COMPARED WITH OTHER CITIES, New York City offers unusually generous public assistance for the elderly and the isolated. Practically every neighborhood has a senior center that serves lunches, organizes social events, and helps senior citizens enroll in public programs. Community groups and neighborhood organizations encourage people to age in naturally occurring retirement communities, which keep them from losing touch with friends, family, and local institutions; rent control policies, while weaker than they once were, allow retired people on fixed incomes to stay in their homes. Volunteer programs connect the retired healthy elderly with their less mobile counterparts, so that the visitors maintain a sense of purpose while the visited get a break from the monotony of long, solitary days. The Office of Emergency Management does special outreach for the elderly when the weather is dangerously hot or cold, and local postal workers check in with residents when mail accumulates in the box of an older person.
But New York City has nearly a million senior citizens—its elderly population alone outnumbers the total population of all but the nine largest U.S. municipalities—along with hundreds of thousands of others who live alone. It is, no doubt, a wealthy place, yet when the economy is sluggish the city government struggles to fund its public programs, and the cutbacks can be painful.
Meals on Wheels is one of the nation’s most popular public service programs. Who, after all, could oppose a policy that delivers hot food to sick or homebound residents? No one ever demanded that New York abandon its commitment to feed the hungry, but in 2004 the city announced that, to save money, it would terminate the contracts of sixteen nonprofit senior centers that handled the delivery program in the Bronx and turn them over to three large contractors who could do it more efficiently. Gaining efficiency required one simple change: Rather than delivering hot meals on a daily basis, the contractors would deliver frozen meals once or twice a week.
News of the plan incensed the city’s old people and their political advocates. Mayor Michael Bloomberg had anticipated that they would be upset about the loss of hot meals. But he failed to recognize that the program delivered human companionship and well-being checks as well as food, and that the coldest consequence of the change would be depriving New York’s most vulnerable residents of the rare occasions when they could see and be seen by another person. The controversy made it into local papers and TV news shows, and it didn’t look good for the Bloomberg administration. Soon the two sides reached a compromise: Residents of the Bronx would be enrolled in a pilot program called Senior Options, which would offer those capable of heating frozen food with a choice to get daily delivery of a hot meal or frozen meals delivered once or twice a week.
Community organizations in the Bronx criticized the program for deepening the isolation of local seniors, but in spring 2008 Mayor Bloomberg’s office declared that the pilot program had been a success—so much so that it would soon end daily delivery of hot meals to most residents and instead offer frozen meals in all five boroughs. Bloomberg insisted that his motivation was not the overall cost savings. The budget would remain fairly constant, keeping in mind that the city needs to provide far more meal delivery service to meet growing demand. Regardless, another political fight began, only this time the governor’s office got involved, demanding that the city answer a number of questions: How will the city address the problem of social isolation? How will it ensure that seniors are able to manage frozen meals? (Some elderly people should not be encouraged to use their ovens regularly, for fire safety reasons.) Will the city guarantee that seniors will still receive quality meals? And what will the city do when there is inflation in the prices of food and gas?
The New York City Council organized a hearing on the proposed change, and in early June the New York State Assembly threatened to pass special legislation to block Bloomberg’s plan. Bobbie Sackman, policy director for the Council of Senior Centers and Services of New York City, encouraged the state to do “the right thing to protect and defend the long tradition of neighborhood-based senior services that have made New York City a model for the nation.” Home meals are especially important for the frail and the very old, Sackman noted, because they have trouble getting out to the local senior centers that broker programs. “For an eighty- or ninety-year-old person, a daily knock on the door is important.”
In fact she was understating the issue. Isolates like Guy and Paul are not the only ones who need attention. These days most of us know someone—a parent, grandparent, neighbor, or friend—who’s on their own and could use some extra care or another daily visit. And none of us—no matter who we are, how much money we have, where or how we live—can escape the possibility that someday the person waiting for that knock on the door will be someone we love—perhaps even us.
7.
REDESIGNING SOLO LIFE
THE EXTRAORDINARY RISE of living alone is not in itself a social problem. But it is a dramatic social change that’s already exacerbating serious problems for which there are no easy solutions: Social isolation for the elderly and frail. Reclusiveness for the poor and vulnerable. Self-doubt for those who worry that going solo will leave them childless, or unhappy, or alone.
Today our species has about 200,000 years of experience with collective living, and only about fifty or sixty years with our experiment in going solo on a massive scale. In this brief time, we’ve yet to develop any serious public responses to the challenges related to living alone. Occasionally, a political official, religious group, or cultural critic tries to reverse the tide of history by persuading us that we are, in fact, better off together: The marriage promotion campaigns sponsored by President George W. Bush’s administration. The divorce prevention programs run by churches. The popular books like Marry Him, The Case for Marriage, and The Lonely American. Or the calls for adult children to take in their elderly parents, lest they be left to spend their golden years alone. But these attempts at moral suasion are destined for failure—and not only because their strongest proponents tend not to practice what they preach when their own happiness is on the line. The case against living alone simply runs counter to our modern sensibilities. And when millions of people from all parts of the globe believe they’re better off solo, it’s hard to convince them they’re wrong.
What would happen if we spent less energy on these futile campaigns to promote domestic unity and focused instead on helping people live better—healthier, happier, and more socially connected—if they wind up in places of their own?
We could, for instance, begin thinking about how to redesign our metropolitan areas so they better meet the needs of the people who live and work in them. As the Yale historian Dolores Hayden has shown, most modern cities and, especially, suburbs were designed for nuclear families in which the mother stayed at home to do domestic work while the father labored elsewhere; so, too, were most residential units, both apartments and stand-alone houses.1 These old forms don’t suit today’s world, where women work outside the home and millions of people live alone. And from an environmental perspective, they may even be dangerous, because sprawling, sparsely populated, car-dependent metropolitan areas dominated by large private houses require greater energy consumption than densely populated urban centers. How might the physical places that we call home be redesigned to suit the new metropolitan population, in which most adults are workers and singletons are ubiquitous?
Answering this question is especially urgent for the most vulnerable of those who live alone, the frail elderly and the poor. Today the two most common forms of specialized housing for these groups are the nursing home and the single-room occupancy dwelling, or SRO. But both of these housing options scare off more prospective residents than they attract—and for good reasons.
Nursing homes, the places of last resort for old people who require assistance with basic activities (such as bathing and getting out of bed) and can no longer live by themselves, need not relegate their residents to a sentence of living d
eath. Although most of the 3 million or so Americans who move into one each year are likely to get good care, far too many of them will not.
Most old people who live alone have a catalog of nursing home horror stories at their disposal, which they’ll share in interviews after just the smallest provocation. “One woman I know very well had to go to a nursing home,” says Edna, who’s in her eighties and clings to her independence as if her life depends on it. “She wanted to see me, so I went up there. Ugh! It was horrible! She sat there in this room. And there was one woman screaming her head off. Right over here—” She points to a spot nearby. “I don’t know what was with her. Somebody else was howling over here—” She points to a spot in the other direction. “There were noises all around us. Oh God! So she said to me, ‘I know it may not be easy, but will you please see if you can get me out of here?’” Edna promised to do her best, but she lacked the clout or the resources to do much about the situation. Before long, she got news that her friend had died. “All I could say was ‘Thank God!’” Edna remembers. “Oh, it was terrible!”
A neighbor of Edna’s had a similar experience. She lived alone, had retired early, and then got sick before she had a chance to enjoy it. “They sent her to that terrible place, and she was there a long time. Anyone who went up there came back and said, ‘My God, how does she stand it?!’ Finally she died. Finally. I don’t know how she stood it there. So you live alone. And like it. Get along as best you can.” Do anything, Edna says, to avoid a nursing home, because in her view it’s tantamount to being buried alive.
I’ve seen nursing homes of all kinds and levels, from well-maintained (though still quite lifeless) places where residents get private rooms and attentive care to those that I’d turn down if my only other option was a grave. The Amsterdam Nursing Home, a handsome brick high-rise that abuts the Columbia University campus on Manhattan’s Upper West Side, could easily be mistaken for an expensive co-op apartment building. Not only does it have good doctors, nurses, and social workers, it also offers the kinds of programs and facilities found in a high-end assisted living facility: wireless Internet access, live concerts twice a week, a library cart, an arts and crafts group, day trips of all kinds. This is unusual. Harlem is just a few blocks away from the Amsterdam; the South Bronx is just a few miles farther. Although there are some well-managed nursing homes in these neighborhoods, there are more that get disturbingly low ratings for nurse staffing, health inspections, and overall quality.2 This may not be surprising, but it certainly isn’t acceptable—particularly not for the people who live in them.
Unfortunately, most older people who need a nursing home have trouble avoiding low-quality facilities. According to a 2006 Consumer Reports analysis of 16,000 nursing homes across the United States, some two decades after the federal government passed historic legislation to improve conditions for nursing home residents—the 1987 Nursing Home Reform Act—“bad care persists and good homes are still hard to find.” The study’s key findings confirm the horrific stereotypes that strike fear in everyone searching for a facility where they, or their parents or grandparents, can get good care and assistance. On their site visits investigators found scores of abuses: Unattended residents getting bedsores, even when they have no risk factors. Workers ignoring doctors’ orders. Medication errors. Unsanitized dishes and utensils. Widespread failure to comply with laws that require homes to make inspection records available to anyone who requests them, including prospective residents and their families. The problems are worse in certain states, including Illinois, where the government allows nursing home operators to admit young people with severe mental illnesses, including those with criminal records. The result, as the Chicago Tribune reported, is not just “compromised care,” but a spike in crimes against elderly residents, from robbery to rape and homicide.3
Bad social policies and weak regulatory oversight aren’t the only sources of trouble for nursing homes—so too are some of the companies that have acquired them. The Consumer Reports study is but one of many to report that the lowest-quality facilities tend to be managed by for-profit corporations, and that independently run, nonprofit nursing homes are more likely to provide good care. A New York Times investigation of private equity firms that recently acquired nursing homes reports that “at 60 percent of homes bought by large private equity groups from 2000 to 2006, managers have cut the number of clinical registered nurses, sometimes far below levels required by law.” And that “during that period, staffing at many of the nation’s other homes has fallen much less or grown.”4 Is it a coincidence that, compared with the national average, the investor-owned homes also have more serious health deficiencies cited by regulators, a higher percentage of long-term residents whose need for help with daily activities has increased, and a higher proportion of long-term residents suffering from depression or anxiety? These outcomes have been facilitated, if not promoted, by federal officials whose weak penalties for offending companies send a laissez-faire message to everyone in the industry. And although meaningful reforms are clearly in the public interest, they are difficult to enact now that the nursing home industry has established an influential lobbying presence in the key sites of government power, from state capitals to Washington, D.C.
But reforms are necessary. After all, if nothing changes, what will happen when you, your partner, or your parents find yourselves searching for a nursing home, with no place else to go?
Recent changes in the nation’s stock of single-room occupancy buildings have made many of them similarly inhospitable, to the extent that they are even available. The supply of SROs has been dwindling for decades, largely because they’ve tended to be located near downtown areas that have been revitalized and owners across the country have sold their buildings to developers or converted them into luxury properties on their own. The remaining buildings have transformed from their historic role of sheltering mainly migrant workingmen. The massive deinstitutionalization of the mentally ill, along with the growing number of people who cycle in and out of the criminal justice system, has produced a new population of marginal men in need of SRO-style accommodations. Today, most SROs contain an unstable mix of the poor, the old, the mentally ill, substance abusers, and ex-convicts. SROs may work for some, but for others they are impossible communities, and in all but the best-managed facilities both residents and staff struggle to maintain decent conditions. Like nursing homes, SROs are in desperate need of redesign.
Redesigning the places where people live alone is only one way to address the challenges of a singleton society. Another is to improve the material objects we keep around us, and to design new ones to help those most at risk of isolation become better connected to networks of social support. This, of course, is something we are already doing quite effectively. Massive investments in communications technologies have helped usher in what we alternately call the Network Society and the Digital Age. These technological innovations haven’t merely benefited people who live alone; they’ve also produced the conditions that make solo living attractive, because cheap, accessible communications systems, from the telephone to the Internet, allow us to remain connected while living alone. The next frontier of this ongoing technological transformation is home-based robotics, from “smart home” devices that assist with everyday tasks such as cleaning and getting entertainment to even smarter machine companions that could be particularly helpful for the homebound. These technologies aren’t cure-alls. They’ll be expensive, and the prospect that they could be used to substitute for human contact raises serious ethical questions. But this hasn’t kept engineers and computer scientists from developing new machines that might someday help compensate for our social failures. We need to understand what they are making, and to get people with different backgrounds and experiences to help them, since we all may be touched by the outcome of their work.
PEARL IS JUST A FEW INCHES over four feet, and her hearing, speech, vision, and memory are far from perfect. She
moves slowly and has trouble with stairs. She loses energy quickly, and occasionally she crashes from overexertion. Still, Pearl can be tremendously helpful to people who want to live on their own but need special assistance. She is steady, so they can use her to stay balanced when walking. She knows when they should take medications, and provides reliable reminders if they forget. She can help them get connected to the Internet, or to contact family, friends, and health care providers. She monitors their activities and recognizes unusual behavior, such as failing to get out of a chair or neglecting to go to the bathroom. If they don’t respond to her prodding, she’ll ask for an explanation. If she doesn’t get one, she’ll call for help.
Pearl is still developing. She may get taller, but even if she doesn’t, her arms will soon grow long enough to reach items stored on top shelves or pick up things from the ground. She’ll be able to do a few onerous household chores by herself, and to help with others. Her speech will improve, as will her ability to understand language. She’ll play interactive games, and music and TV programs. She’ll be able to warn about threatening weather, answer the phone, program the DVR, and control the lights. When she has access to high-speed wireless service, she’ll transmit remote video and audio signals, mediating virtual meetings in real time. She’ll become a better companion and caretaker—still a robot, but one with a more human touch than her peers today.
Going Solo Page 19
