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The Last Place You Ever Live

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September 17, 2012

My mother needs her loom, and my father wants a wood shop. What do Baby Boomers consider before they sign away their worldly wealth?

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Image courtesy Mark H. Anbinder

Within the first forty minutes of our tour, my mother discovers a major problem: The crafts-room is not up to her standards. She doesn’t see a throwing wheel or a sewing machine. She doesn’t care for the vinyl floor or the folding tables. She’s not crazy about the light. If she donated her loom, she asks the sales associate, they certainly wouldn’t put it here, would they? There must be another facility for the serious artisans.

The campus of Cokesbury Village occupies several square miles of farmland outside Wilmington, Delaware. It sprawls and rolls down a manicured hill towards a creek-sized tributary of the Delaware River. The landscaping, dotted at intervals with footbridges and filigreed lampposts, is somewhere between arboretum and theme park. Cokesbury’s main building—a twelve-story brick and steel construction—could be easily mistaken for a Hyatt from the 1980s.

The sales associate, a thin woman with a pencil-skirt who is scheduled to spend the next five hours escorting us the full width of the campus, shakes her head.

“No, Mrs. Fischer, this is what we’ve got right now for crafts. But if you were to join the residents’ council—they often consider improvements and expansions to our community.”

My father and I watch as my mother retrieves a spiral notebook from her purse and makes a note of the deficiency. My father is leaning heavily on his cane, short of breath from walking. Except it’s not really a cane; it’s a trekking pole, like for hikers and backpackers. We don’t call it a cane because to do so might make it permanent.

***

There are two times in your life when you’d be likely to encounter the term “continuing care retirement community”: in your later decades, when a fall or a hospital visit makes clear that your house is no longer a safe environment, or in your thirties, when on an unremarkable Sunday evening your parents call to tell you that they’ve decided to stop living in the shadow of your father’s health and resolved to move somewhere that can better serve their changing needs.

A CCRC is essentially the equivalent of organic farming for elder care. It’s not quite a retirement community, nor is it exactly a nursing home either. Pioneered by the LifeCare Corporation in 1971, a CCRC is a vast self-contained campus, complete with housing options ranging from airy cottages to hotel-style apartments, dining facilities, and acres of nature-paths. Amenities rival those of a small city, if a small city was built entirely by AARP The Magazine: There are woodshops and pottery studios for hobbyists, simulcast operas and visiting professors for intellectuals, weekly get-togethers for social butterflies, language classes, dances, and independent lending libraries. Cafeteria menus are designed by executive chefs–even the inoffensive wall-art is made on premises.

But the more important function of a CCRC is to provide a comprehensive logistical answer to the end of life—a complete package deal, if you will. While most residents arrive as fully functional retirees with pastimes and furniture and plans for the future, they soon embark on the journey of medical services that will unavoidably define their penultimate years. This begins with occasional in-home nursing visits and progresses steadily through motorized wheelchairs and special diets, minor surgeries and regular physical therapy (strength training, aquarobics, neuromuscular re-education). At some point residents leave their homes for a central facility where rooms—or rather, apartments—are attended by a full-time staff of geriatric professionals. Eventually, they come to a building known as the skilled nursing annex, where doors are adorned with grandchildren’s cards and tiny dried flowers. Residents never exactly die; the community loses someone. Cottages are gut-renovated. Apartments get new paint, new carpet, new appliances. A new family arrives to vet floor plans and pricing options. To every season, etcetera, etcetera.

This year my mother turns sixty-six and my father seventy-one, marking the decennial anniversary of his botched heart-valve replacement surgery, a bottomless crisis resulting in a stroke that hobbled his left hand and foot, an aortic aneurysm, and a steady decrease in heart function every year. Average age of entry into a CCRC varies by location but is generally between seventy-eight and eighty-two, making my parents among the youngest of potential residents. This is a concession they are willing to make. Insurance providers will barely look at my father’s medical records, much less extend to him the kind of long-term coverage he’ll almost certainly need in the near future. Live-in care is out of my parents’ price range, and my mother is fifteen years off from an actual nursing home. Though I’d envisioned them in their later years buying a condo and hiring occasional help, I now understand that’s not an option, and I can’t say I blame them. A CCRC is the best solution to a problem that doesn’t actually have one.

No organization officially records the size of the CCRC industry. The non-profit Leading Age comes closest, estimating that nearly a million Americans live in two thousand such facilities. And I’ve agreed to go tour them, helping my parents over the course of a weeklong, three-state trip to choose the place where they will spend the remainder of their lives.

***

Following our visit to Cokesbury Village, we head north towards Pennsylvania and a community called Kendal. My mother insists on driving. She complains that I go too fast and my father is no longer legally able.

In contrast with the farmlands of Cokesbury, the campus of Kendal looks like a utopian commune. Smooth concrete walkways are cut at perpendicular angles through flat expanses of grass. Cottages are attached in long rows, radiating out like spokes from a wood-paneled central building. On our tour, the sales associate discusses Tchaikovsky and the Ballet Russe with my mother, showing us to a model home hung with dream catchers and bits of beach-glass. My father and I follow at a distance, paced by his bad foot and his need to stop every fifty feet for a rest.

Our morning agenda is split down the middle. My mother’s itinerary includes houses, skilled nursing, and ample time to meet other residents. My father, a physicist who once built amplifiers and furniture in our basement, is primarily concerned with the wood and machine shops. Though the hazard of operating a table-saw with his stroke-damaged hand seems obvious, we don’t press him on it. He, in return, doesn’t protest when our tour of the cottages runs over by an hour, forcing us to skip his shop visits in favor of lunch.

Kendal’s café boasts tablecloths and daily specials. We’re invited over by a purple-haired woman with an oxygen tube and a man who introduces himself as the former provost of a Massachusetts prep school.

“We can spot a prospective family from a mile away,” the provost laughs. “Even with old eyes.” His handshake is firm and welcoming.

My mother, herself a former newspaper reporter, has prepared a set of questions in her spiral notebook. How did they come to be at Kendal? Have they been happy with the staff and the cleanliness of the facilities? How liberal are the other residents? Our lunch companions seem impressed by her diligence.

“I’m always telling people not to wait,” the provost explains. “The community, the friends we’ve made, the peace of mind. I wish I could’ve moved here when I was your age.”

I wonder how many other visitors have sat here with this particular couple. Their answers fit flawlessly with the rest of the morning’s sales pitch: a touch of humor, a bit of seriousness, an acknowledgement of how difficult the decision can be.

The purple-haired woman looks for a moment at my father’s lobster-claw hand and then touches him gently on the shoulder.

“I know it seems like such a change,” she says to him, “but for me it’s turned out to be a whole new lease on life.”

***

After Kendal we stop for dinner at a place called The Char Pit. The menus are encased in smudged plastic and the turkey burger I order is the consistency of vulcanized rubber. I cut my father’s steak into pieces. He can fork or knife, but not both at the same time.

“So,” my mother says, “what did we think?”

“The biggest variable is how much space we get,” my father says. “I think you probably preferred the grounds at Kendal, but the homes at Cokesbury were larger on average.”

In my professional capacity as a marketing consultant, I’m supposedly qualified to view my parents with a degree of demographic objectivity. They’re technically “leading-edge Baby Boomers,” members of a generation of about 80 million people. I regularly traffic in stats regarding their composition: Boomers currently account for about half of all US discretionary spending; one of them turns sixty-five every eight seconds. The Baby Boomers, I’ve intoned in meetings and on conference calls, are fiercely independent, largely affluent, and prepared to redefine the stages of life that fail to meet their iconoclastic needs. Ken Dychtwald, a media personality who has made a fortune as an expert on the Baby Boomer market, refers to this phenomenon as the “Age Wave.” He promotes, in books and lectures, the hypothesis that the entire locus of American consumer society is shifting from the demands of the young to the demands of the old as the largest generation in history prepares for the end of its collective life.

Though the exact financial arrangements vary by community, if my parents qualify, then they’ll be basically guaranteed to sign away the entirety of their worldly worth.

But gaining entry into a CCRC seems to render the image of the super-empowered Baby Boomer ridiculous. To start, prospective residents must prove that they are both fiscally solvent and physically capable of “independent living” at the time of admittance. Most non-profit CCRCs will continue to care for residents who exhaust their assets “through no fault of their own,” and so my parents are expected to submit an exhaustive financial and medical review, to estimate whether they will run out of money before they die or vice versa. Then my parents will have to wait for a unit to become available. Provided it’s the one they want and an administrative officer has determined that they’re eligible, they will be responsible for obtaining a lifetime lease on the property—a spectacular euphemism for a $400,000 cash purchase that retains little or no equity. Each month of residency, they’ll be additionally responsible for payments used to cover shared medical services and community-wide insurance, ranging from $4,000 to $6,000. Though the exact financial arrangements vary by community, if my parents qualify, then they’ll be basically guaranteed to sign away the entirety of their worldly worth.

“I was a little concerned about the community at Cokesbury,” my mother says. “I met a former Presbyterian pastor while you were in the bathroom. We had a nice talk about religious tolerance, but there’s just something comforting about a place like Kendal—knowing that it has a Quaker affiliation.”

“I think I’d still like to go back to Cokesbury for another look,” my father says.

My parents’ accountant doesn’t think they should bother looking at all. Even if they can afford it, CCRCs are a gamble. Due to their financial complexity, they are generally run by large corporate entities (the Kendal Corporation—the Pennsylvania Kendal’s namesake—being the largest and most well-organized) that can facilitate the industrial-scale debt and leverage necessary for operation. They may issue bonds or act as an investment vehicle to raise capital.

Unsurprisingly, many have been hit hard by the economic downturn. High profile bankruptcies including Erikson Retirement Communities and Chicago’s Claire at Water Tower have resulted in foreclosures and receiverships, coloring the industry’s promise of security with a palette of doubt.

“If Kendal seems like somewhere you’d be interested in, we can call about scheduling an overnight next month.” My mother folds and refolds the napkin in her lap. “In either case, we’ll still need to start getting the house ready for the realtor.”

Whether my parents can sell their house in this market is an entirely different issue. They’ll need to time the sale to within a several-month window of a unit becoming available. Their real estate agent has started using the term teardown.

“I’d like to have a better sense of our options before we get rid of anything. I’d like to know that wherever we’re going will have room for my shop tools, for example. I don’t want to just throw them out because we’re in a hurry.”

My mother frowns at this. The belt-sander and radial-arm saw have sat unused in the basement since 2002, the summer of the surgery that will not be named.

“Oh goodness,” she says. “Come on.”

“Come on, what?” my father says.

My mother doesn’t answer. She folds her napkin again.

“Come on, what?”

***

Collington is in Maryland, a twenty-minute train ride from Washington, D.C. The facility is off of a four-lane highway, set back behind a guard booth and a long rise of tree-capped hills. It’s the most modern of the places we’ve seen and also the most pre-fab. Colonial-style buildings are arranged in evenly spaced cul-de-sacs, with a wide ring road around the grounds. Speed limits—5 miles per hour—are posted in an oversized font.

Because of a late departure (my father searching for his spare bottle of neurontin; my mother rapping her knuckles on the wall every two minutes for him to hurry), we arrive an hour and a half past our tour appointment. The chipper middle-aged sales associate accepts our apologies with a smile and a wave of her hand—and then suggests that due to limited time we might want to goose my father with a little extra horsepower. She produces a wheelchair from a closet in the marketing office, black vinyl with the word ‘loaner’ stenciled across the back.

I shake my head before my mother can say anything. The sales associate indicates we can do an abbreviated tour if we’d prefer. My parents share a quiet word that concludes with my father handing me his trekking pole.

“It’s just for a few hours,” he says to me.

We struggle with the stirrups. I’ve never helped my father—or anyone else—into a wheelchair. The series of hinges proves more complicated than it looks. Finally the sales associate intervenes, lifting his bad foot onto the platform with startling efficiency.

“Let’s please not get used to this,” I say.

My father smiles a half-smile I’ve never seen before. Maybe it’s one of sadness or sympathy. I can’t tell. With his velcro New Balance shoes and an oversized Baltimore Inner Harbor cap to keep the sun off his head, his smile has become that of an old man, grateful for the kindness of others. At which point I realize the stupid, obvious thing I should’ve seen the moment our trip started: The purpose of these places with their beautiful vistas and their endless amenities is not to make my parents young again. It’s to make them comfortable being old.

My mother agrees to start the tour with a visit to the woodshop. I ask the sales associate for directions. Then I instruct my father to keep his hands inside the ride and begin running.

I push the black rubber handles as hard as I possibly can, committing the full force of my legs to forward motion. Past a certain speed the wheelchair takes on a violent shimmy. When we round a turn, I make cartoon race car noises. Collington’s perplexed residents stare as we rush by in a blur of father and man-child.

Since a fall outside of a CVS two year ago, my father has barely felt capable of leaving the house unaccompanied. But the man now talking to the shop-master seems suddenly like the bearded physicist I grew up with, forgotten but not gone.

My mother and the sales associate catch up with us in the parking lot of the woodshop. My shirt is soaked through from armpits to neck.

“What took you so long?” my father asks as I help him out of the seat.

Inside the shop, the sales associate introduces us to a short and portly man who runs the community’s repair service. Residents can bring their antiques—steamer chests and lamps and end tables with sagging joinery—to be refurbished free of charge. He and my father move quickly from handshakes to admiring the shop’s ventilation system. They compare tools they’ve used, projects past, lessons learned from kickbacks and locked blades. They walk with the same irregular motions, the same attention to errant cords and foot-level obstructions. Since a fall outside of a CVS two year ago, my father has barely felt capable of leaving the house unaccompanied. But the man now talking to the shop-master seems suddenly like the bearded physicist I grew up with, forgotten but not gone.

The effect vanishes when he settles back into the wheelchair.

In the interest of time, the sales associate offers to take my mother through the skilled nursing annex while my father and I find food to accompany his afternoon pills. Collington’s main building includes an old-time-y deli where we find fat-free chicken salad and unsalted potatoes.

On a bench outside, I open the plastic containers one-by-one and hand them to my father. We watch the residents filter in and out of the main building, supported by four-footed canes and wheeled walkers.

“This must not be easy for you,” he says to me.

“I guess,” I say. “Is it easy for you?”

“All I have to do is get dragged around for a few days.”

I mumble something resembling an agreement and discover that I’m having trouble meeting his eyes.

“I remember when this happened to my dad,” he continues. “He was diagnosed with mesothelioma from his years at DuPont—this was before you were born. I remember those first real changes in him, when he wasn’t quite my father anymore. The hardest part wasn’t seeing him change. It was knowing he knew I saw it. That really broke my heart.”

I excuse myself from the bench, explaining that I need a bathroom.

Locked in a handicapped stall with an emergency pull by the toilet paper, I sit on my heels and cry. The bathroom is empty and so I really go for it: wailing, shaking, snot streaming from my nose. The minutes wash out in long blurry streaks. Pressure fills my chest like sinking to the bottom of a pool. The light goes flickering and dim.

When I return, my mother and father are debating whether the Toyota will break two hundred thousand miles on our way back. Neither of them mentions the redness ringing my eyes, but my father squeezes my shoulder as I help him into the car.

We drive home, or my mother does, anyway. I lie and say I have a meeting I need to prepare for. They drop me at a train station so I can make it back to the city in time for work the next day. I promise to call the minute I get in. They ask me if I’m okay. I tell them: “Sure.”

***

In the immediate aftermath of my trip, I witness a range of reactions from the people I know. Close friends—whose families are younger and healthier—ask thoughtful questions and listen dutifully, demonstrating a mix of sympathy and nervous apprehension. Professional acquaintances in their forties and fifties express condolences in conspiratorial tones, implying that I’ve been provisionally admitted to the Dead Parents club. The girl I’ve been dating breaks up with me, explaining that she doesn’t think I’m in a good place for a relationship.

Whatever knowledge I’ve brought back seems to make people uncomfortable. They see themselves and their loved ones in it. It bothers them. It bothers me too, of course, though telling them that would be pointless.

The remarkable character of aging is the way it draws each of us towards the same inevitability, the same anonymity, the same identical end.

Part of what makes the truth of aging so unnerving is its scale. It’s the elephant to all of our blind men. For example—did you know that there’s an entire retirement city called The Villages in Sumter County, Florida? The place is “age restricted,” meaning that no person under the age of nineteen is allowed to visit for more than thirty calendar days in a single year. Inhabited by a mere eight thousand residents a decade ago, the community expects to reach 110 thousand by 2016. It is currently considered the fastest growing micropolitan area in the United States, with the highest concentration of Social Security recipients in any single zip code. Paul Ryan recently gave a speech there about how he’ll save Medicare. He appeared alongside his mother.

Or how about this: To this country’s 80 million Baby Boomers, the rest of the world shrugs. Most of Western Europe is experiencing a similar demographic bulge. Japan is not birthing enough children to replenish its population, and has begun building robots to help take care of the elderly. For a while, northern Mexico had a boom in nursing homes that catered to budget-conscious Americans. I assume the drug war has done away with all that.

But after a while I start to think that scale alone isn’t the problem. It’s that the scale robs us of our individual agency. The remarkable character of aging is the way it draws each of us towards the same inevitability, the same anonymity, the same identical end. Everyone on the planet will experience it in one form or another, as one of the few rituals we share across our species. Except as tiny people with worries and chores, obligations and hopes, we are painfully ill-equipped to reconcile the distance between the personal and the universal. We perceive our own outline in the facts and empirical evidence, and imagine that we can make things different for our parents or ourselves.

Mostly we are wrong. Incontrovertibly and terrifyingly wrong. So we scramble to control whatever we can, in whatever infinitesimally small measure is possible.

The last place you ever live is not really a place. It’s a compromise. It’s a wheelchair or a cane, an argument, a difficult decision, a humiliation to be ignored. It’s a cleaving to the parts that were, and a progressive resignation to the parts that are no longer. It’s the temporary safety of particulars—will the new house be big enough, the food fresh enough, the other residents friendly enough? It’s a father seeing himself through his son’s eyes, or a wife trading hope for common sense. I’m sure it’s millions of other things too, depending on whom you ask. We are sons and daughters, after all, and susceptible by default to the terms of cliché.

If I only get to pick one, I guess it would be something resembling a simple question, probably the same one my parents are asking themselves right now.

How can I possibly make this my own?

G

John Fischer is a writer and marketing strategist. His work has appeared in PANK Magazine, Palooka Journal, Freerange Nonfiction, the New York Observer, the Random House anthology Twentysomething Essays by Twentysomething Writers, and has been recently nominated for a Pushcart Prize. He has on thin professional pretenses: commuted to Disney World, attended the Sturgis Motorcycle Rally, toured the various convenience-store chains of the Tri-State area, and been interviewed about trends and culture by Newsweek, ABC News, and Monocle Magazine.

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4 comments for The Last Place You Ever Live

  1. Comment by Mike Albanese on September 17, 2012 at 11:46 am

    MY GOD – he’s talking about US? How can this be? Was Woodstock really that long ago?

  2. Comment by ned hege on September 18, 2012 at 12:17 pm

    A very moving article. I was also in tears with John as the article ended. It would be interesting to find out how Europeans are working through this period. What is similar and what is different? We – my wife and I – have lived/worked through these times with all our parents and some grandparents. Most were at home until a final illness and even then came home or remained at home till the end. No CCRC options were used or even considered. I know they were fortunate in that respect although it didnt always seem so at the time. There is an organization called Partners In Care in Annapolis MD that sends volunteers to provide free assistance of many kinds to the elderly. In turn the volunteers earn credits to receive similar assistance when they are in need (I’m now finally moved to contact them). I hope we can conjure up more of these pay-it-forward approaches. Certainly we will need wider doorways and fewer stairs. But the CCRC picture is rather bleak, with its shake the last nickel out of your pockets and no you do not have any equity approach – it is after all just another for profit business with shareholders and bonuses and – you get the picture. There may be little or no difference, but perhaps the non profit “industry” can do a bit better – or not. Perhaps I’ll find out sometime in the possibly near future.

    Yes, Woodstock was a long time ago. Now, turn around and look – and move – forward.

  3. Comment by jpeckjr on September 23, 2012 at 11:00 pm

    Bless you, John, for taking them seriously in their quest. For not trying to talk them out of it. For knowing it is hard for them and for letting them know it is hard for you.

    Try to remember they were making adult decisions before you were born. My mom reminded me of that 27 years ago when she moved into a CCRC. She is 91 now, still living independently, still interesting and enjoying life.

    And bless your father for squeezing your shoulder. You needed that every bit as much as he needed to run in a wheelchair.

    You are doing exactly what you are supposed to be doing for your parents — accompanying them, helping them listen, learning from them about life, letting them decide, reassuring them you are there for them, agonizing about it probably more than they are.

    You’re a good son.

  4. Comment by jpeckjr on September 23, 2012 at 11:06 pm

    An additional note — the CCRC where my mom lives is an independent non-profit corporation with no shareholders to satisfy. She has not been financially drained by it. Investigate the possibility of a non-profit CCRC.

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