the professionalization of care


Hiring a housekeeper to help me with physical tasks I can no longer do has completely changed my quality of life. I am no longer drowning in dust. I no longer spend hours on my back fantasizing about things I would change in my environment if only I could; we have hung pictures, fixed air drafts and water leaks, weatherized doors and windows, rearranged storage, and done dozens of other tasks that I would previously have done for myself without a thought. Since the stroke in November 2012, every task—no matter how small—usually involves some sort of work-around.

Hiring Karen, my housekeeper, has enhanced my ability to remain independent. But mostly it has helped me forge a friendship with someone who really, truly cares. I am deeply thankful.

She comes in once a week for three or four hours, and we probably spend a quarter of our time interacting with her 3-year-old daughter, smoking cigarettes, drinking coffee, and catching up on one another’s weeks. Last week she asked if she could work an hour less for me; she has developed quite a reputation out here for providing a wide range of quality care, and one of her elderly clients lost his balance and injured himself, and needed extra help getting ready to visit the doctor.

It used to be that families provided most care for their elders. When I was very young, my great-grandmother lived with my maternal grandparents, so this arrangement seems quite normal to me. Yet as families have become geographically dispersed, it has in fact become a relatively unusual practice.

Elderly parents living with their children declined from about 70% in 1850 to about 12% in 1980. But according to a 2014 report from the Pew Research Center—in part, because of the recession—multi-generational households are on the rise. Now, 18% live this way, and the total number of Americans living in such households has doubled, to 56.8 million.

I have heard many stories that the reason some families have stuck together is that multi-generational households have become dependent on the elders’ monthly Social Security checks coming in. According to a 2011 report by Generations United, 63% of respondents to a survey agreed that “Social Security plays a vital role in the financial stability of our multi-generational household.” I have even heard about at least one adult daughter here in Texas who kept the bodies of both her deceased parents buried under the floorboards of her home to ensure continuation of the monthly benefit checks.

One wonders to what degree this also influences families to demand that health care facilities do “everything possible” to keep their elders alive long beyond the point where their lives are rewarding? Modern health care, with its reliance on endless intrusive tests, CAT scans, mind-numbing medication, and imprisonment in heartless facilities, can be literal torture to old people who would just prefer for nature to take its course.

Two-and-a-half years ago I wrote a post about providing care to spouses, partners, or loved ones, but what happens when you are alone and you are the one requiring care? I have been extremely fortunate: my doctor, my home health care nurse, and my housekeeper could not better meet my present needs. But are most older people so fortunate?

Just because someone has met basic training and licensure requirements does not guarantee they will provide caring services. One would presume that the level of caring is greater among family members, but as the example of the above Texas daughter suggests, this is not always the case. Yet at the very least, if you rely on your children for care in your old age, this is something you have had a lifetime to influence.


Some may say that today’s Groove of the Day is a bit of a downer, but this version is so beautiful I had to share it with you. The original song, of course, is in French and sung by Jacques Brel.



Groove of the Day

Listen to Laurika Rauch performing “The Old Folks”


Weather Report

Cold and Cloudy in the morning, 55° and Partly Cloudy in the afternoon



5 Responses to “the professionalization of care”

  1. 1 anonymouse
    January 29, 2016 at 4:44 pm

    When my father passed, my 85yo mother moved in with my family, at my insistence. This joining of the generations was not forced by finances, but rather concern for her health and safety living alone at least 1200 miles from her nearest relatives. We are happy to have her here, but of course it hasn’t all been smooth sailing, as generations learn to live together for the first time. And since my children had never really known my parents, there hasn’t really been much of a multi-generational reunion, or bonding for that matter. I understand my kid’s point of view, as I had never met my maternal grandparents, and never really known my paternal grands. Still, I’m grateful to have the opportunity for a few years together as an extended family, and thankful for the peace of mind this arrangement provides us both.

  2. January 29, 2016 at 10:50 pm

    I think the decline in the percentage of the elderly parents living with their children is largely because the society is capable of giving good care for them and they don’t need much supports from their children. My grandparents have passed away now, but the time they lived with my family is really enjoyable and memorable.

    Thanks for your thoughtful post 🙂

    • 3 anonymouse
      January 30, 2016 at 5:33 am

      I think your comment about “don’t need much support from their children” is important, not just medically speaking, but financially. My parents were determined to “not be a burden” on their children, but that independence led to separation of the generations, both geographically and emotionally, and so in their later years, they found themselves isolated and felt somewhat forgotten by the younger generations.

      • January 30, 2016 at 6:51 am

        I believe our society’s emphasis on children achieving “independence” from their parents can lead to a certain amount of dysfunction in some families. I had an insight about a decade ago: that we have forgotten how to be families and have been pulling in a lot of separate directions. A certain amount of this is healthy, but in too many instances, it has gone too far and is out of balance. In many cases–especially in the area of wealth creation–we have thrown out dynastic notions of building on what previous generations have created, and there is a dissipation of resources over the long term. I hope that every family can become more self-reflective and achieve its own balance in multi-generational developments.

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