Every so often I see articles focusing on how older people resist change. “Set in their ways,” they say.
Or I talk to someone with an aging parent, who says, “My mom won’t participate in activities in her wonderful assisted living home. I don’t understand why.”
Or worst of all, “Mary doesn’t want to leave her home and move into a care center. Just stubborn, I guess.”
I must admit I get furious when I see comments like these. It’s not about change. It’s about moving to a difficult or intolerable situation.
There are 3 ways people experience change.
1 – Change of location.
So Mary doesn’t want to move to assisted living, where she’ll lose a lot of her privacy. She’ll be forced to follow meaningless rules. She can’t just go out and have a cup of coffee; most of those places require being driven, which means asking staff for help…which means you go when it’s convenient for them. It’s not a hotel (and I’m getting they remind you of that fact on a regular basis).
Is she resisting change? Tell Mary you’re moving her to a suite in the Ritz-Carlton where she’ll be on her own with no surveillance and no medical requirements. The hotel is located in a walkable location so she can just walk out the front door for shopping or coffee.
She wants to go off her diet and eat chocolate? If she’s 82, what’s the problem?
I’m betting Mary won’t have any problem accepting that change.
And next time you find yourself in a noisy hotel with an uncomfortable bed, imagine you’re told you must stay there for the rest of your life. Your food will be chosen by others every day and most likely will be bland a best. Would you welcome this change? Or would you find yourself saying, “Send in the Mafia hit man.”
2 – Change in experience.
I’ve seen articles complaining that seniors won’t use “assistive devices,” such as walkers and canes. Or they don’t want to go out as much.
How do you feel about walking around in snow boots? I don’t know about you, but those boots slow me down. Or carrying an umbrella in the rain. Or you didn’t read the weather report, so you’re bundled up on a warm day or under-dressed for the cold. Minor inconveniences, but they change the experience.
Now try using devices that aren’t just cumbersome: they attract patronizing looks. When I hurt my knee, I got lots of unwanted and undesirable attention, just walking down the street, first with a big elastic brace and then with a cane. Definitely changed the experience.
And then think of the “activities” in those assisted living communities. It’s like being on a cruise. Some people love cruises and some can’t wait for them to end. But this one doesn’t end.
Part of the enjoyment of activities, such as art classes and clubs, is the opportunity to meet and interact with people you rarely see otherwise.
You meet new people. In a “community” you see the same people over and over. That obnoxious bully shows up in a class you’d otherwise enjoy. You have the same conversations at meal times.
Some people are fine with this. Others feel like screaming and running away.
3 – Change in the meaning of an experience
Doing something for a purpose is different from doing something just to pass the time. Some people are happy doing this to pass the time. Others want to see mastery. They want a scorecard.
Some people want to stay alive under any circumstances. But for others, there’s no reason to keep going if every day brings nothing but misery.
I’ve often referred to Susan Jacoby’s book, Never Say Die. She recounts the story of a man who loved living alone. Now he was forced to live with a caretaker. One day he stole the caretaker’s keys, drove to a bridge, and jumped to his death. His life had become unbearable.
“He shouldn’t have had to go to a bridge,” Jacoby says.
I think she’s right. Patrick Henry famously said, “Give me liberty or give me death.”
Even prisoners can find more opportunity to put meaning in their lives than residents of eldercare homes.
In his book Rethinking Aging, geriatrician Nortin Hadler explicitly compares nursing homes to prisons. The prisons win: (pp 171-172): “It is a sad commentary that some elderly people would be better off committing a felony such as counterfeiting money; in prison, their assets are preserved, their meals are guaranteed, and their health care is scrupulously monitored and fully covered.”
I’d add that prisoners can have more rights than residents of nursing homes; I’m not an expert here, but I gather that prisoners. can refuse medical care. That’s not always possible at nursing homes. Prisoners also have more options for purposeful activity.
Being tied to a bed or a wheelchair because you’re a fall risk. Wearing diapers because there aren’t enough staff to allow people to use a bathroom with dignity. That’s the reality of many nursing homes and rehab centers.
Frankly, it seems. cruel to criticize people who resist these changes. Instead, as I say in my book, we should make it easier to opt out. There never will be pleasant options for helpless old people. Staff in nursing homes will always be at best indifferent and at worst cruel and abusive.
Let’s stop saying older people resist change…unless. they’re turning down a suite at the Ritz Carlton with opportunities to live independently. Instead, I’d like to hear more questions about how individual people value living and dying.