[Paleopsych] NYT: Under One Roof, Aging Together Yet Alone
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The New York Times > National > Under One Roof, Aging Together Yet Alone
January 30, 2005
By JANE GROSS
STRATFORD, Conn., Jan. 28 - Everyone complains about the food. Nobody
wants to sit with the misfits. There are leaders and followers, social
butterflies and loners, goody-goodies and troublemakers. Friendships
are intense and so are rivalries. Everybody knows everybody else's
Except for the traffic jam of wheelchairs and walkers, the dining room
at the Atria assisted living community here might as well be a high
Mary Mercandante, 88, has an explanation for the restive, gossipy
environment when old people are forced to live under one roof, even in
a top-notch place like this. "Nobody wants to be here," said Mrs.
Mercandante, who has lived in the residence for all of its five years
and has a gold key to prove it.
Phil Granger, a chipper 84-year-old newcomer, agrees that no one
welcomes assisted living's stark reminder of mortality. "There's
everything anybody could want here," said Mr. Granger, who spreads
good cheer by dispensing hard candy, except to diabetics and those
with dementia, who might choke. "The only thing wrong with this place
is that we're all old. We remember what we used to do and can't do
When introduced in the mid-1980's in the United States, assisted
living was hailed as a dignified alternative to nursing homes. Its
chief attraction was a well-appointed private apartment rather than a
fluorescent-lighted double room along a linoleum corridor. The monthly
costs, which average $2,524 nationwide and thousands of dollars more
here in Connecticut's wealthiest county, include a common dining room,
transportation, housekeeping, activities meant to relieve isolation,
and à la carte services for changing personal care and medical needs.
In the last decade the number of elderly Americans in assisted living
has tripled, to nearly one million, and industry experts say the
residents, overwhelmingly widowed women with an average age of 85,
have steadily grown older and frailer. A study by the National Center
for Assisted Living, an industry group, shows that half the residents
have some degree of cognitive impairment, three-quarters need help
bathing, 8 in 10 cannot administer their own medication and more than
90 percent can no longer cook or do housework.
Residents who leave assisted living usually do so not because they die
but because they run out of money, and go to nursing homes. There the
impoverished, including middle-class men and women who have outlived
their savings, are covered by Medicaid as they are not (except for a
small percentage) in assisted living.
The federal government has already made recommendations to improve
quality control and correct misleading advertising in assisted living
facilities. But only a few sociologists and public health researchers
have studied the social organization and daily preoccupations of these
communities. Dr. Catherine Hawes, a professor of health policy at
Texas A&M University, is one. She describes them as "high school all
over again, without the expectations."
Keren Brown Wilson, who ran some of the nation's first assisted living
homes, in Oregon, said that "naïve notions about the socialization of
older adults" leave many residents wondering why they are not having
as much fun as the happy people pictured in retirement brochures. The
Atria brochure, by example, features photographs of people who look to
be 60 to 70.
"We pretend everything is wonderful," Dr. Brown Wilson said, "which is
an unrealistic expectation at this stage in life."
This stage in life, experts agree, is bleaker than most Americans
admit. Humbled by the loss of control and fearful of the future, many
older people complain incessantly, most often about the food. Also, in
a cruel sorting process, they ostracize others more impaired than
themselves. The hierarchy by disability "is really fear," said David
Vail, executive director of Atria Stratford and president of the
Connecticut Assisted Living Association, an industry group. "They
don't want to look at what they might become." Both the crankiness and
the cliques are on view in the dining room of the Atria Stratford,
home to 120 residents, many of whom good-humoredly call themselves
"inmates." But also on view are acts of exceptional kindness, budding
friendships and sparks of romance between flirtatious women who dress
for dinner and chivalrous men who hold their chairs.
King of Crankiness
The king of crankiness, by his own account, is Bill Haug, 87, who
finds fault with just about everything. The chicken is dry and the
soup lukewarm. The fitted sheet does not quite cover his bed. What the
menu bills as cranberry juice is actually cranberry cocktail. His
hotheaded letters to management are legendary. So are his tirades at
meetings of the residents' council.
Mr. Haug writes the letters on the same electric typewriter he uses
for love poems, sent back to him unread by a woman he dated after his
wife died. Bluster turns to tears in the privacy of his apartment,
where only the typewriter and crossword puzzle books are his own. The
shabby furnishings were borrowed from Atria's storeroom. Within
months, Mr. Haug says, his nest egg will be gone, despite selling his
house, car and possessions. Then he will have to go into a nursing
To Mr. Haug's right at the dinner table is Mary Thompson, 85,
statuesque, dressed to the nines and reluctantly resettled here by an
adult daughter. Mrs. Thompson sometimes gets confused, insisting she
is in a hotel while her home is remodeled. At meals, she bangs a spoon
on her glass or hollers to get the waitress's attention.
Mr. Haug pays her no mind. But it took lots of shuffled seating
assignments to achieve this peculiar if peaceable arrangement. Most
residents have no patience for either of them. Behind his back Mr.
Haug is often called a windbag. Mrs. Thompson's behavior provokes
cries of "Shut up!" from nearby tables, where fear of the future
trumps empathy. Everywhere but the dining room, Mrs. Thompson is never
more than inches away from Christine Schwinbold, 88, who is a full
foot shorter and cheerfully forgetful. The pair, who even accompany
each other to the ladies' room, are known as the Bobbsey Twins and are
generally given a wide berth.
Plans to Call a Cab
Mrs. Schwinbold declares that her former home in Wisconsin is just
down the block. Other residents were so tired of hearing about Beaver
Lake that they showed her a map. It made no difference.
Gwendolyn Lord, director of food services, separated the two women at
meals because "they feed off each other's impairment," with one or the
other hatching plans to call a cab and go home. This way, Ms. Lord
said, Mrs. Thompson, a great beauty in her time, holds court with Mr.
Haug and two other grumpy old men. And Mrs. Schwinbold is the perfect
dinner companion for others who are similarly impaired but less perky
Ms. Lord's latest seating dilemma is which woman to put in the "ghost
seat" occupied by Ann Cerino until her sudden death on Dec. 26.
Leaving a chair empty after a funeral is a mistake, Ms. Lord said. So
is an all-male table, a waste of scarce resources. "Men have a duty to
flirt with the ladies because the desire to be admired doesn't go away
with age," Ms. Lord said. "Plus, assuming responsibility for their
female tablemates enhances their masculinity."
Mrs. Cerino's wake and funeral drew a big crowd of residents,
including Mr. Granger, in a new topcoat, who drove there in his
souped-up 2001 Impala, mostly used to visit his own wife's grave.
Mrs. Cerino was the queen bee here, holding court all day in the snack
bar, known as the country kitchen. She also ran the all-important food
committee - assisted living's equivalent to being president of the
student government - which debates the merits of chunky versus smooth
spaghetti sauce and whether the fish should be fried or broiled.
Meanwhile her 90-year-old husband, Tony, a shy man, watched television
in their apartment upstairs.
Mr. Cerino was dazed in the weeks following the death of his wife of
67 years, so Pete Piretti, 83, kept an eye on him. Mr. Piretti lives
alone in a studio, while his wife, Millie, who has had Alzheimer's
disease for 18 years, is upstairs in the dementia unit. Mr. Piretti
had some homemade tomato sauce, Mrs. Cerino's recipe for polenta with
beans and a jug of Chianti. The two men had a jolly evening in
Apartment 306, neither directly mentioning the other's heartache.
"He can cook better than I can because I didn't have to," Mr. Cerino
said, obliquely referring to the many years Mr. Piretti cared for his
wife and assumed all the housekeeping duties.
The Pirettis, high school sweethearts, arrived at Atria Stratford on
March 17, 2002, when Mr. Piretti said he was close to "the breaking
point" and afraid he would strike out at his wife. He is not alone in
knowing the precise month, date and year, a grim milestone that stays
fixed in memory.
For Mr. Granger it was Oct. 4, 2004, shortly after his wife died and
he realized he "couldn't hack it" at home alone. Arline Brady, 87 and
nearly blind, came a month earlier. She had taken a bad fall in her
Florida condominium and, she said, her five children "told me I
couldn't live alone anymore." Similarly, Helen Simics, 78, moved here
at the insistence of her brother and sister-in-law, on June 21, 2000,
after she broke a hip.
Leaving an assisted living community, on average after two and a half
years, is rarely voluntary. Three residents died at Atria Stratford in
December. Others, when their assets are gone, will go to nursing
homes, which charge 40 percent more on average but accept government
reimbursement. The best known in these parts is Lord Chamberlain. The
euphemism for winding up there is "being sent across the street."
Most states in the last few years have begun small, experimental
programs that permit Medicaid to pay a portion of the cost of assisted
living: the personal care and medical services that are tacked on to
the monthly charge, but not the rent itself. Nationwide, according to
a 2002 study by the National Academy for State Health Policy, 102,000
assisted living residents, or 11 percent of the total, received this
benefit, double the number in 2000. But rarely is it enough to allow
people to stay in an apartment for more than a few extra months.
That is because of the traditional fee structure in assisted living.
At Atria Stratford, for example, a studio costs $3,400 with no special
services. Medication management adds $400 a month. Help bathing,
dressing or eating can cost an additional $1,400 a month, for a total
of $5,200. Of that amount $1,800 would be covered by Medicaid if Atria
participated in Connecticut's tiny waiver program. It does not.
Statewide, Mr. Vail said, there are 9,800 assisted living units and
only 75 Medicaid waiver slots. So he advises families to calculate
when their money will run out and move before that point, since
nursing homes, if they have a high enough percentage of Medicaid
patients, can push those with assets to the top of the waiting list.
Mr. Piretti, a former gas station owner, currently pays $3,400 a month
for his apartment and an additional $5,500 a month for his wife's care
and accommodations, a stunning sum to him. "When we run out," he said,
"she'll go on Title 19," as Medicaid is known in Connecticut, "and
I'll go live with my daughter."
It is a workable plan. Especially if Mr. Piretti remains as fit and
independent as he is now, able to drive to stores that sell supplies
for the log houses he builds from kits and the decoupage watering cans
he decorates with magazine photos. He is among just 20 residents,
mostly men, who need no assistance but meals and housekeeping, Mr.
The discrepancy seems to be a result of men moving here earlier than
women, who want to stay home as long as possible, often until their
adult children intervene. Men, by contrast, seem to willingly relocate
when their wives have died or deteriorated to the point they cannot
run a household anymore. Here they will be taken care of by a largely
female staff and have the companionship of the female residents, who
outnumber them 4 to 1.
"I couldn't stay home alone," Mr. Granger said. "My wife was my life.
I just didn't know that until she died."
Big Men on Campus
Now Mr. Granger is one of the big men on campus. He favors a tweed
cap, has all his faculties and still drives, even after dark. But
grief for his wife is fresh and his outings take him no farther than
Riverside Cemetery, 4.1 miles away by his reckoning. The other
candidate for romance is Pat Jordan, 94, whose wife died here last
year. Mr. Jordan is a charmer. His arrival in the country kitchen or
the arts and crafts room brings a blush to the faces of at least two
women. One is Mrs. Brady, a well-to-do widow whom Mr. Jordan describes
as "one classy gal." The other is Doris Mauri, 85, who never married
and worked with computers. Mr. Jordan says Miss Mauri is "a quiet
girl, a decent girl and my very best friend here."
"I'm very fond of her," he added. "But I have no love interest in
anyone. I don't think my Florence would like it."
But Colleen Douglas, the activity director, has not given up hope. She
is not the typical aerobics-instructor-type who is often hired to lure
the old folks to the 9:30 a.m. seated exercise class. Residents love
her faux leopard skin coat, red furry boots and year-round tan, as
well as her sharp wit. Activity directors, more typically, are cloying
The daily activities schedule here nevertheless has a cookie
cutter-feel. On Dec. 28, for instance, the lobby signboard, headlined
"Today's Opportunities to Engage Life," lists exercise, penny poker,
word games, afternoon snacks and socializing, bingo, and a Gene
Hackman movie, "The Heist." But outside the formal schedule, Ms.
Douglas injects a bit of pizzazz.
One recent day she baked apple pies, using a resident's recipe. She
never pushes organized gaiety on loners, like Miss Simics, who prefers
reading The Connecticut Post in the lounge each morning and then
spending the rest of the day puttering in her apartment. Ms. Douglas
gets a kick out of seeing Mr. Jordan return from the store with a
six-pack of beer. And she does not tattle on a resident with no
serious disabilities who has a forbidden hot plate.
Mr. Jordan is her best shot at every activity director's dream: a
wedding. "Nobody wants a romance in this building more than I do," Ms.
Douglas said. "So if I'm moving in a woman who still has her mind and
walks, I go to Mr. Jordan. So far he's still mourning his wife. But
I'll keep trying."
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