How to die alone
Idealized small towns, elder orphans, and how to outlive your friends and family
I've been reading Aging People, Aging Places with a certain wistfulness. My plan had been to buy a car in May of 2020 and spend the next two or three years in North America's rural communities to see first hand how care work is managed in places with little formal care infrastructure.
People love to tell me how caregiving isn't a problem in small towns, because they take care of their own. Reports on the state of rural care paint a dire picture of people unable to access medical care and facing insufficient caregiving support. Both are probably true. I wanted to hit the road and see for myself. I'd learned so much about care work in Asheville, North Carolina by staying in the homes of people who need and/or provide care and getting involved in the local community for three months.
When I'd gone to Asheville, it had seemed like a small city to me. I'd been researching care work in New York, Toronto, Montreal, Chicago, and Boston. Asheville has fewer than 100,000 residents, although that’s hardly evident with all the tourists.
In other cities I mostly met with people to learn about their lives. I’d go to their offices, tour facilities, and chat with them over coffee. Sometimes I stayed with caregivers for a few days. It was very different to stick around in Asheville for three months, talking to the same handful of people day after day. To see and participate in their lives, rather than just hearing about it.
A friend who's a professional storyteller and another who’d spent a year traveling around the US as a Fulbright Scholar helped confirm my choice of the Honda Fit as my ideal road trip vehicle. With my car picked out, I arranged to spend June and July in Clarenville, Newfoundland. Population: 6,600.
You know what happened last March. I never bought the car.
Chapter 3 in Aging People, Aging Places is Lillian Wells' urban community vignette. She writes:
"The reality is that older people have often outlived family and friends, and it can be difficult to reach out on your own to new experiences, when familiar supports are unavailable."
Like the depiction of rural communities as a caregiving ideal and a caregiving crisis, I adamantly disagree with her statement while also knowing it's true.
Wells is pointing to two things:
older people have often outlived family and friends, and
it can be difficult to adapt to change and try new things without the support and encouragement of family and friends.
How is it that it's considered normal for people to outlive their family?
How does one become a solo senior (or, the more patronizing term, elder orphan)? I imagine the most expedient way is to disown your family, but that's not outliving anyone.
It’s simple enough to imagine having a spouse die first or to get divorced. It also requires one to not have children or for all their children to die. I don't have kids or a spouse and I have a pretty small family, yet it's still hard to imagine how I could outlive them all. It would require an abundance of tragedy.
How far does the term 'family' extend?
My mom took care of her own mother. She also took care of the brothers of each of her parents. If we keep going, we're going to need to start making charts to show the connections. Let’s just say she wouldn’t have qualified for FMLA, since few of these people met the very limited legal definiton of family. My dad's sister's daughter's daughter lived with us for a while. A decade after my parents got divorced, that same "cousin" moved back in with my mom, bringing her son along.
My dad took care of his aunt, from a side of the family long estranged after his mom died and his father remarried. He lived with his grandparents for a while and, decades later, moved in with their neighbor when she needed care. I grew up calling this former neighbor 'grandma,' just like I refer to her daughter as my step-mom, even though none of these relationships are legally recognized. Adrienne let me take time off to stay with my (fictive) grandmother when my (fictive) step-brother was in a coma.
Both of my parents, who are among the young old who text me pictures of their bike riding adventures, are the oldest in their families, fictive or not. Still, it’s impossible to imagine how they could outlive the rest of their families in whatever time they have left. They both have a knack for collecting more.
How do you outlive your friends?
I imagine this would be most likely if one were to form a group of friends in elementary school and admit no others. To allow it to atrophy as people move away, marry, and die. The smaller the original cohort, the higher your odds of being the last one above ground.
Living to a ripe old age can't guarantee you outlive your friends. One would have to resist the urge to form relationships with the surviving spouses of their friends, to not bother getting to know the people they work with or keep running into, to avoid any sort of group, to not talk to their neighbors. It requires an active choice, repeated daily for enough days to outlive everyone else.
Like the sole survivor in a disaster movie. Only there has been no disaster. The world continues on and they politely decline, opting out.
Still, let's remember that I'm 36. I don't know what I'm talking about. I have outlived very few of my family and friends at this point. Who knows what's in store. It feels cavalier to act as if it's impossible for all of my friends and family to die when we're in the middle of a pandemic, when cars crash, when there is war.
Most of my friends are roughly my age, but certainly not all of them. I make plans with my friends' kids because other adults do not share my enthusiasm about going to the petting zoo again. I swap memes with the teenage kid of a family that rescued me during the pandemic. I am occasionally surprised to realize a friend is turning 60. Bob was 72 when he died last year. I wonder if all of this is weird.
Is it really more common for a woman to date a man who's 20 or 30 or 40 years older than her than to be friends with someone with that sort of age gap? Would people snicker at both?
Wells points out how difficult it can be to get around the city if you have limited mobility. I most often chat with my neighbors in the laundry room, which is up two steps in our otherwise accessible building. With the pandemic, I hardly saw anyone. Downtown Toronto is a city of studio and one-bedroom apartments. The property manager reminded us regularly that we were not permitted to have visitors during lockdown, which stretched from the fall to the spring.
The construction around my building when I was last home in Toronto made the sidewalks so inaccessible it felt like a joke. For several days the sidewalks on both sides of the street were closed at both ends of the block — a new tower on one end, repaving on the other. We were meant to access our block through a park. Once the repaving was done, the city closed off the park to discourage a forming encampment.
Here in Calgary, the sidewalk cafes are on the sidewalk, requiring pedestrians to go up and down off the curb to walk where there would normally be parking. There are little temporary ramps set up, as if that makes the up and down zig zag route accessible. It's annoying just to walk along, without groceries to carry, a stroller to push, or a walker to steer.
It makes me think of the Kelowna golf course community I spent a month in, where it was not officially a 65+ community but my age made me stand out. The normalization of using golf carts made minor mobility issues a moot point. You could drive your golf cart just about everywhere and ambulatory wheelchair users could manage the rest of the way. Any pathway made for a golf cart is also wheelchair accessible.
The layout of each home maximized privacy between bedrooms, recognizing that the nuclear family was a rarity in this neighborhood. The clubhouse was a natural center of the community, within a few minutes of every home.
The woman whose home I stayed in wasn't much of a golfer. After years of caring for her husband at home, she downsized to a new community while staying in the same town she’d lived in her whole adult life. She loved the easy to maintain, accessible, and stylish house she’d bought. She quickly became friendly with her neighbors and added new groups of friends to her existing social world.
An article in the Harvard Business Review suggests there's more to outliving your friends and family beyond death and inaccessibility:
"Tammy English, of Washington University, and Laura Carstensen, of Stanford University, found that the size of people’s networks shrank after the age of 60, not because these people had fewer opportunities to connect but because, increasingly, they perceived time as being limited, which made them more selective."
Later in the book, Olive Bryanton, Lori Weeks, and William Motelpare point out how heterosexual women are likely to outlive their male romantic partners. Downsizing a home that's become too difficult and expensive to maintain can mean leaving a familiar community.
The current and coming cohorts of women over the age of 85 are more likely to be frail, depressed, and widowed than the men in their age cohorts. Women of this age are generally less educated and more likely to be poor, due partly to the caregiving responsibilities they took on.
Have elders outlived their family and friends or are they being cut off from them? Are they being excluded by an inaccessible environment and poverty or are they just not interested in spending time with people unless they really, really like them?
During the pandemic many of us have become increasingly isolated. Elders are still trapped in residential care facilities and hospitals without being permitted any visitors. Others are sequestered in their homes, with less care than they need, for fear of contamination from a virus.
Even before covid-19, it's easy for those with mobility issues and limited money to spend to become trapped at home. It's easy to be homebound if you need ready access to a toilet and even easier if you require an accessible one or changing facilities suitable for an adult.
Reading about the type of support families provided to the 85 and older women in a study later in the book makes it easy for me to understand why "caregiving" is such an ambiguous term. Snow shoveling, meal delivery, home repairs, housework, grass cutting, bringing out and putting away patio furniture, helping with internet issues.
I think of how when I have friends come over, I often enlist their help. A jar I can't open. The couch that's too big to carry onto the balcony on my own. The way my neighbors and I took turns shoveling each other's sections of the sidewalk all winter, even though I was just a temporary resident. How I'll drop food off at a friend's place when he's at work, since I have his key and can't seem to figure out how to cook for just one person. How the same friend regularly rescues me from home repair projects gone awry.
When you're part of a community your whole life, there isn't a point where you stop providing care and start needing care. The care just shifts to match what we need and what we are eager to give.
When I was in Asheville and Calgary without a car, both cities where you can survive without a car although it isn't always easy, I almost never had to take a cab. People invited me along when they ran their errands. They brought me on hikes and to special events. Then they got used to inviting me to things, so they invited me out with their friends and to their family parties. Not having a car probably got me invitations I wouldn't have gotten if I'd been self sufficient.
Still, I used to hate going to visit my parents in the house I grew up in. I felt like a child waiting at the train station for my parents to pick me up. Having to rely on people to give me rides everywhere left me feeling trapped. Asking friends to get together felt like an imposition, since the only diner within walking distance was not somewhere anyone wanted to go.
It’s different now that my dad lives close to the train station and there are lots of places worth going within walking distance. My dad sometimes drives from one side of his very small town to another so he doesn’t bump into neighbors and end up getting waylaid helping them change a hard to reach lightbulb and then joining them for coffee.
He does that sort of thing for family friends. He’ll also do it for strangers. Which is how strangers end up spending the holidays with us a decade from now.
Thank you to the authors for giving me so much to think about in the chapters they wrote and to Maxwell Hartt, Samantha Biglieri, Mark Rosenberg, and Sarah Nelson for fostering this vital conversation.
In the US, Caring Across Generations is recruiting their next class of Care Fellows. The Care Fellowship offers a unique opportunity to sharpen written and oral storytelling skills, learn about and advocate for caregiving policy, engage in civic leadership, and connect to other family caregivers. The deadline to apply is August 19th.
If you’re eager for good news that isn’t just fluff and positivity porn, Good Good Good shares stories about people creating change and gives readers the tools to do the same.
If you’re looking to learn about other people’s experiences of care work, including how they got through it, I just gave our care work library pages a facelift.
As I read through this, I wondered why, and I wondered at the depth of your experience or the lack thereof.
I wish you would have looked at epigenetics, or the passing down of family relational dysfunction before casting your assumptions.
My parents and my husband's parents managed to alienate most of their closest relatives by the time they were elderly. That left the 2 of us to take care of them with very little help from our sibs or their grandchildren.
And now that torch has passed. My husband and I have a very "distanced" relationship with our own children. The relationships with nieces and nephews are cut off by them for some trivia that we have done or left undone. So much for my goal of not passing on the relational pattern.
We are in AZ in a small "idealistic" tourist town. My husband has multiple end-stage conditions and likely I will be left to "die alone". I have mobility issues and will be using whatever funds are left to hire people to take me to doctor's visits, procedure appointments, and any necessary out-visits. Visiting family and old dear friends involves transportation to the closest airport, 2 hours away, and flying on overcrowded planes and navigating long distances in those airports.
Unless I move, I will most likely die alone. And I see my situation repeated in my neighborhood and among other people I know. Money and views aren't everything. I am sad. But alas, I continue to nurture new friendships and relationships. But I have low expectations of a peaceful departing in the loving arms of my family.
And that's the way it is.
Thank you for sharing Cori. I found the article interesting and I will probably read the book you cited. I find it interesting people feel caregiving differentiates from small towns to big cities. I do think in certain communities neighbors look after neighbors in some ways. I do have a client who is 94 and lives alone in an over 55 community. I only am with her two days a week for about 4 hours each day (she does not want anyone else or any more days). She is fiercely independent, yet has difficulty walking and doing things for herself (but don't tell her that). Her family lives within an hour of her, but all work so they don't come by as often as she'd like. When I am there I prep meals and do some light housework, but mostly keep her company because she is lonely. Covid was very hard on her as although she only had a few social outings pre-covid, she did have them. I know her neighbors keep an eye on her and handle trash, bringing the mail in, etc. It's harder when they go on vacation, but we make it work. My client always asks, "why am I still here?" I usually say because you have not finished learning and not finished teaching. She has told her family she will NOT leave her home and they will have to carry her out when it's time.
Family dynamics play a huge part of whether or not caregiving will be involved. Some care enough to ensure there are good private caregivers...some don't.
I have many single female friends and we are getting to an age...we have always looked out for each other. We check on each other and help each other when we can. As most of us know sometimes asking for help is difficult, but it seems friends step up even when you least expect it.
I hope future generations (as I don't think it will change significantly in my lifetime) find a way to turn around the horrible perceptions surrounding nursing facilities as I have seen first hand goods one and bad ones.