Senior Power:“You got end-of-life issues?”

By Helen Rippier Wheeler
Monday July 05, 2010 - 11:08:00 AM

Nationwide, 59%-75% of long-term caregivers are women. With an estimated 3.4 million caregivers, California leads. There appear to be at least 2 caregiver species: one is paid and comes via a third party, usually a government or for-profit agency. The other is often a woman family member. A potential problem associated with freelance or independent care-giving is the likelihood of no employer-provided benefits. 

Food for thought: Joy Loverde serves as a “consultant to…the fast-growing eldercare advisory industry.” Her “Complete Eldercare Planner” refers to “caregivers” and to “Caregivers, professional.” She associates the professional ones with case managers, dissatisfaction, in-home helpers, jobs contracts, and tax considerations. 

A problem inside and outside nursing homes is elder abuse and neglect. In 2006, 20% of reported elder abuse involved caregiver neglect. Both family caregivers and nursing-home staff often feel frustrated, isolated, and stressed. Nursing-home staff may be underpaid, overworked, and inadequately trained and supervised. Such conditions increase the likelihood of abuse because, despite less than ideal working conditions,family members and nursing-home staff have power over patients. Currently, there is an increase in both nonprofit and for-profit agencies that purport to recruit, train and supervise “professional” caregivers... But “professional” means learned, expert.  

The aging population has twice as many women as men over the age of 85. “Long term care and aging” is one of the current legislative concerns of the California Commission on the Status of Women. Because women are more often than men in care-giving roles and also outlive male spouses, a burden hits them doubly-- having first to interpret and make decisions for loved ones, then having to ensure their own wishes are respected when their time comes. With only 1 in 4 persons having an advance directive in place, critical decision-making may be left to others at the end of life.  

I know an R.N. associated with a geriatrician’s practice. Patients were reporting dissatisfaction with “agencies” – long delays in dispatching someone, abuse, etc. She follows-up, eliciting patients’ evaluations of caregivers and their sources, and has evolved her own list of caregivers. If a patient is not satisfied with the caregiver whose name she has provided, the referral is stricken from her list.  

To commemorate Mother's Day 2010, OWL (Older Women’s League—The Voice of Midlife and Older Women) featured end-of-life issues in its 30th Anniversary report. With Representatives Tammy Baldwin and Earl Blumenauer, OWL held a Capitol briefing “to begin a more civil discourse on end-of-life decision-making.” 


What happens to senior citizens when they become elderly and alone —where and how do they live, and with whom?Aging-in-place is a term heard these days, said to be the ability to live in one's own home, wherever that might be, for as long as confidently and comfortably possible. It is also said that “Livability can be extended through the incorporation of universal design principles, telecare and other assistive technologies.” I wonder who pays? Who care-gives? Who cares?  

Many senior citizens have lost the homes they once owned, or they may have always been renters. Many aged persons have no family. In rural communities especially, old women may have worked all their lives caring and nurturing family and community members but have never been on a payroll with “benefits.” 

Dependency on a paid caregiver and subsidized housing can be precarious for an elder. Approximately 25% of elder abuse occurs in nursing homes and other retirement facilities. English may not be the victim’s “first language.” There is fear of losing the rent subsidy. Building management may be hostile, indifferent. And there may be fear of losing an adult child’s approbation. 


Here are a few people within my ken. I’ll give them names. 

Norman spent his final decades in a low-income seniors/disabled persons’ rent-subsidized housing project. He was all 3: low-income, elderly, disabled. He was alone and without family. Marginal. The county dispatched Miranda “caregiver” who jabbed, pushed and yelled at him. When not with Norman, she was often chatting with building staff. The small studio reeked. While inventorying his possessions during one of his hospital stays, she was overheard to comment to Mollie, “We can sell this.” When asked why he didn’t request a different caregiver, he responded “I’m afraid.” No eccentric recluse, he wanted to be out and about. When no building staff were on the premises, he would walk the corridor, leaning on his walker. 

Mollie volunteered at the Community Center. She had raised 2 children and worked as a caterer. During her first 10 years in her senior housing room, she served as president of the residents’ association and prepared the annual Thanksgiving dinner. During her final decade when her health began to wane, several unsatisfactory care-givers supplied by the county and independents, came and went. She was 95 years old when she emerged from her apartment late one night, fell and could not get up. Much later a neighbor saw Mollie in fetal position in a dark corner of the unlit lobby and summoned paramedics, despite her “Don’t tell my daughter” plea. Within the month, she was gone to “assisted living.” 

Tiny caregiver Michiko is standing at the curb of a major thoroughfare managing a wheelchair occupied by Roy, a former academic.He broke his hip several years ago while in the office of the apartment building where he lives, when he fell off a chair that had a broken arm. An hour or so later, both are still waiting. A taxi pulls up and parks on the opposite side of the street, then drives away. Finally, another taxi appears where they are waiting. Roy needs access to the front passenger seat. Singlehandedly, Michiko manages to move him out of the wheelchair and into the front seat. Then she hauls the wheelchair around to the back of the taxi and strains to lift it into the taxi trunk. She returns to buckle Roy’s seat-belt and “tuck him in,” then gets into the back of the vehicle. 

Ahmad and Leili speak almost no English. They are Medi-Medi, i.e. have Medicare and Med-I-Cal. She shepherded him to a clinic and was encouraged to return for a physical examination for herself. A large “mass” was discovered, and she was referred for a mammogram. He was able to get the form interpreted by displaying it to a neighbor. Surgery followed. The good news is that in-home supportive services has provided a genuine giver-of-care, a nice guy I’ll call Ron. He is bilingual and has a car, helpful in this situation. 

Senior citizen Lily apologized constantly. She confided that during her middle years, she had had 42 ECS treatments. Her life was built around a cat, for which the landlord required a signatory. In order to hide her deteriorating health, she ventured nightly from her fourth floor studio via the emergency stairwell. Ultimately, she was placed in a mental institution several communities distant. 

People often questioned that Hillary, who lived alone in a subsidized rent unit, actually had no family. She needed surgery and was assured that a caregiver would be provided following discharge from the post-surgery rehabilitation center. She was returned home by ambulance; the social worker handed her a blank application (no accessible phone number) for a caregiver and suggested getting an Alert emergency button. This situation was also in part attributable to the surgeon’s refusal to record in patient’s chart need for post-hospitalization stay at the rehabilitation center and subsequent care.  

On a positive note … Grandma W was a farm wife. Sometime around 1908, she was widowed “early.” She raised 10 children, determined that “the state” would not take them and that each would get through 8th grade. As she aged, other than rheumatic knees, she was in good health-- in winter, in her rocking chair in the warm kitchen doing something productive-- stringing beans, peeling potatoes, etc. 

In 1957 I visited for her eighty-seventh birthday. We were sitting together on the porch when an old-fashioned horse and buggy drove by, and she said wistfully “Your grandfather courted me in a buggy like that.” Her reputation as a strong, caring woman had grown, and now she was being cared for. 

To earn money in ways country women could, my grandmother and a daughter had converted the living room into a U.S. Postal station, boarded the summer minister in the spare bedroom, and cared for more than 50 state foster children who had called her ‘grandma,’ been kissed good night, and received an occasional slap. Grandma W was so highly respected and well known that her funeral in 1963 drew crowds that overflowed the Grange hall in the isolated community. When she died, she was 93 years old. There had been no thought of “putting her in a nursing home.”  


Since publication of the “Awareness, prevention, and confrontation of elder abuse” column (Planet, June 8, 2010), I have received informative emails from people throughout the United States. I’ll share some of their great ideas and leads: 

Emily Grose for the National Council on Aging (NCOA) provided information about a new film, An Age for Justice: Confronting Elder Abuse in America. A national screening initiative to distribute it and 11 other videos has been launched. Community organizations, senior centers, and all others are invited to host screenings in order to raise awareness about the silent issue of elder abuse.Additional information at  

Several people reported disgruntlement regarding American volunteerism and ombudsmanship. Advocate Sam Perlin wrote to commend, the unofficial website for Harris County Long Term Care Volunteer Ombudsmen. The “official” website is at the Center on Aging at the University of Texas Health Science Center, Houston School of Nursing.  


For your consideration: 

A lot of old people and students wear their keys on a chain or cord around their neck. But be sure to insert the keys-end of the cord into your bosom/chest. Do not walk around the streets with the keys dangling visibly!  

Thursday, August 5 at the Albany Library, 1247 Marin Av. Easy parking. “Laughter is still the best medicine with proven physiological and psychological benefits” declares the Albany County Library Program for Older Adults. No reservations required for Laughing for the Health of it! With Bev Bender – Certified Laugh Leader. Refreshments. Also at library branches throughout the County; see  

Helen Rippier Wheeler can be reached at 

No email attachments; use “Senior Power” for subject.