She’s also scared, because, in a life that often feels empty and cruel, Edith has always taken pleasure in her capacity to live independently—or at least on her own. “I was always so blessedly independent,” she says. “Now I’m saying, ‘How am I gonna take care of myself?’”
From an outsider’s perspective, it appears that she cannot. Edith’s weight has dropped to around 80 pounds since the accident, down from 132. With her teeth falling out and no dentures in place, she has been relegated to a liquid diet—“like a baby,” she says. A nutritionist advised her to grind foods in a blender, but her arm injury makes it hard to use her hand, and the help she’s gotten hasn’t been sufficient. Part of the problem is that Edith distrusts the Medicaid system, because she fears that a government agency will refer her case to the human services divisions, which will force her out of her home. Her fierce will to remain independent has led her to refuse much of the public assistance that is available to her. “I want to keep my apartment,” Edith insists. “And I’m just in a panic that they want to shove me into a nursing home. I don’t think it would work.”
Edith, who’s done her share of time in medical institutions, has legitimate concerns about what her life might be like in a nursing home: Poor care from indifferent staff members. Physical confinement in a drab setting. The sheer boredom of living in a place where nothing happens except death. “Mentally, I’m still very alert,” she argues. “I’m afraid I’d be miserable there.” And who can deny this risk?
Certainly not John, who’s homebound, in his eighties, and doing everything he can to stay in his apartment. He’s a retired social worker who’d spent part of his career caring for residents in a nursing home, as well as a tough part of his life taking care of his mother when she was in one, too. John is adamant: “Anyone who has any idea of what a nursing home is will try and make every effort to stay in their home and their community. I really know that, from firsthand experience.” The problem, John says, is not only that nursing homes rarely have sufficient staff to address their residents’ many needs. It’s also that the social environments they produce are consistently boring, dreary, alienating, and, above all, depressing. As a social worker, John recalls observing that old people who moved into nursing homes had virtually no chance of getting better or becoming more independent. “It’s the last stop,” he says. “That’s it.”
John regrets that he and his sister had to move their mother into a nursing home, but after she fell and broke her hip at home they had no other option. “I got one of the best,” he reports, “but after three years it started to sink. The food, the menus—they were always the same and the people there used to complain. I came once on a holiday—there was one nurse or one attendant for twenty patients, and when she had to go to the bathroom it was terrible. That’s not fair, you know? They cut their staff to save expenses, and then it stank.” After that visit, John and his sister were so upset that they decided to move their mother to another home, but the change proved traumatic. “She only lasted a week,” he says, his voice betraying self-doubt and perhaps some shame about what happened. “She couldn’t take the change.”
For Edith, the scariest thing about nursing homes is not the quality of care they offer, but the fact that moving into one would cut her off from her family and friends. “I have friends coming once or twice a week now,” she tells me. “And I have two cousins who are close to me. They call a lot.” She still gets lonely quite often, and she wishes she had more companions, people who could be her sounding board, who would understand her need to complain and vent. But she also knows she has more friends and family than other people in her situation. “Some older people don’t have anyone coming to visit,” Edith remarks. “Nobody to check in on them. I’m lucky there.”
It’s strange to hear this from an elderly shut-in who’s struggling with loneliness and depression. But it’s true. Some seniors do become deeply isolated after outliving their family and friends, and typically the most isolated seniors are men. The gendered nature of social isolation is, by now, a well-documented social pattern.13 We know, for instance, that at all stages of adulthood men are less adept than women at making and maintaining friendships, and they are similarly less able to sustain ties with family members, including children. These abstract social facts became more tangible during my study of the great Chicago heat wave, in which one of the most surprising findings was that elderly men, who were far less likely to live alone in the city (mostly because their spouses tended to outlast them), were far more likely to die alone in the disaster. Moreover, by at least one intriguing measure, they were much more likely to be thoroughly cut off from family as well: Of the fifty-six victims whose cases were handed over to the Cook County Office of the Public Administrator because no one came to claim the body or the estate, forty-four of them—roughly 80 percent—were men.
WHETHER MALE OR FEMALE, it’s never easy to identify the most isolated elderly. During the heat wave, the most vulnerable among them became visible only after they perished in their sweltering homes, sometimes several days after their final breath. By definition, the truly isolated do not participate in the senior centers, religious organizations, and volunteer networks where scholars and journalists who investigate the older population usually recruit their subjects. We spent years combing New York City in search of shut-ins and socially withdrawn seniors who would speak openly about their situation, and although each of the men we found had his own individual story, together they had much in common: a spouse lost to death or divorce; weak ties to children and other family, or no children at all; a small or nonexistent friendship network; physical or mental illness; a repellant personality. And although many longed for more companionship, they, too, preferred living alone.
“I lead a dull life,” Guy says, just a few minutes after agreeing to be interviewed in his drab Chinatown apartment, a place he’s struggled to maintain since his second wife left him five years ago. “I don’t talk to nobody. I don’t contribute to any causes. I like to sit in the courtyard, walk the streets at night. I recite poetry. And I drink—the best thing is Canadian vodka.” He conveys a deep sense of anger about the world and the way his life has turned out: “Miserable—I told you that fifty times!” During the conversation he rails against President George W. Bush and Mayor Michael Bloomberg, says the Russians have no good poets (“they’re all rhymers”), claims blacks are “too stupid” for higher education (and then says he’s joking), and declares that “any hospital with a cross or a Star of David is bad.” At times he’s playful, but in a cruel, disdainful way. Although he says he enjoys having company, he cannot help but drive you away.
Guy is childless, but he’s not entirely friendless or isolated. His sister lives in his building, albeit on a different floor, and when his wife left him she moved into his sister’s apartment, so they are separated yet tantalizingly close. They don’t spend any time together, but now that Guy, who struggles with arthritis, has trouble walking without his cane, his ex-wife will occasionally come by to drop off food or bottles of water. It’s an odd arrangement, but Guy says he’s happier with it than he was with their marriage. “Things are much better now,” he insists. And of all the people he complains about, his ex-wife is not among them, nor is the one who’d left him before she did.
His closest friends are from his student days, about sixty years ago, and his service in the navy. It’s a psychological closeness, not a physical one, though. One of the men he speaks of, a high school classmate who lives in California, rarely visits. The other, a cartoonist who lives in Connecticut, used to join him for lunch in Manhattan every once in a while. “But now he’s busy trying to bring over a Russian wife,” Guy says. “He’s not in the neighborhood much, and I’ve never visited him.”
Long ago, when the Lower East Side was more Italian and Jewish, Guy knew more people in the neighborhood. In recent decades, the area has become more heavily Chinese and far more gentrified. He’s
aged in place, but the place has changed with age, too. If, on the one hand, the change makes him feel culturally estranged from the community, it also makes him feel more comfortable on the streets. “It used to be vicious here,” Guy says. “The Italians terrorized the place. The Chinese keep it safe.” These days, his most regular companions are the people from Meals on Wheels, who come by every weekday, with a double meal on Friday to help him through the two days on his own.
As the interview winds down, Guy apologizes for not having a more compelling life story. “I’m sorry to bore you so much,” he says, and then he offers to share his “secret of life”: “If you are miserable, imagine a good life and imagine that you are having that life. I didn’t know that before. Now I do, and I’m not afraid.”
Guy’s secret wouldn’t do much to help Paul, a widower of four years in his eighties who also lives alone in Chinatown, in the same large apartment where he raised his son and cared for his wife as she succumbed to metastatic cancer. Once, the living room was clean and neatly decorated. It’s still spartan, but now the table is piled with old photographs, pens, and notebooks. And the floor is lined with tubing from the machine that Paul, who’s losing his battle with chronic obstructive pulmonary disease, needs to get oxygen at all hours of the day. Before his wife died, Paul enjoyed walking through the neighborhood, shopping, and socializing with the other old-timers who’d aged in place as the Chinese and then the young hipsters moved in. Now he says, “I spend my days on this couch, watching television. I can’t read because of the medications I’m taking. My eyes are blurred. My breathing is better when I’m not doing anything. If it’s not too hot, I’ll look out the window. If it’s too hot, I’ll just sit here or lie down on the bed.”
Unlike Guy, Paul admits that he’s suffered from his neighborhood’s ethnic turnover and from what feels like the steady disappearance of his longtime friends. He has lived in the area for more than fifty years now, and he fondly recalls the days when he and his neighbors would drop in to each other’s apartments to socialize, when he was surrounded by good friends and infused with the sense that he belonged. “It used to be Italian, Irish, Spanish, Jewish. Then they tore down tenements and put up the housing projects,” Paul remembers. “The Irish people and Spanish people who lived there before never came back, and the kids we raised grew up, bought houses, and left the neighborhood too. It’s just Chinatown now. I like it here, but the neighbors don’t have anything to do with each other. It’s not like it used to be.”
The social distance from his neighbors is difficult, Paul says, because being homebound is isolating, and he wishes more people would stop by to visit or at least see if he has any needs. He has one old friend who has stayed in the neighborhood, who, fortunately, has volunteered to take Paul to the doctor and come by regularly with coffee or a meal, or to help pass the time. Paul’s son, who lives in Staten Island and has two children, divorced recently and is so wrapped up with his own issues that he comes by only every two weeks or so. (When it comes to visits from children, at least, Paul might have been better off if he’d had a daughter, since in the typical division of domestic labor women tend to be more active caretakers of their parents than men.) “My wife and I used to go to their house and spend the day with the grandchildren,” he recalls. “Now they come here for a few hours a couple times a month.”
The absence of friends and family from his daily life has made Paul dependent on professional service workers. He gets two meals delivered each weekday because his social worker noticed that he’d become frail and emaciated and made special arrangements to supplement his diet. A home aide comes every week to clean. Paul is eligible for a home health attendant from Medicare, and he can get additional care when he returns from a stay in the hospital. Most of the elderly people we interviewed expressed great interest in this kind of service, because visits from home care workers offer personalized attention and face-to-face interaction—sometimes the only one they get in a day. Paul, however, complains that the people they send him can’t speak English. Their company makes him feel alienated, so he usually sends them out to get him fresh fruit, which has become a real luxury, thereby leaving him even more time to be alone.
Paul says that trying to fill the endless cycle of open, unscheduled hours is one of the great challenges of living this way. His mind wanders everywhere, and while sometimes it takes him back to better times and warmer feelings, at others it lands on the rough spots: his wife’s illness, his spells in the hospital, the time the power went out in his building and six paramedics had to carry him down before bringing him to the emergency room. He also gets anxious: What will happen if his friend gets sick and can’t help him any longer? What if there’s an emergency? What if the electricity goes out again and the paramedics can’t fix his respirator in time?
Paul tries not to fixate on these questions. At some level, he says, we all have to make our peace with worries like these. “I mean, I can’t sit here with a sad face all the time. That’s not gonna help me at all. This is it, and I’ve got to look at the brighter side, to make the best of it. That’s what I try and do.”
STORIES LIKE PAUL’S AND GUY’S make it clear that being male is not the only risk factor for social isolation. Others include being childless, or living far from your children; being sick, particularly if the illness leaves you homebound; being depressed, or struggling with another mental illness; and being poor, which increases the odds of facing nearly all the risks of winding up old and alone. According to an influential report from the Commonwealth Fund’s Commission on Elderly People Living Alone, of all seniors living alone and below the poverty line, one out of three sees neither friends nor neighbors for as much as two weeks at a time, and one out of five has no phone conservations with friends.14 None of these qualities are distributed equally, of course. Elderly Latinos and African Americans who live alone are much more likely to be poor than their white or Asian counterparts, for example.15 They’re also less likely to get appropriate medical care and treatment for mental illness, and more likely to feel that the place they live is unsafe.
This feeling matters, because, as scholars, policy makers, and advocates for the elderly have begun to recognize, certain neighborhoods can be inhospitable for older singletons. Neighborhoods that are far from family and friends aren’t the only places where older residents face heightened risks of isolation. So, too, are those that have become abandoned, impoverished, or violent, such that street-level conditions—a lack of grocery stores, well-maintained sidewalks, or safe public spaces, for instance—give elderly singletons little incentive to escape from their private burrows and participate in local life.16
Unfortunately, poor and depleted urban neighborhoods are now quite common in American cities, particularly in the regions that suffered most from deindustrialization: the Rust Belt and the Northeast. The old residents of such places are twice removed from public attention: first because of their age, and second because of their location. And while this is true in cities across the United States, it seems especially cruel in New York City, where the most dangerous and isolating neighborhoods lie in the shadows of the most safe and prosperous communities on earth.
In the mid-2000s, United Neighborhood Houses (UNH), which provides funding, policy research, and program support for more than three hundred New York City settlement houses and community centers, took up the challenge of determining precisely which parts of the city were especially likely to isolate older singletons. The organization had been serving New York’s seniors for more than eighty-five years at the time, but never before had it made a special point of assisting those who lacked companionship and social support. As Jessica Walker, the program officer who led the project, recounts: “The agencies and social workers in our network kept telling us how many isolated people they were seeing, and we knew there were even more isolates out there who were essentially out of sight. This used to be something that everyone took for granted. We started to
see it as an emergency in slow motion, and we needed to understand just how bad it was.”
The UNH research staff reached out to leaders in the government agencies that were also spending more of their time and resources responding to the needs of seniors who live alone, including the city’s Department for the Aging. “You have to understand that this issue affects almost everything that we do now,” the department’s former commissioner Edwin Méndez-Santiago tells me. “It’s not just doing outreach during blackouts or heat waves. It’s the senior centers, housing, Meals on Wheels, home care. The older population that lives alone drives a lot of this, and when they’re isolated, that’s the hardest thing of all.” Needless to say, he was eager to have his agency cooperate when UNH called.
Drawing on the city’s best available data (but not, alas, any measures of neighborhood-level residential or commercial density, nor of crime), UNH determined which parts of the city contained high proportions of both old people living alone and old people with special needs living in poverty. “You can’t do a survey of isolation,” Walker explains, “because you’ll probably miss the most isolated people. So we tried to find out which neighborhoods had the biggest risks of isolation. And what we found was not a complete surprise.”
“Aging in the Shadows,” a UNH report published in 2005, revealed that residents of Central Harlem, where 50 percent of all elderly people live alone, and East Harlem, where 40 percent do, face the greatest threat of isolation. If you factor in the prevalence of psychological distress, as Lloyd Sederer, New York City’s deputy commissioner for mental hygiene at the time of the study, did, a few more risky neighborhoods pop out. “The most vulnerable was the South Bronx, where we actually began a special outreach program to screen for depression,” Sederer tells me. “But the Lower East Side of Manhattan, Bedford-Stuyvesant in Brooklyn, and Coney Island have problems as well. We would love to do more in those areas, and in many others, too. Right now it’s a question of resources, and when money is tight, finding money for this kind of problem is not easy to do.”
Going Solo Page 18
