Some months ago, I helped to pack up my mother-in-law’s belongings and moved her to an assisted living facility.
If that sounds unremarkable, consider the fact that she was 103 at the time and reluctant to budge.
When Nona joined our household, at age 97, she was remarkably fit and alert but unable, finally, to stack the firewood that had warmed her kitchen. Alone in her little brick house on Main Street, she had reached the limits of aging in place. So she traded independence for some familial attention, living in a small apartment downstairs.
My husband and I assumed the arrangement would see her through to the end. Then, last summer, she began to falter. Her muscles weakened and her memory sputtered. We needed help.
The Census Bureau describes centenarians - people 100 and over - as both rare and distinct from other older Americans. The Twin States counted fewer than 300 in this category in 2010. But their numbers are growing, and so too are challenges related to their care. Some centenarians will be lucky enough to stay in their homes, or with relatives, until they die.
Others, like my mother in law, will have to make end-of-life transitions to residential-care settings. Thirty-five percent of women 100 and over live in nursing homes, according to a recent Census report, compared with just 7 percent of women between 80 and 89. The proportion is large because the pool of centenarians is relatively small. Still, as the figures suggest, the oldest of the old require special and costly attention. In the years to come, more and more families will face caregiving dilemmas similar to ours. “She’ll land just fine,” Nona’s attentive doctor assured us, even though we were skeptical. Long into her 90s, this one-time headmistress had balked at the idea of leaving her home, built in 1772 as a one-room schoolhouse.
How, then, to broach the subject of moving to an institution offering communal meals and humming with health aides? My husband loaded his iPad with photographs of her new room and pitched the benefits of a place where she’d be cared for 24 hours a day. She studied each bullet point of his carefully crafted Power Point presentation. There were tears, of course. But they were mine, not hers. I feared an involuntary move would further compromise her health. She, on the other hand, appeared unfazed. “Will I have to dress for dinner?” was all she really wanted to know.
Geriatrician Dennis McCullough, who traced the arc of his own mother’s end-of-life care in his book “My Mother, Your Mother,” told me that people who live to 90 and 100 are increasingly frail, but still able to adapt at the very end of their journey. “It gets easier beyond a certain age,” he said. “The issue is how we can make these transitions without feeling guilty.” In the end, Nona absolved us of guilt and taught us about grace in deep old age. “This is a good place,” she said as she blew out the candles on her 104th birthday. “This is a good place.”
