My Life as a 20ish Single

Looking back on the last few years of my mother's life, with 20/20 hindsight and the belated knowledge that came from four years of reporting about aging for The New York Times, my single biggest mistake was not finding a doctor with expertise in geriatrics to quarterback (to lead/direct the operations of) her care and attend to the quality of her life, not merely its length.

Given the crisis in supply and demand - too many old people and too few geriatrics - I may not have succeeded. But if I had, many of our crises might have been avoided. Those include unnecessary trips to the emergency room that left her in worse shape than she had been beforehand. It also includes surgery to remove a benign tumor from the outside of her spinal cord after it had already done the worst of its damage and with no regard for her advanced age.

It was after that surgery that she took a precipitous nosedive (a sudden, swift drop), moving to a nursing home and suffering a series of T.I.A.'s, or very small strokes, which eventually left her paralyzed, incontinent, unable to speak and barely able to swallow. Later, both Dr. X and Dr. Y told me that no doctor familiar with the physiology and psychology of the elderly would have operated on her without at least a discussion of the special risks to the aged.

My second biggest mistake was accepting the conventional wisdom that nursing homes are terrible places, to be avoided under any and all circumstances, and that assisted-living communities, with their pleasant apartments and other amenities, could accommodate my mother's needs until the end of her life. Assisted-living facilities do offer an ever more expensive list of add-on services, including private duty, around-the-clock assistance. But too often they cannot meet the needs of deteriorating patients, forcing a series of relocations, each more destabilizing than the last.

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My third mistake was being gleeful (adj. joyful) when my mother, then in her mid-70s, chose to sell her house on Long Island, flee the snow and the need to drive, and move to a retirement complex in Florida. Now when she didn't answer the phone, I assumed, there would be someone to check up on her. She would have grab bars in the shower and pull a cord for emergencies. I wouldn't be so frightened all the time.

What never occurred to me is that my mother no longer had a home, we lost the option of setting her up with home care. Eventually too incapacitated to live out her days in assisted living and unwilling to move in with either of her children, a nursing home was her only choice - a happy one, as it turned out, but not in the early going, for any of us.

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There's no way around this uncertainty, no way of knowing what's going to happen next so you can plan according.

Excerpt from NYT The New Old Age - What I Wish I'd Done Differently