By Abbe Pick

While it is well known that humans are creatures of habit, it is inevitable that we will encounter transitions in life which we are ill equipped to manage. In our prime, we may likely see ourselves as champions of change; yet, as we age, internal faculties that were once built on strong foundations of resilience begin to break down, and our capacity to control change rapidly diminishes.

Although I am 29 years old, my friend, Annette, provided me with a glimpse into the aging process as she attempted to manage major life changes as a nonagenarian. I met Annette in the fall of 2014, just a few days before her 98th birthday. As we began our weekly visits over the next year and a half, I witnessed both the complications as well as the potential beauty that could be found in growing old in a 150-square-foot studio on the Upper West Side of Manhattan.

Annette spent the majority of her 50-year career as a legal stenographer and secretary, retiring at 72 with a pension that she had expected would completely provide in her old age. As an only child, unmarried and living on her own, Annette took pride in the friendships that sustained her throughout life, and she found a community in the wide spectrum of social and educational programs at neighborhood organizations. However, as she aged and recovered from a series of surgical procedures, Annette found it harder to attend programs outside of her home. Once a social worker determined that 24 hour care was required for Annette to live safely in her studio apartment, Annette’s freedom was compromised overnight, and she entered a new routine, with an aide by her side.

For the next three years, Annette paid out of pocket for her required 24 hour care, and while she came to rely on the trust, comfort and routine that she had developed with her aides, her savings dwindled.

On the eve of what should have been a time for Annette to reflect on her 99 years of age, she was instead faced with losing control of yet another aspect of her life. She had depleted the savings that were set aside for her 24 hour homecare, and through the guidance of her devoted cousin, embarked on a 14 month journey to enroll in Medicaid. Although the aides that had accompanied Annette for years were at times unreliable, they supported her with a generally predictable routine that gave Annette a small sense of control over a life that was slowly escaping her grasp. However, since her private aides were not in the Medicaid network, Annette had to entrust new aides that were under Medicaid’s provision.

While changing a routine is difficult at any stage of life, Annette’s challenges were compounded by her age. As control over her life continued to slip with the transition from private care to Medicaid aides, seemingly trivial tasks, like checking the mail and cooking a potato, preoccupied her thoughts. Annette clung to anything reminiscent of a glimmer of control over what had recently been a predictable routine. I, too, noticed that she had become agitated as her quiet curiosity, so central to our weekly visits, had vanished just the same.

In his NY Times bestseller, Being Mortal, Atul Gawande writes that although it is not entirely controllable, there is space for the elderly to maintain their self-worth even at the end of life. Annette’s story, which echoes that of millions of seniors who struggle to age with dignity, highlights our personal and communal need to build a beautiful and honorable aging process so that seniors can maintain even the smallest sliver of control over their lives.

While the last weeks of Annette’s life were replete with transition from private care to Medicaid, she was able to maintain one constant, the support system that she had built over the past two decades in her neighborhood. Although it is certain that one’s aging journey will be fraught with unpredictable transitions, it is upon each of us to ensure that isolated seniors in our community are equipped with the tools to navigate the ever-changing landscape of old age. Annette’s last few months of life taught me that as flexibility wanes with age, we, as a community, should keep two strategies in mind when attempting to maintain a senior’s dignity:

1.  Schedule predictability, even one activity, into a senior’s daily routine
2. Use the senior’s support system as a provider of joy and self-worth

Two days before she passed away, I fed Annette applesauce. I discovered that as much as Annette was disconcerted by the home care transition as well as a recent heart attack, she felt supported by her community even from a hospital bed. I believe that it was this reminder of her community’s support that enabled her to find a small sense of joy and dignity in a life that was now almost void of control. As her lips smacked against one other with each spoonful of applesauce, Annette exclaimed: “Is there more? That stuff is delicious!

Abbe Pick is a Planning Execuitve at UJA-Federation of New York and a former friendly visitor at DOROT.