Who Will Care for You in Your Old Age, If Not Your Kids?

A better plan for elderhood

Today’s post comes with a big assist from the Auntie Collective. Auntie Bulletin readers responded to last month’s survey on Love for Elders, and they have a lot of wisdom to share. These Aunties’ ideas appear throughout. Huge thanks to those who participated.¹

What does it look like – what does it feel like – to have a good end of life?

I hope the final years of my life will be something like what my grandmothers experienced.

My dad’s mother, my Grandma Sis, died last year at age 96. In the last decade of her life, three of her five children lived within 30 minutes of her, and all five visited often. She had a large extended family, all of whom believed they were her favorite.² When, for financial and health reasons, she could no longer live in her own home, one of her sons and his wife bought a house and moved across the country so that she could move in with them. With occasional support from other family members (including me), my aunt and uncle managed Sis’s medications and her finances and her calendar; they figured out what to do when she ran out of money; they drove her to doctor’s appointments and to church, and they helped her with bathing, dressing, and other activities of daily living.

After several years, my grandmother’s care needs exceeded what they could provide, so she moved to an assisted living facility with a very sweet staff whom she adored, and where she had her own room and bathroom. When she got sick – which happened often, because 96 – there was a good hospital nearby and Medicare paid for her care and a friend of the family who’s a doctor was able to give us lots of helpful guidance. She retained most of her cognition and memory until the end of her life, and died surrounded by her loved ones.

Grandma Sis and me, 2017.

My mom’s mother, Grandma Jean, died at age 92. Like Sis, when Jean needed to move out of her own home for financial and health reasons, she moved in with one of her children. Grandma Jean lived with my parents for several years – I lived there, too, for two of those years, and it was an enormous gift to get to spend so much time with my grandma. She was brilliant and hilarious and so loving and so kind. I still think about her all the time, and aspire to be like her.

Jean had dementia, and the time came when she needed to move to a memory care unit in a nursing home where she received great care. My mom and one of my aunts visited her almost every day for the next several years – the remainder of her life. Jean was a lifelong political progressive who followed the news carefully, and if her mind had still been with her she would have been appalled at Donald Trump’s election. She died on the day of the Women’s March, January 21, 2017. My mom and my aunt and my sister and I were with her all that day, singing and telling stories and crying and laughing together as we sent her on her way with all the love in the world.

Grandma Jean and me, c. 1997.

Both of my grandmothers had access to high-quality care in the final years of a long life – indeed, in both cases, this care likely prolonged both of their lives by several years. Both of my grandmothers died surrounded by their children and grandchildren. For several years, both lived with family members who loved them and took good care of them and worked long and hard to figure out next steps when they could no longer live at home. Both of my grandmothers’ adult children recognized when they should no longer be driving, and lovingly took away their car keys. Their adult children managed medications and finances when my grandmothers definitely no longer could. Much of this care was performed by daughters, daughters-in-law, and a granddaughter (me).

My mom took care of her father, her mother, and my father (her husband) for over a decade – from my early 20s to my mid 30s. Despite not being trained in medicine or nursing or care-giving or navigating our f***ed up healthcare system, she did an amazing job. It makes me cry thinking of what a wonderful caregiver she was to them as they suffered from dementia, illness, and heart attack/coma. It was a thankless job and she had to quit her own job to do it, which now leaves her in a precarious spot. — an Auntie Bulletin reader

Howevermuch parents protest that they didn’t have children in order to be cared for in their old age, what happened for my grandmothers is usually what happens, if we’re lucky. If we get old (which most of us will, thanks to modern medicine), and if we need care (which most of us will, I hate to tell you, but it’s a fact), and if we have adult children who are in our lives (especially if we have daughters) – our adult children are by far the most likely people to provide or find suitable care for us. For many people, whether or not they admit it, relying on the kids is plan A. In the case of my grandmothers, Plan A went pretty darn well. Five stars! Or at least, like, four stars.

Me, I don’t have kids. I have no idea who might offer care to me if (when) the time comes that I need it. People without children do not often have access to Plan Rely-On-the-Kids. Neither do people whose children, for whatever reason, are unavailable or unwilling to provide care. So what are the alternatives?

I expect to outlive my loved ones – I have no bio relatives left alive other than my mom – and I have a feeling the children I do know and love will have their hands full with their own parents and bio relatives. — an Auntie Bulletin reader

Many people hope, instead, to save enough money to pay for the care they need – assuming such a need arises (and they hope it won’t, because of course they do, because of course we all do). But Plan Save-Enough-Money depends on the crucial step of our recognizing and acknowledging our own need for care, which many of us are bad at. (I have lots of elders in my life, and trust me when I say that most people do not get better at asking for or receiving help as we age).

The biggest issue I want to make sure not to repeat is my family’s denial over my Nana's need for care – Nana herself, but also my mom and her siblings want to believe that Nana is invincible. She is a strong woman and was quite invincible into her 90s. Unwillingness to recognize the truth meant that our family delayed seeking treatment for her dementia in a desperate bid to keep her in her home. We did not start the conversations early enough. — an Auntie Bulletin reader

Plan Save-Enough-Money also requires us to still have the physical stamina and cognitive capacity to make very complicated arrangements and potentially move households when the time comes. But for as long as we retain these abilities, it’s likely to seem that the time has not yet come. And then one day the time does come, but by then we may no longer have that physical stamina or cognitive capacity we were relying on to make a change.

For many of us, though, the true fatal flaw in Plan Save-Enough-Money is that it requires us to be millionaires. Long term care these days can easily cost $100,000 (US) per year. Both of my grandmothers needed over a decade of long term care. I’m no personal finance expert, but it’s my understanding that most of those who do style themselves personal finance experts say we need to save well over a million dollars (US) for our old age, largely in case we need to pay for long-term care. (The personal finance expert I actually trust, Dana Miranda of You Don’t Need a Budget, argues that the entire Save-Enough-Money plan is delusional. She demonstrates that this plan hasn’t even worked for most Boomers, let alone the rest of us).

Something I think sucks about Plan Save-Enough-Money is it’s just so fundamentally individualist and every-person-for-themselves-ish. It actively aims to avoid interdependence. Do not imagine you can rely on your loved ones. Do not ask for help. Do not plan to offer help. Care isn’t something you do, it’s something you buy. Heck, maybe an AI can do it. Eww, capitalism, gross.

Plan Save-Enough-Money: one star. Next!

Now, oooh, a robust social safety net would be nice! I’d love to live in a place where that was Plan A! If you live somewhere with decent-quality universal healthcare and a functional mechanism for ensuring elders receive the care they need, I am so stinkin’ glad for you and yours. May your place’s social safety net last a thousand years, and may it become stronger and better with every passing year. May it spread around the globe and one day cradle us all in its warm, woven embrace. Five stars to Plan Safety-Net, if you can get it!

I'm appalled at how normal medical fundraising has had to become. I live in a country with "universal healthcare" that's starting to be eroded by conservatives and businessmen. I am afraid that despite our best efforts at community care, there are still things that are beyond the skill level of the community and we can't catch up fast enough. — an Auntie Bulletin reader

However: hi, I’m in the United States – 👋🇺🇲🦅☠️– and so, alas, are 73% of Auntie Bulletin readers. Sucks to be us! As you may be aware, Medicare and Medicaid are under aggressive attack by the party in power. I know fewer and fewer US residents who are counting on these programs to still be around by the time they turn 65. And even if they are – unless we get a pretty amazing overhaul – accessing Medicare or Medicaid to pay for long term care is currently an incredibly byzantine process. People on the Save-Enough-Money Plan, if they find they have, after all, not saved enough money, can theoretically access Medicare funds to pay for a bed in long-term care. However, it’s super complicated and confusing even if you’ve got a PhD and most of your marbles – ask me how I know – so good luck figuring it out when you have early-stage dementia. Plan Safety-Net, US version: one and a half stars.

I fear that my friends and I won't be able to support each other like we do now, because we will all be in survival mode. I fear I will receive bad care in hospitals, with no one to advocate for me when I'm weak, sick, or disabled. I fear that I will die alone. — an Auntie Bulletin reader

Oh, one Auntie Bulletin reader has another alternative in mind! She writes:

I don’t have any hope someone will be there to fight for me when I get older. I kind of have the Switzerland model in the back of my head. I’m not trying to make light of this. I don’t believe I will have the money to protect myself the way you need to be protected when you’re old in the US, so I want to be able to say goodbye on my own terms.

Ah, Plan Switzerland. In case you’re not familiar, what we’re talking about here, Aunties, is physician-assisted suicide – and I’m sorry for being glib. I’ll stop.

Switzerland is the only (?) country in the world where assisted suicide is legal for people without a terminal diagnosis. Amy Bloom wrote a lovely, brutal memoir about going to Switzerland with her husband so that he could die with dignity after being diagnosed with Alzheimers. Anyone who wants to seriously consider assisted suicide one day should read it, and I think you’ll find this plan is truly not for the faint of heart. Plan Switzerland: Two stars. No, zero stars. Ugh, I don’t know. This joke isn’t funny anymore.³

We need a better game plan for elderhood.

Personally, I am a huge fan of Jody Day’s plan, which she outlined in my interview with her last week. In her small community in rural Ireland, Jody is currently working to build a hyperlocal, intergenerational network of community care and mutual aid, which she calls ALTERKIN (for Alternative Kinship Network). The ALTERKIN model involves recruiting eight or so people who commit to be each other’s people for the long haul. It involves regular get-togethers, for fun and for the purpose of knowing what’s going on in each others’ lives and responding to needs as they arise. I think this plan is beautiful and realistic. FIVE STARS, JODY! ⭐⭐⭐⭐⭐

As a childless person, I have been thinking a lot lately about my own beloved elders who don’t have adult children in their lives. As an Auntie, I have a much more flexible schedule than my friends who are raising young kids. I’ve been thinking that I’m willing to do some significant care work to support my elders as their needs increase. I’m hoping I can convince a couple of childless friends in particular to accept my support.

I’m a primary care doctor. So many patients I see don’t have the support they need to get in and out of their homes, take medicines, or be nourished by good food. — an Auntie Bulletin reader

Big picture, I hope a lot of us will increasingly contribute to hyperlocal networks of community care. I think this is one of the wisest things we can do to care for our own future, in fact, because when the kids around us grow up in communities where caring for one another is an everyday part of life, they’re more likely to grow up and replicate that kind of care for us.

Now, according to our recent Auntie Collective Wisdom survey on loving our elders, Jody and I aren’t the only ones thinking along these lines. I pay close attention to the community care and mutual aid discourse these days, and my sense is that the idea of building little intergenerational networks of community care is gaining more traction in more places every day. I honestly do not believe the greedy, ignorant fools will win. I think love will. I think it is winning already.

When I'm very old I hope to have a younger 'team of guardians' who advocate for me (legally, medically and for my housing/general comfort) according to a set of guidelines we'll have written together. I hope they will be people I fully trust and love and who genuinely want the best for me, finding warmth and satisfaction in their shared care work. — an Auntie Bulletin reader

I hope we can form inter-generational friendships and community. I am so grateful for the elders in my life that I'm not related to. I would love to have a similar community of people with age diversity. As a long term goal I would love to have a house with some sort of community garden/gathering space that my neighbors are welcome in 24/7. — an Auntie Bulletin reader

I hope to have a network of people around me, maybe living together in a big house, maybe just in the same neighbourhood, but looking after each other. — an Auntie Bulletin reader

I know a lot of people who are choosing not to have kids – often driven by climate anxiety. My greatest hope is that we can learn how to build interconnected networks of care when we are young and middle-aged, so that there will be a structure to support us when we are old and don't have adult children to care for us. The care work sector (in-home aides, hospice nurses, senior home staff, etc.) is already so strapped and the work is underpaid/undervalued. As a society we have to be working on solutions to address these pain points, and also be building the interpersonal connections that can supplement what the professional care work/caregiving sector does. — an Auntie Bulletin reader

My siblings and I were lucky enough to grow up with beloved elders in our neighborhood, including surrogate grandmas and friends of our grandparents and older couples at our church. It connected me to the wisdom of a whole other generation, little things passed on like songs, stories, folk remedies, recipes, card games, etc. Now, as an Auntie, I feel so fulfilled and proud to watch the little ones growing up around me and I like to share with them what I know and remember. — an Auntie Bulletin reader

I guess I’m hoping, a bit transactionally and a bit magically, for some balance in the universe. Here’s my incantation: If I care for the elders in my communities now, the care I need in the future will materialize. When we show love to our communities, the love will come back to us. May it be so. May it be so.

Related Reading from The Auntie Bulletin

What We Worry About is Not Death, It’s Vulnerability

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Here’s What You Might Do With Your One Wild and Precious Life

Collecting the Wisdom of the Aunties: Complicated Mother’s Day

Here in the United States, next month is Mother’s Day – a holiday that can be really hard for a lot of people, including those who have hard or nonexistent relationships with their own mothers, those who would like to be mothers but are not, those who are parenting under impossible conditions, and those who have lost a child. My friend Ryan Rose Weaver, who runs a support group for survivors of perinatal loss, refers to this holiday as Complicated Mother’s Day, which seems just right to me.

If Mother’s Day is complicated or rough for you, how so? This month’s survey consists of just this one open-ended question. Feel free to think outside the box.

I’ll be collecting your ideas for the month of April. As always, when you complete a reader survey you’ll be entered to win a 12-month paid-tier subscription to The Auntie Bulletin.

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1. Charlotte won the Love for Elders survey prize: a 12-month paid-tier subscription to The Auntie Bulletin. Congrats, Charlotte!

2. When I spoke at Sis’s memorial luncheon, I brazenly claimed – in front of several of my cousins – that I was her favorite grandchild. I was joking (mostly), but I kept it up as a running bit between the tears and memories, and afterward so many people approached me to say that they were her favorite, too.

3. I have lost more than one immediate family member to suicide, and let me assure you that it deeply, deeply sucks. To the extent that I seem to be joking around about this, please chalk it up to the gallows humor of the darkly embittered. If you live in the United States and are thinking about self-harm, please dial 988 for the Suicide and Crisis Lifeline. If you’re outside the US, here’s a list of suicide and crisis hotlines around the world.