A wonderful Oxygen Mask Moment in the lyrics, the laughter, the love of life. It looks to me like the key is to just keeping singing and dancing. My mom would agree.
Month: July 2025
Behind Closed Doors – The Silent Struggle of Caregiving
Caregiving is the great, unseen work of a lifetime, whether it’s for aging parents, young children, or a person with a disability. It often goes unnoticed, uncelebrated, and un- or under-paid. It typically requires sacrifice of self in multiple ways, from dialing back career aspirations to a different look to retirement to shouldering physical (adults who are deadweight are heavy and those who are combative make care tough), logistical (ever tried to get someone who doesn’t understand words or can’t sequence directions to sit on a toilet?), and emotional (it may not be personal but some days you can only take being told to go away or shut up so many times) weight. In short, caregiving is a challenge that comes with a side of detriment to one’s emotional and sometimes physical well-being at various stages whether the caregiver is a family member or a paid aide.
Is it because we are taught not to stare when we see someone with a disability that we collectively generally don’t see or acknowledge caregivers? Is it because a lot of care happens behind closed doors so it’s simply not in our view very often (until we experience it ourselves and then suddenly we see these quiet laborers everywhere – driving cautiously on the highway with an older person in the passenger seat, pushing a wheelchair through the supermarket, waiting at the bus stop)? Is life just too busy to occupy ourselves with imagining what it’s like to give everything you have physically and emotionally at work and then go home to care responsibilities there, too, from one’s own kids to one’s own parents? Is it just too hard to face it so we ignore it? That is, until we are in it or need it ourselves?
Bradley Cooper recently produced a new Caregiving documentary that sheds light on this enormous blind spot and need in American society. It highlights different stories about caregiving and caregivers. It tells the story of paid and unpaid caregivers navigating the challenges and joys of this deeply meaningful work. By intertwining intimate personal stories with the untold history of caregiving, the documentary reveals the state and the stakes of caregiving in America today.
So much is broken about the medical system in the US, and caregiving is a separate but related dimension of that brokenness. Everyone needs it or does it at some point and yet there is nothing about long-term care that is straightforward or easy. It’s a big, complicated, expensive system. Reform is plodding – at best. Link here to my prior musings and stats about long-term care – Don’t You (Forget About Me)
Some strategies to make immediate improvements for paid caregivers:
- Pay workers a living wage. That should go without saying, but it needs to be said because it is not in any way a given; one cannot show up as one’s best self at work if one is barely able to cover rent and perpetually stressed about making ends meet even while working full-time;
- Create pathways for career advancement. Professional development and the ability to grow into better roles at work matter tremendously for worker satisfaction. By giving motivated employees a career ladder for upward opportunity, they will be more willing to stay, thus reducing turnover while increasing the quality of care;
- See the hard work these people do and acknowledge them. Like really notice them. Say their names, take an interest in who they are, and thank them for the non-glamorous and often grueling work they do. We’d (hospitals, assisted living facilities, and families) be so screwed without them.
- Check out organizations like the National Domestic Workers Alliance who work to highlight these disparities and change the status quo.
Some strategies to make immediate improvements for family caregivers:
- Show up. No one should have to take on the burden of caregiving alone. It’s way worse when a caregiver realizes that they haven’t been forgotten, but actually that no one has thought about them at all;
- Frequent check-ins: Even if it’s just a short text or phone call, regular check-ins can help the caregiver feel supported and not alone. It’s a small but meaningful gesture that can have a big impact;
- Be proactive, not reactive: If you notice the caregiver is struggling, don’t wait for them to ask for help—step in. Take on specific tasks – offer to assist with hands-on tasks like cooking, cleaning, running errands, or handling paperwork. The more you can take off the caregiver’s plate, the better. Often, caregivers won’t reach out for support until they’ve already hit a breaking point;
- Acknowledge their sacrifice: Caregivers often go unrecognized for the enormous amount of work they do, so it’s important to make them feel appreciated.
Besides working for policy change that can positively impact the care industry, as with all things: treat every living creature with respect, dignity, love, and curiosity. Everyone has a story to tell. Everyone deserves to be seen and heard. If you are interested, you can add your own caregiving story at Well Beings, an on-going, multi-platform campaign to address critical health needs in America. Lots of resources to learn from there as well.
Take care of yourself. If you are a caregiver, take extra care. Caregiver Syndrome – also known as caregiver burnout – is real. It is “a state of physical, emotional, and mental exhaustion experienced by individuals who provide care for a chronically ill, aging, or disabled person.” Symptoms include: feelings of overwhelm, sadness, anger, irritability, anxiety, depression, guilt, resentment, fatigue, body aches, physical ailments, and neglecting personal needs. Mel Robbins dives into this subject in her podcast Overloaded, Exhausted, and Ready for a Reset: 3 Doctors Give Their Best Advice. It resonated with me completely. I have BEEN THERE. You know what one of the doctors recommends at the end? Putting your own oxygen mask on first. Huh, I wonder where I heard that before?
Take a deep breath and maybe a couple minutes of quiet for yourself.
What Are We Without Our Memories? – Reflections Six Years On
This post follows up on a piece I wrote in November 2019. I asked in that post: what is life without a memory? I didn’t have any good answers at the time. And I still don’t, not really. But I spend a lot of time wondering about this. In fact, I woke up in the middle of the night the other night wrestling with this question. My middle-of-the-night-brain thought I should write about it only to discover when I woke up that I already had. Six years ago. Which just confirms that everything old is new again in my brain.
The big questions I have are what – and who – are we if we don’t have a memory? I also wonder what goes on inside my mom’s head – what is she seeing when she points to things that aren’t there, what is she trying to describe when she can’t find words, is more of her there than I realize, should I be more patient and move more slowly when trying to engage her, what does it feel like to entrust oneself and one’s well-being completely to another person, what is she holding on to this version of life for?
The mom I have now isn’t the mom who raised me, except in glimpses of a smile or a laugh or a familiar look (she was – and remains – a superior eye roller). She has no agency – she has no decision-making or verbal capacity, is completely wheelchair bound, and requires a mechanical lift to transfer her from chair to bed. She is quite literally a body without the instructions that typically come from a mind. But this body of my mom’s and the essence of who she was and who she remains to me are still here on this Earth, a living, breathing human being who exists, who needs food and care and love even though it’s hard to tell what impact any of it has on her. Ah, except for music. If she is awake, she still responds very clearly and enthusiastically to music by tapping her fingers or bouncing her foot.
Prior to my 2019 post, I had read Dr. Atul Gawande’s book Being Mortal: Medicine and What Matters in the End. I was inspired and grateful for the new perspective he presented, appreciative of his recommendations for aging and for dying well, and encouraged to see the emphasis on quality over quantity when it comes to facing terminal illness and one’s mortality. I found myself wondering, though, how one can have a meaningful, purpose-filled life and live life to the fullest until the very end, which are the premises of Gawande’s book, if one has no agency and can’t remember anything. It’s one thing to live in the moment, moment to moment. That’s enlightenment, or approaching it. But isn’t life, ultimately, a collection of memories? The best parts of life are the living of it and then the reliving of our favorite memories through pictures and sharing stories, anecdotes, and things learned along the way. When someone dies we bask in the memories of our times with that person. So many of my conversations start with, “Remember when?” What happens when you don’t? Who are we without our past? Without memories, what does it mean to be alive?
Since 2019, I have tried to connect with Dr. Gawande a couple times to see how he would answer those questions or what he would recommend. I have not had any luck finding a good email address for him so what I have sent has gotten bounced back. Rather than waste more time trying to find his email address, I instead tried to answer my questions on my own by digging around on the web to see what he has said on the subject. The answer isn’t super straightforward – with cognitive issues it seldom is – but it leans on the importance of dignity, joy, and connection, even if they only occur in one moment and then the next moment and then the next.
Gawande challenges the idea that memory alone defines us. Though he doesn’t minimize the loss of being alive without a memory, he invites us to expand our definition of “being alive”:
- It’s not just what we remember, but how we feel, how we’re treated, and how connected we are.
- Meaning can be found not just in grand narratives but in small, sensory moments.
- Even as memory fades, the present self still experiences emotions, relationships, and little pleasures—all of which sustain identity and meaning.
Gawande’s core insight is that:
Memory loss may chip away at the narrative of self, but not the essence of life.
Even without remembering yesterday, living today—with dignity, comfort, connection, and choice—can still be deeply meaningful. The best we can do is to provide as much autonomy, purpose, joy, dignity, and connection as possible. The emphasis becomes the small moments and an identity rooted in feeling versus memory.
It’s surely not the life my mom would have wanted, but by reframing my expectations in this way at least I know that my mom has all of the elements of a quality life.
Considering. I am not so enlightened and rose-colored-glasses that I completely accept this reframe. It definitely feels like a consolation prize, though I do appreciate the perspective shift and the reassurance that what little moments of joy and love and music my mom experiences throughout her days matter.
As to wondering what is actually going on inside her mind, well, that’s actually a WAY more interesting subject I plan to delve into further. A friend recently recommended the Telepathy Tapes podcast, which “explores the potential telepathic abilities of nonspeaking individuals with autism.” That is cool in and of itself. What does this have to do with my particular plight? Well, there’s an episode on telepathic communication with Alzheimer’s patients as well. Woo woo? Perhaps. Worth trying? Abso-freaking-lutely. Imagine what I could learn from sitting quietly a bit more, breathing deeply, and listening. Maybe I’ll hear my mom’s voice and gain deeper insight in our journey together. If nothing else, it’s good practice for putting my own oxygen mask on and finding my peace, quiet, and stillness.
My mom was – and remains – a beautiful and incredible human.
A 10 Second Oxygen Mask Moment
This was just too good and fitting not to share. Deep breath. We got this.
Don’t You Forget About Me Part IV – The Cost of Long-Term Care
Picking up from Don’t You Forget About Me Part III, which is now 2 years old because, well, I was stuck.
…I love where my mom lives, and also…
…it costs a fortune. Like mind-blowing amounts of money.
The exorbitant cost comes up in the NPR episode I was interviewed for (spoiler alert – I said it cost $100,000 a year. That was a lowball estimate that is now 2 years old – and, another spoiler alert, it doesn’t ever get less expensive). Over my years of caregiving for my mom, I have investigated options to save money for her care every which way possible (they are quite limited). You need to be full on flat broke (like $2000 left in your bank account) to qualify for Medicaid. And then many private care facilities don’t accept Medicaid.
What happens when you don’t have the money to pay for care, in home or at a facility? And then what happens when you run out of money? You know how moving is hard? And moving people with cognitive issues is really bad for them because it’s disorienting and confusing? And then often there are physical ailments that come with aging on top of it? If by some miracle your loved one just keeps on living for no good reason other than that they have some crazy will to live, you will almost undoubtedly run out of money before anyone steps in to help you. I was advised to get in touch with Medicaid when it looked like my mom had about 6 months of money left. Until then, you’re on your own.
“Most assisted living facilities provide what is considered “custodial care.”
Custodial care typically includes assistance with activities of daily living. These are tasks like eating, bathing, dressing, and using the bathroom. In some cases, it can even include health-related activities people usually manage on their own. Some examples would be taking daily medications or using eye drops.
Custodial care can be either long or short-term, depending on your condition. It can be provided in an assisted living facility, nursing home, or even in your own home with a home health aide under certain circumstances.
Medicare typically does not cover any costs associated with custodial care if that is the only type of care you need.”
Medicare covers Part A and B medical needs, including doctors visits, medically necessary therapy, and prescriptions (if you have Medicare Part D). Supplemental insurance through an organization like AARP is a good idea to pick up the balance of medical coverage because there always seem to be copays and other things that Medicare doesn’t fully cover (hospital care costs are 80% Medicare, 20% supplemental last I checked; yes, it’s confusing. Very). Does long-term care insurance make a difference? The jury is out. Check out this website about long term care insurance and you tell me.
So, if you don’t qualify for Medicaid or you just prefer a private facility for any number of reasons, where does that leave you? In the uncomfortable middle is where it leaves you. Neither Medicare nor supplemental insurance covers a penny of the 4 main categories of cost for a private assisted living facility, which include:
- Daily rate – essentially this is rent charged as a daily fee on a monthly basis, basically a “tenant at will” set up;
- Service package – this refers to the level of care the resident requires, from needing to be fed to needing help with bathing, dressing, transferring from bed to chair and back, etc.;
- Medication package – medication, at least in Massachusetts, has to be distributed by a qualified nurse from bubble packs provided by a pharmacy;
- Continence management – in a true cradle to grave twist, many of us will return to diapers at the end of life.
If you live in a private care facility and, against all odds, you end up living longer than expected, you do in fact get kicked out when you can no longer pay. I thought there was no way that would never happen, but I was wrong. Most facilities work with residents to try to make it work financially, but what if the parent is nearing 100 and the kids are in their 70s and retired, too? At a certain point something has to give. Because who has a spare million dollars?
All of the above is true in a world where the US government funds Medicare and Medicaid. Should that change, an already unsustainable, true stuck-between-a-rock-and-a-hard-place situation simply gets worse. There has to be a better way than the expectation of bankruptcy as the health care end game. This reality requires taking regular deep breaths to prevent hyperventilating. Once calm, it’s time to think about realistic, actionable solutions and working with your senators and representatives to make those a reality. Also continuing to fund Alzheimer’s research is a very good idea. This is not an issue that is going away until someone figures out how to stop it.
Put Your Own Oxygen Mask on First 