Managing Up Ain’t What It Used to Be

Avivah Wittenberg-Cox FRSA offers her opinion on how we treat ageing populations in the modern West, coming to four very personal conclusions about how she will approach the matter.

Managing up used to mean having the political savvy to convince demanding bosses to get you in the door. For many Boomers, it now means having the medical savvy to keep unexpectedly old parents from death’s door. Or at least find a graceful way of gliding through it. 

Lunches with colleagues and clients used to be about work and gossip, now it’s all about ageing parents. We love them dearly, but the two power women eating a life-stretchingly healthy salad with me in London admitted to getting into their car, or walking over a nearby bridge, and screaming at the top of their lungs after a session with their progenitors. They recommended it as stress relief.

We’re all shocked by the monsters we seem to become. Impatient, frazzled, and ungrateful. Did I say guilty? But we explain it away by the monsters they’ve become – parents unrecognizably impatient, frazzled and ungrateful. It’s one thing managing a two-year-old’s tantrum. We know there is nowhere to go but more civilised. The difference in managing our declining elders is that there is nowhere to go but less so. All the filters disappear when people are unhappy, lonely or in pain. They lean to the brutally honest. Their sharp comments wound the children deep within their children. Or their friends. They do this most freely with those closest to them, of course. As my mother told her best friend recently when she objected to a particularly sharp jab: “I treat you like family.”

It’s another facet of a much broader longevity dividend. Our parents are living much longer than they (or we) ever thought they would. Often their own parents did not, so they are unfamiliar with the protracted ageing process, never managed one, and didn’t plan for their own. By the time they get there, and realize just how long they are living, they are past managing it. So it falls on their kids, who are shocked to find their own retirement years (and sometimes their savings) hijacked by caring for their elders. It wasn’t what anyone was expecting.

And expectations are everything.

It’s a teachable moment watching all this unfold. It’s a change in the bigger picture, as entire societies age. Our children will be far more familiar with the old-old than we are, simply because there will be so many more of them. My mother’s and grandparents’ generation were decimated by war, so my mother is the first really old person I’ve ever known. The arc of life towards its end is unknown territory to most of us, having had it swept under the carpet or into specialized care for so long. Millions of people are struggling with their parents in a system totally unprepared for the onslaught. No one is ready. And unprepared ends are not pretty, as Atul Gawande so eloquently wrote in Being Mortal.

In this summer focused on the aging at hand, I am discovering the competitive advantage of nations, something I learned about in business school, through a whole new lens. The contrast between my father-in-law’s care in the UK and my mother’s in Canada could not be greater. And these are two countries with solid, national health care systems. He had a painful and humiliating last year that saw him forced out of his out of his house and moved into a nursing home months before his death. My mother, at 94, still lives in my childhood home, supported by a palliative care unit from one of the country’s top hospitals who come to see her at home. My father-in-law got care for his various chronic conditions in 15-minute slices of over-stretched carers’ time. My mother gets a couple of hours each day from the same, much-loved helper, a weekly visit from a nurse, and doctors who come to her house. All for free. I’m not even talking about the US, where inequality and insurance companies reign and dial the stakes up to insanity-making (mostly for women) and bankruptcy-inducing.

Gratitude has grown deep. I have spent the summer with doctors and nurses whose patience and kindliness and ability to sit and listen and empathize are far beyond my own. I have been touched by the kindliness of a local carpenter and his big, manly assistant, who generously (and urgently) spent several of their summer Sundays building a raised garden deck for my mother when she could no longer manage the stairs – and shared in our delight at seeing her back outside for breakfast. I have appreciated my old Jewish mother developing a close and mutually appreciative relationship with her kindly Muslim carer, a recent immigrant into Trudeau’s Canada. And I have thanked my lucky stars that my husband has a strange talent for doubling as a saint, at least with his in-laws.

Of course, as I and all my Boomer cohort watch this unfold, we’re learning (or swearing we have) how we’ll do it differently. I’ve promised my kids the following, and asked them (and now you) to hold me to account:

• I will not underestimate the probability of a longer-than-expected life (I am currently clocking in at 105 on Deathclock.com). Read Lyndsay Green’s book cogently titled You Could Live a Long Time. Are You Ready?
• I will plan for this myself while I’m still able and move into appropriate housing (with no stairs) well before I need it. I have put all my wishes into writing and will post the Do Not Resuscitate note on the fridge as of a certain age (I’m not yet 60, so I consider this last slightly premature). Have you written your Advanced Health Care Directive? Here’s a state-by-state list of forms for the filling.
• I will move to my home country of Canada, which has legislated assisted dying, in time for older old age, or at least make sure I can still get on a plane to Switzerland (kudos to Dignitas for all their wise work and enlightened, intelligent support).
• I will not put one of life’s weightiest decisions – when to die - on my children’s shoulders and psyches. I’ll write it down. I’ll even publish it if that helps.