. But Sherry never gets away from the feeling that she just doesn’t do enough. “There’s always guilt,” she says. “I know she is better off where she is, but that doesn’t make it any easier. “
FOR VICKI YARBROUGH, FEW THINGS IN life are easy these days. For the past year, her life has centered around her mother, Virginia. The 78-year-old matriarch of her family suffers from severe dementia. And Vicki devotes her life to saving what is left of her mother from this disease.
A year ago, Vicki left her job as a salesperson for KOAI-FM radio to care for her mother. Virginia Yarbrough is a heavy woman, but her daughter bathes her, dresses her, shows her how to wash her hands, and feeds her. Since Virginia is in the advanced stages of Alzheimer’s disease, her daughter constantly reminds her how to swallow her own saliva, tells her what she is eating, and cleans her up when she uses the bathroom. It’s almost impossible to wake her mother from a deep sleep in the morning. But Vicki awakens several times each night to find her mom in a dark closet, trapped in the bathroom, or shivering in her bed without covers.
While she loves her mother dearly, this patient, 39-year-old caregiver hates the disease that destroyed this kindly woman and devastated her family. “I have two sisters and a brother who simply can’t accept what has happened to her. They call, but they can’t see her. And you know, I understand how they feel. We were a very healthy family, and now this.”
Virginia was living alone in the family home in Kansas City when she was diagnosed with Alzheimer’s eight years ago. Family members saw her confuse night with day, hang all of her clothes in the living room, and put garbage in the refrigerator. For the first seven years, Vicki cared for her mother by long distance from Dallas, with the help of” a sister. Her mother’s bills came directly to Vicki, who paid them. She got power of attorney over her mother’s affairs after a family member took money from the older woman,
But as the disease progressed, Vicki knew her mother would have to come live with her, “I’m the youngest of eight kids. My father died back in 1977.1 always knew that I would take care of my mother. Since I’m single, I thought it was possible. I had no idea how difficult it would be.”
Vicki gets a break each day when her mother spends some time at the Irving Adult Day-Care Center. There, staff members stimulate the minds of dementia patients with art projects, crafts, and storytelling. Vicki usually comes to the offices of the Alzheimer’s Association of Dallas during the day and volunteers on the help line, counseling other caregivers. Hearing others’ problems makes her feel better. Now she is chairman of the Association’s major fund-raiser, Memory Walk, which takes place Sept. 21 at NorthPark Mall.
“I can’t work at a full-time job,” Vicki explains. “I only have a few hours when lean be away from mom. And even while I’m away from her, I can’t help thinking about what I’ll need to do with her later that day.”
Because of the difficulty, and because she is running out of money, Vicki Yarbrough is about to reach the point many caregivers hit; the decision to place her mother in a nursing home. She knows that time is fast approaching. She’s even taken her mother with her to tour several homes. It’s only then that Virginia seems to understand what’s going on around her. She will say something about wanting to stay with her daughter, and Vicki will put off her decision.
But soon enough, Virginia Yarbrough will go to a nursing home. Her daughter will return to her sales job, to a life that has eluded her for the past year, There will be tears, guilt, and remorse. Vicki may even change her mind a couple of times. Then she will do what has to be done.
BEYOND THE BROCHURES
An expert’s recommendations on elder care
SHOPPING FOR THE IDEAL NEW HOME for your elderly relative? Jere Reiser, a geriatric care manager, tours local retirement facilities and nursing homes regularly. The following are his recommendations for the best of everything where elder care is concerned. See page 27 for more information on area facilities.
Best Location: The FORUM and MARRIOTT Brighton Gardens, which are located in North Dallas, near shopping and churches.
Most Pleasing Interiors: THE Forum may look like a prison on the outside, but no expense was spared on the decor.
Most Spacious: MONTICELLO WEST; rooms are larger in the older facilities.
Best Cooperation with Outside Companions: For people who like to employ a private companion to handle many personal chores, the Dallas Jewish Home for THE Aged {Golden Acres) allows you and your helper complete freedom.
Best Food: PRESBYTERIAN VILLAGE NORTH, both in the main dining room and in the personal care area.
Best Value for the Money: HILLTOP HAVEN in Gunter, near McKinney, is a jewel among elder-care facilities in the suburbs.
Most Helpful Employees: THE TRAYMORE has consistent management and a very low turnover rate for employees.
Busiest Programs and Activities: CLASSIC Residence by Hyatt has a full slate of programs in the facility, plus its own buses to take residents to activities in the city.
Most Unusual Activity: JULIETTE FOWLER HOMES has a garden with beds raised so that people in wheelchairs and walkers can tend their plants in the warm months.
Where He Would Put His Own Grandmother: All tilings considered, Reiser says THE TRAYMORE is where he would place a relative of his own. -L. U.
The Aging of Dallas
●The 212,887 people age 60 and older in Dallas County represent 11 percent of the county’s total population, a 62 percent increase since 1970.
●If current fertility and immigration levels remain stable, the older population will be the only age group to experience significant growth in the next century.
●In the next 25 years, the older adult population will more than double.
●43,400 people over age 65 live alone; 81 percent of them are women.
●In the past decade, the fastest growing segment of the population-those over 85-grew by 51 percent.
●The areas with the highest percentage of residents in the older category are die Park Cities and Oak Cliff.
●30 percent of die older population will spend some time in a nursing home.
●87 percent of Dallas County residents age 60 and older are above the poverty level ($7,360 annual income for an individual, $9,840 for a couple).
Statistics from Senior Citizens of Greater Dallas
Related Articles
Media
Will Evans Is Now Legit
The founder of Deep Vellum gets his flowers in the New York Times. But can I quibble?
Restaurant Reviews
You Need to Try the Sunday Brunch at Petra and the Beast
Expect savory buns, super-tender fried chicken, slabs of smoked pork, and light cocktails at the acclaimed restaurant’s new Sunday brunch service.
Arts & Entertainment
DIFF Preview: How the Death of Its Subject Caused a Dallas Documentary to Shift Gears
Michael Rowley’s Racing Mister Fahrenheit, about the late Dallas businessman Bobby Haas, will premiere during the eight-day Dallas International Film Festival.