By Alec Pruchnicki, MD
I’ve worked at the Lott Assisted Living Facility (ALF) for over 14 years and have been involved in the care of probably over 500 elderly individuals. They all faced increasing difficulty staying in the community but did not need to be in a nursing home. At the urging of family members, social workers, or case managers, these individuals agreed to move into an ALF. I can’t remember any individual who moved in for trivial reasons. For all of them, some aspect of their social support deteriorated or collapsed and they were in dire need of a safe living environment.
For some of the elderly, the problems are very individual. For example, a longtime spouse dies and the children, if any, are too far away or too limited in resources to care for the parent. Even if the spouse is alive, stress and social isolation can make the healthy partner deteriorate. Nearby friends and relatives may have died or moved away. (See the New York Times article “Caregiving is Hard Enough. Now Try Isolation,” dated August 4, 2017.)
Even if an isolated individual can receive home services, such as a home aide, or nursing and medical house calls, these can be inadequate and are seldom available 24 hours a day. Even with these services, an old walk-up tenement can become a prison for a person with arthritic legs, a cane, a walker or, worst of all, a wheelchair. Medical deterioration and depression are common. Some landlords, eager to get their hands on a rent-controlled or rent-stabilized apartment might not be willing to accommodate an old person, and sometimes might even engage in harassment. Of course, even under the best of circumstances, gradually rising rents can sometimes be challenging for a person on a fixed income.
Neighborhoods change too. Close friends die or move away. Familiar stores close and are replaced by more expensive ones. Churches close, and senior centers and libraries might experience cuts in services and/or hours. Although the City as a whole is safer, crime hasn’t disappeared completely; a low level of danger in the past might now be absolutely intolerable to a fragile old person.
Margaret Chin, the chair of the New York City Council’s Committee on Aging, has estimated that there are 200,000 individuals on waiting lists for senior housing in New York City. Few are enthusiastic about moving, but they often have to. And, with the aging of the population, this problem could get worse unless the Federal, State, or City governments find a way to cope with this. Will they? Will the private sector? Will we?
