MILLCREEK — A good-natured group of elderly people has gathered for breakfast in the small common room at Highland Cove Retirement, an independent and assisted-living community.
Eugenia Sutcliffe, 82, is a transplant from Arizona, and everything about the Wasatch Front seems different and a bit unnerving. Tiny and tidy and perfectly coiffed, she left an art therapy practice in Phoenix two years ago to be closer geographically to her daughter and grown grandchildren, who live in Park City and Salt Lake City. She left behind friends and clients and — it seems to her on cold days in Utah — even sunshine.
America is aging rapidly, its population of those 65 and older now more than 46 million, or 1 in 7 people. By 2060, that number's projected to double, which means the country has to figure out whether it will have a robust or frail age-friendly infrastructure. Where people live in old age is no small matter. Seniors may need help with transportation, may be ill or weak, may not be able or want to cook. A support network, formal or informal, may become crucial. At the same time, where to live may not really even be a choice, depending on what someone who's old can afford and how that's person's health holds up.
Most senior citizens will stay in their own homes, usually by choice but some because they can't afford another option. It's hard to predict when you're younger whether you'll become so frail you'll need long-term care or so lonely that moving doesn't seem so bad. Physical and mental health, finances and relationships all impact the decision, but no factor plays stronger than family ties, with adult kids moving closer to their parents or parents moving to be closer to their kids.
That's what Sutcliffe did, moving into a one-bedroom apartment filled with pictures and pottery she created and a trove of flowering plants. But though she brought with her some of her favorite things, she feels downsized, just like her living space, and more than a little lost. The roads and people don't feel familiar; she doesn't dare venture too far lest she not find her way home. Not long after she moved, Sutcliffe was diagnosed with cancer, which also increased her sense of being lost.
She lives among relatively new acquaintances, whose ages stretch from mid 70s way up into late 90s, and she hopes they will become dear friends. In a retirement community that has a continuum of care, these are the independent folks — but not so independent that they stayed in the homes where they had careers, raised kids and might have grown old mostly alone.
The men and women at Highland Cove have chosen to live where they can retreat into their own apartments and shut their doors or mingle with others at a similar stage of life. Some, like Sutcliffe, do both, emerging mostly in the mornings for a shared breakfast or for Friday game night where they play the card game Apples to Apples.
As they introduce themselves at breakfast, you meet the woman in her 90s who moved here after a car accident, the 85-year-old who was moved her by her kids after she fell. A man who is very quiet pipes up unexpectedly that it's friendly, "communicable, like a disease. It catches onto you." He's been here six years and his neighbors feel like sisters and brothers, he adds.
Sutcliffe is still trying to figure out who she is in Utah. In Arizona she had a career and friends and familiar places. In Utah, she lives and plays and sometimes grieves, she says, in the precarious stage of adulthood that life coach Nancy Levin once described as being between “no longer and not yet.” No longer young, and fearful of what's ahead.
Finding your place
When polled, seniors routinely report they’d like to grow old in their own homes, in the communities they know, surrounded by familiar things. But it’s not always possible. And studies show that for some, home alone is mostly just alone.
Old people can feel isolated whether they're still at home or have been taken from their homes. Those feelings are problematic for older adults, and the impact on health is roughly comparable to smoking, according to research published in Proceedings of the Royal Society B, the United Kingdom's flagship biological research journal. Isolation and loneliness have been linked to woes including ill health and increased dementia.
Seattle-based A Place for Mom, the largest senior living referral service in America, polled families last year and found that while 62 percent of seniors wanted to stay at home, nearly three-fourths of those who ended up in assisted living grew to like it. They saw big improvements in social connections, physical health and nutrition — three challenges when old people live alone.
Because most people would rather stay home, families often don't consider other options unless a crisis occurs.
Old people may not always get to choose whether they stay in their home. Some will stay because they can’t afford to leave, even if it's no longer ideal or safe. Paul Kleyman, director of Ethnic Elders Newsbeat for New America Media, has reported on aging for more than 40 years. Nearly half of Americans 65 and older have fixed incomes that are modest and struggle to get along as prices rise, he says, adding that pensions have weakened, long-term care is a poverty program (Medicaid funds about 65 percent of patients in nursing homes) and people worry about outliving their money.
The World Health Organization lists factors that impact how well old people do in their physical environment: They must be able to get around both indoors and outdoors. Housing must accommodate their limitations and be affordable. Transportation must be considered, a dilemma for old people who may no longer drive safely but still need to get to stores and doctors and run errands.
WHO also lists social aspects to living well in a community, from socializing and attending events to having opportunities to work if they wish. The elderly have to have ways to communicate with others and to get information. And, of course, they need healthcare facilities that aren't too far away.
Stephen M. Golant, a University of Florida geography professor who wrote “Aging in the Right Place,” says old people especially need to get enjoyment, stimulation and a sense of belonging from the places where they live.
While agreeing that seniors need basics like transportation, he argues if all a city focuses on is creating walkable communities, it leaves many older folks behind. Some would benefit most from connectivity so they could FaceTime with grandchildren or order in groceries. Telehealth, smart home technology and other modern tools could greatly improve lives, but old people must have access and understand how to use them.
Life among peers
Golant says there is no mystery to the allure of aging in a familiar place. Old people, he says, “get pleasure and enjoyment from where they live, but they also feel competent there.” Safety is a worry for academics and adult children. Unless they’ve fallen, which casts a pall, old people think instead about being able to do things successfully: “Can I accomplish this?”
He also thinks that while it’s good for old people to mix with young people, they also benefit from living next to other old folks. They should have both.
“Typically, our social networks, our friendships, are with people at the same stage in life as us. The question becomes, 'What is the rationale to argue that when you’re older, you should change the patterns of interactions you’ve had your entire life?'” he asks.
Moving in with one's children may sever important old connections unless care is taken to nurture them, Golant warns.
The loss of old connections is part of Sutcliffe’s struggle. She wants to be involved, to contribute — she still has a few art therapy clients who talk to her on the phone while they look at the art on their computers — but she also longs for familiar streets and faces. Right now, everything feels too new — except her body, which sometimes seems to deliberately remind her that it’s old.
Familiar old connections keep Bob Egbert, 85, going. He lives in a Bountiful neighborhood where he sees his daughter and his little brother, who’s 82, daily. He also sees old friends. A stocky 5-foot-8 with sandy-colored, curly hair, he’s a retired ironworker surrounded by photos from his long life. His living room is immaculate and artfully arranged; he explains he dusts it, but it’s exactly as his wife, Beneta, kept it. She died 16 years ago. He likes familiar things.
He says he loves his kids and they love him, but he wouldn’t want to live with them. “Some boss me a little,” he says sweetly.
Egbert gardens and sometimes, when he wants more company, he visits the local senior center. It serves lunch and there are classes and activities, but it's also full of familiar neighbors and friends.
A literal village
Some towns have nonprofit membership communities called “villages” to help the old who want to age in place. Right now, there are dozens in the Village to Village Network nationwide. They vary but share basic concepts.
Villages meet local needs of people who want to age at home, with paid staff and a strong volunteer corps providing the backbone. Membership fees pay for the staff, who help arrange affordable services. Volunteers may provide transportation, home repairs, outings or other services. Local businesses and service providers may offer discounts to village members, but the village also serves the important function of vetting providers — a kind of Angie’s List for old people.
Most towns don’t have a village. There are none in Utah and few nearby.
The fees and services vary depending on the village, says Candace Baldwin, director of strategy for Aging Initiatives at Capital Impact Partners, which partnered with the first U.S. village, in the Beacon Hill area of Boston, to form a national village network.
“The village model is rooted in the desire to connect neighbors, a spot where folks who are aging have a place to come and someone who advocates on their behalf,” she says.
Every day, villages nationwide arrange a ride to the doctor for someone, but they also find walking buddies for physically active members. Someone can learn to play pinochle or find someone to sit for an hour with one frail spouse so the other can go shopping. Baldwin tells of arranging for volunteers so someone could return home after surgery, of dog walkers and respite care and a pal with whom to dine. Villages help people plan their retirement, teach them about investing, explain what it means to sign a do-not-resuscitate order. Some have social clubs and affinity groups, fitness classes or book clubs.
Trained volunteers ask new members questions: What skills do you have and what do you want to gain? What’s on your bucket list? Villagers may themselves become volunteers for their broader community, helping out at local schools as tutors, for instance. Baldwin says everyone has something to give.
Even areas without villages have gathering places to speak to a universal longing. In Utah, if it's not church, it's often one of the senior centers that county aging agencies run.
You enter Salt Lake’s Tenth East Senior Center down a long hall, its whitewashed brick walls covered with photos at eye level.
A series of tables supported sign-up sheets: On this late-winter day, anyone over 60 can sign up for yoga, guitar, circuit training, computer class, the AARP Smart Drivers Course and Car Fit Program or study astrology, French or Spanish. There’s a book club and a list is filling with people who want haircuts. The fullest sheet is the one offering discounted massages. Names are even scribbled in the margins.
In January, director Shawn Ashby said the center served 44 congregate meals and 274 people over 60 showed up for those meals or for programs — a total of 2,377 program hours.
There’s a thrift shop and a dining room, and the art class was packed with seniors. In a bright lobby area, Bruce Jaynes, 69, was doing a jigsaw puzzle. Almost daily he works on puzzles, which get swapped out regularly. Even when he's working alone, he can feel a bigger community close by, just through the doorway.
Helen Rollins, a retired nurse and one of Sutcliffe's new friends, tells "The Onion Story" to explain why she likes the independent living community where she and Sutcliffe live: “If there’s something you can’t do, there’s usually someone here who can.” A resident named Ted recently needed an onion. One neighbor had a chopped onion, another a half onion, a third some frozen onion.
His age and health meant Ted couldn’t just hop in a car and run to the store. But he didn’t have to.
Eugenia Sutcliffe's new community came through.
Editor's note: Lois M. Collins reported this story as part of a 2016 Journalists in Aging Fellowship supported by New America Media, the Gerontological Society of America and the Silver Century Foundation.