in the worst of times and the best of times
Jeannette Franks, Aug. 25, 2021
The 2020-21 pandemic indelibly engraved on our collective psyches the importance of family, friends, and community support. It is intuitive that love, friendship, conversation, even conflict, are essential. In our later years a robust social safety net can not only mean the difference between life and death, but we also know that positive social support can contribute to a good life and a good death.
I am including in this big social support bucket not just relationships but governmental and societal life jackets. We sometimes take programs such as Social Security, Medicare, Medicaid, long-term care, Area Agencies on Aging, non-profits, and public health agencies for granted. Watch out! They are often threatened by new administrations, new administrators, and new legislation.
During the COVID crisis, many who were formerly contributors to food banks became recipients. Some agencies make the people they serve feel embarrassed and demeaned. Others do not. So, not only are social services often in jeopardy of negative changes, but services might be provided begrudgingly.
During the pandemic, at a time when those in my eligibility tier (70 and over) were struggling to find vaccine appointments, a member of my book group sent an email to all of us, announcing the availability of vaccine appointments at a hospital an hour away. We all signed up and were successful. So many seniors locally were struggling to get appointments that a non-profit that usually provided volunteers for transportation and other services, trained a cadre of volunteers to find appointments, notify and sign up those eligible, and set up transportation. This combination of personal networks and a well-organized non-profit is exemplary and effective.
On a human level we can individually and collectively nurture our personal relationships consciously. Think of ways to foster a sense of community in your neighborhood. What comes to mind? Backyard barbeques, joint garage sales, progressive dinners moving from one home to another one, a course at a time, consciously creating connection. In my condo we have a weekly social hour.
In my small town, for many neighbors the emergency preparedness process set up by our city introduced neighbors to each other and established life-long friendships. Partners in 43 states have used this “Map Your Neighborhood” disaster preparedness program. The website will pop up if you search for “Disaster Services and Supplies”. The detailed booklet covers what to do in earthquakes, heat waves, blackouts, tornedoes—the potential disasters list is huge. The official website did not at the time of this writing this include pandemics, but our city used the structure created by Map Your Neighborhood to recruit leadership, find and share emergency supplies, locate those in greatest need, plan for the future, and alert the community by emails and texts to quickly changing situations.
Structured social support consists of two distinct yet intertwined spheres. A nurturing community has both non-profit and for-profit agencies that respect and assist people of all ages, backgrounds, ethnicities, and incomes. A good community is an elder-friendly community.
The World Health Organization (WHO) has created guidelines that transcend countries and cultures. Ireland was the first to be recognized as an elder-friendly country. Montreal, Canada and Portland, Oregon and recognized as elder-friendly cities. A genuine age-friendly community has a competent Public Health Department, and in my opinion, health insurance for all. The pandemic has revealed many lacks in health care such as an initial shocking shortage of personal protective gear for front-line workers. Many communities responded by sharing skills and materials to sew masks from scratch.
An important factor in an elder-friendly community is safe, accessible, affordable transportation. While not all of the oldest-old are unsafe drivers, many are. Yet the lack of public transportation, especially in rural areas, is a huge barrier to giving up a car. In addition, many Americans identify independence with driving. Teenagers and those over 85 have the highest rate of accidents per miles driven. All age groups should be subjected to identical scrutiny. Perhaps we need comprehensive driving exam for every driver every 10 years?
No one policy has solved the demented driver dilemma. Every family figures out different strategies—or not. We told Dad that the car had been recalled and made sure he had plenty of other options to get where he wanted. Eventually he stopped asking when the car was coming back. I know some families that have disabled the vehicle. If one doesn’t have the mental and financial wherewithal to plan and execute car repair, it cuts down on dangerous drivers.
I attended a panel at a national aging conference on dangerous drivers. One organization had created a ‘driving advance directive’. The person in peril of being at risk in the future signed a document saying that he or she knew that at some time “I will be an unsafe driver” and designated a specific person to make that decision. The audience thought it was a brilliant idea until someone asked, “Did it work?” “No”, was the sad answer.
Not just Alzheimer’s, but many of the other dementias—Parkinson’s, stroke, Lewey bodies, brain tumors, reduce the ability to drive dramatically. Other age-related disabilities such as tremors, slowed reactions, stiffness to view side traffic, and more interfere with driving.
Most states have a protocol where physicians can report unsafe drivers. One hopes that when that is reported, some action is taken. There are even apps such as “Bad Driver Database” where you can use your phone to snap a photo of an unsafe driver and it at least creates a record. It isn’t clear again whether any action results from being reported. Some state Departments of Licensing have a form that can be used anonymously to have unsafe drivers evaluated. As an example, here is the link form for Washington state https://www.dol.wa.gov/driverslicense/reportunsafe.html.
Many cars now have back-up cameras as well as sensors around the entire car, warnings systems, automatic braking systems and more to help older driver. Those that can afford it may well benefit from a state-of-the-art car with maximum safety devices. The other vehicles on the road will be safer as well.
Any possible way individuals and communities can provide transportation will foster aging in place.
Getting unsafe drivers out of their cars can save lives, for example my 92-year-old neighbor who backed over and killed a grandmother in front of her horrified grandchildren.
Affordable, accessible housing is another factor that creates an elder-friendly community. Ideally, when new multiple-unit housing is designed, local data on what percentage of the population is of various ages and income are consulted. For example, a one hundred-unit apartment complex could reflect the percentage of older and/or disabled population and sell at a diverse range of prices. So, if 15%, (a likely figure in the US) is over 70 or disabled, 15% of the units are accessible, including a wheelchair-usable entry and bathroom. Permitting for new structures can include requirements of a certain percentage being low income and affordable. How many U.S. communities do this? Few, if any.
Negative social support
While it is easy to acknowledge that social support has positive value, we often have a hard time grasping that there is also the opposite—negative support. Think of those people who suck more from you than they return. Not all relationships are symmetrical, nor must they be. But those people who need so much—so much sympathy, so much help, so much listening, can drag you down. At what point is it harmful to you? How important is self-interest if you are truly needed?
Consider how much there is that can be sucked from you without damaging the nurturing you give others and that you give to yourself. Of course, relationships in our lives differ greatly and change over time. The same person can be primarily the listener in one relationship and the talker in another. But when it is noticeably unilateral over a long period of time, sometimes self-preservation sets in. Allow yourself, to say, “Sorry mom, I can’t come to dinner this week” or “Forgive me, Angela, I must hang up and take another call.” I’m not suggesting totally ghosting family members, unless it is an abusive relationship, but while blood is redder than water, it’s not always the best binding force.
It breaks my heart to have long-time friends that when you talk, it is totally one-sided. There are crises in all our lives. At these times you must receive the pain and sorrow from a dear friend, and listen, listen, listen. However, it can eventually return to a true conversation, in which each person listens and talks. An equal friendship is healthy.
Helping someone in grief here???
There is a myth in America that in the ‘good old days’ families (read ‘women’) took care of aging relatives, while now we are selfish and farm out older people to nursing homes. In reality, quite the opposite is true. As noted earlier, less than 5% of all people 65 and older are in a nursing home. Also, in the good old days, people died much younger. The life expectancy in 1900 was 50 for women and a bit less for men. In 2020 the average person can expect to live to be 80. Of course, many of those in their 70s, 80s, and 90s, need support and current data suggest that a majority of us will be caregivers and carereceivers at some point in our lives. The interdependence of humans is marvelous and productive. While we are a nation founded on a declaration of independence, in fact at all stages of our lives we give and receive interdependencies. An effort to foster interdependence is a normal and desirable state, even imperative.
The analogy of the equity of babies being dependent on parents and then parents becoming dependent on adult children is false. When babies are born, humans in general will learn to toilet independently, go to school, mature and support families themselves eventually. However, it is unlikely that a disabled 80-year old will ever get more independent rather than less, despite the wonders of surgery, physical therapy and medications.
Interestingly, the trend appears to be that, while we used to think of elders moving in with adult children, more often today adult children move in with their aging parents. Housing is crushingly expensive, as is homecare. There is social support in togetherness. But don’t forget the mantra of many a school of social work, “All families are dysfunctional.” To me, it is a question of degree and coping mechanisms. When you hear a complaint that “my kids never come to visit” ponder the possibility that this parent might have been abusive, physically or verbally, or both. Not every family is like Leave it to Beaver. In fact, sociologist Stephanie Koontz wrote a brilliant book called, “The Way We Never Were,” clarifying with research that blended families have always been the norm, and many families are dysfunctional to the point where that is also normal. She also points out, as just mentioned, that life expectancy was so low in the past that it was normal to lose a partner to death and then remarry. Divorce was uncommon because women had few rights. But it was normal to have more than one ‘life’ partner throughout a normal life. She calls it ‘serial monogamy’, which sounds like a delicious breakfast to me.
Holidays
The pandemic gave many families the opportunity to reconsider how and why we come together. Zooming replaced flying across the country for holidays. Various relationships appear to have been improved by distance. Skipping Thanksgiving with querulous cousins was easy! Faking unfelt piety unnecessary. Stressful guilt trips gone. Next year holidays may be more optional than obligatory. Think of creating new traditions with smaller carbon footprints and larger space for joy.
Celebrating the solstice has been traditional for at least a millennium. Traditions and rituals soothe stress. That may be why many risked life-threatening infection during COVID to gather with family and religious groups. Think about creating new traditions that fight isolation, promote happy harmony, and are happily anticipated rather than dreaded.
Pets
While tinder, Matchup.com and other web services make it easier and riskier than ever before to date, the unconditional love of a pet can soften the sorrow of loneliness. Dog and cat adoptions soared during the pandemic. And while it is challenging to manage the needs of a dog when working full-time away from home, there is an entire industry of dog-walkers, doggie daycare, and dog-friendly businesses. Tell an adorable story here.
An epidemic of loneliness
correlations with well-being. NYTimes May 15, 2020 “According to Gallup, Americans are experiencing the sharpest drop in perceived well-being on record.” While fear of death for oneself and for loved ones is part of that, isolation may contribute to a lower disease risk, but it does not enhance well-being. What indeed is perceived well-being? Write about relative deprivation
Other important connections are intersections that we may not recognize as vital, but help foster a sense of belonging and happiness. Those are those seemingly unimportant people with whom you come in contact in a normal day, or even during the pandemic. Think of the grocery workers who look you in the eye at your regular market and honestly ask how you are doing (and vice versa). The kindness of your mail carrier that you know visits your home every day is a little pleasant boost of sociability. Your hairdresser, your physical therapist, your neighbor sweeping her walk. Seemingly trivial conversations enrich our lives with information, humor, and kindness. A book entitled Consequential Strangers M. Blau and K. L. Fingerman researched these relationships with people not relations or close friends and found them they help with a basic human need for community.
Many of us became ‘zoomers’ during the pandemic and my instinct is that we will continue these electronic meetups even when the COVID epidemic is over. Zoom or whatever of the programs you use, both free and for a fee, combat not just loneliness and disconnection, but enable us to participate in meetings, conferences, friendships, and family ties that were inconvenient at best and impossible at worst. One branch of my dozens of cousins zooms every Saturday night. One neighbor video chats with her many sisters every Sunday. Our senior center has an 11:30 zoom every weekday with guest speakers, travelogues, talks on memoire writing, local organizations and more. I zoom quarterly with a statewide council on invasive plants and animals, which I find fascinating and useful. While I would never drive to our capital many miles away, I am delighted to virtually sit in on the briefings from all the experts.
Technical devices can aid connecting with family and friends: GrandPad may be worth the $200, but 8” isn’t very big. Several devices are meant to replace smaller, more complicated phones and larger, more complicated computers. These can be considerably cheaper than most phones or iPads.
The software and devices were used for memorials during the pandemic. It is so important for healing to have some type of ceremony. There is no right or wrong way to do, but evidence indicates that it is helpful to have a gathering, even if by phone, electronic notebook, or computer.
Acknowledging grief
One of the horrific hazards of choosing to work professionally with older people is that I repeatedly lose my mentors, my friends, my colleagues. Even worse, as I age, I lose more and more family to death. It is a reality. Losing a pet can also teach us that life is finite.
Helping those in grief
Over these many years of teaching about end-of-life issues, and personally losing so many of those dear to me, I have learned what is most helpful to say to those in grief.
When you learn that a person has lost a close friend or family member, particularly a beloved partner, please do not immediately change the subject and describe your saddest loss. This is not about you. It shows an incredible lack of empathy to try to offer sympathy by demanding it in return. A famous book on the subject is entitled Don’t Ask for the Dead Man’s Golf Clubs. A young widow with two children was appalled at such comments as, “You are still young enough to remarry.” Or, “He’s in a better place.” To her, a better place was alive by her side.
It is always correct to say, “I’m so sorry for your loss.” Or, “I can’t possibly imagine how you feel.” Because, of course, you cannot imagine how someone else feels, especially with the death of someone much loved. When my beloved husband died, it was agonizing how many people said, “Oh I remember how awful I felt when my husband, (wife, father, or whoever) died.” It put me in the position of saying, “I’m so sorry your whoever died.” While I was sad for their loss, I did not want their added sadness on of top on mine at that time.
There is no wrong or right way to grieve and no time limit to ‘finish’ grieving. Grief takes as long as it takes. I try not to judge a grieving person; while one can be sympathetic and empathetic, each loss is unique and personal. The three most important things you can do are listen, listen, listen. It is a great need of the bereaved to tell their story.
Losses that come unexpectedly, especially death to a younger person, can be especially difficult. It is heartbreaking to lose a parent, but in most cases even more tragic for a parent to lose a child. Compounded losses are also more difficult. To lose one beloved family member is horrendously hard. To lose multiple members of your family is crushing.
My opinion is that to some extent the demonstrations and some of the destruction that occurred during the pandemic were, in addition to anger at hundreds of years of systemic racism and abuse, also about the losses and resulting grief we were experiencing at that time. We lost our freedom to do normal activities, such as go to dinner and a movie. Many have lost friends or family to COVID. We appeared to have lost a functioning democracy for a time. We were grieving the disregard of truth and science. This grief, this anger and fury at injustice and racism, the horrible history of slavery and injustice, were being publicly expressed. There is hope for healing when the depth and profundity of these factors is better understood and addressed.
The paragraph above was written before the bizarre destruction at the Capitol Building in Washington DC on January 6, 2021. While there is no rational explanation of why Donald Trump would encourage people to riot and invade the Capitol Building, I suggest that his followers responded to his mad urging partly because of the grief, stress, and pain of the pandemic. It well might have been, to a certain extent, a manifestation of dysfunctional grief.
Often complicated losses such as sudden or multiple deaths result in dysfunctional grief. What does functional grief look like? Extreme sadness. But dysfunctional grief often shows itself as drug or alcohol abuse, family abuse, blank stoicism, fury—what else? The Native Americans in this country lost countless family and friends, first to diseases to which they had no resistance, then to the so-called “Indian Wars” and forced relocation. They lost their land, their sources of food, their culture, their languages, their religions, and most tragically, their children. All over this country children were taken from their indigenous parents and sent to ‘boarding schools’ where they were forced to abandon their loved ones, their clothes, even, most cruelly, their languages. Many were physically abused with forced labor and sexual abuse. Experts suggest that these multiple, unresolved, and egregious losses have resulted in manifestations of dysfunctional grieving.
Dealing well with loss is immensely helped by positive social support at all levels. Fostering strong positive relationships provides huge benefits for heath, happiness and longevity.
Jeannette Franks, PhD 