A parent is more than just a hand, but the impact they have on their children can be allegorized by the appearance of one. As a child grows up, their parent’s helping hand develops spots, wrinkles, and weakened bones. If you are my grandmother or mom—Virginia Deeds and Nancy, respectively—these hands will have pretty blue veins and sapphire rings to match.

As children grow up, their parents grow old.

Change is inevitable—graduations, grandchildren, and moves across the country. For elderly parents, this change is accompanied by a progression of health concerns that even modern medicine cannot handle without help.

Doctor Mitchell Wice calls this phenomenon the “Sandwich Generation,” where grown children are expected to care for themselves, their children, and their elderly parents as well. A professor in the Division of Geriatrics and Palliative Medicine at Brown University, Wice has grappled with his own relationship to the care of his grandmothers as they were diagnosed with dementia. He has witnessed his in-laws pack up their entire lives and move permanently back to China just so they could afford a live-in nurse.

Familial caregiving of the elderly has become a prescription by the American healthcare system, one which many middle-class citizens cannot afford to provide. Retirement costs an annual average exceeding $50K, but factoring in health care can make this number even more frightening. According to the Federal Reserve Bank of Richmond, it could cost $60K just for an elder’s final three months in the hospital. And with the annual cost of life for middle-aged adults circulating six figures, this age group that’s expected to care for everyone around them struggles beneath a hefty financial burden.

Most families cannot afford home aides or residential facilities for their parents—they can barely afford houses for themselves. How can a child help their parents without compromising their own quality of life?

My grandmother Virginia—us grandkids call her Gigi—made sure to maintain financial and medical independence as she aged. In only her fifties, she moved across the country into a low-cost, government-subsidized, end-of-life care apartment complex. She still lives there today at age ninety-one.

Gigi now needs help from her children to maneuver medical scares, but she’s not helpless without them either. It seems that her secret to a successful descent into end-of-life care is not just the help given by her family and facility, but the effort she made to care for herself while she still could.

Lytton offers both “independent” and “assisted living,” but my mother says the most appealing aspect is its affordability. Residents typically move in when they reach their eighties, alone or with a spouse, and remain there throughout end-of-life care. So for Gigi to enter the facility in her fifties was uncommon.

She was the youngest in her building for a long time. Her neighbors used walkers to navigate the grounds and had weekly doctor’s appointments. Gigi found a friend group amongst these neighbors, but at their dinner parties and birthday celebrations, she quickly became a surrogate caregiver.

“There was one woman who was blind, so mom did all of her shopping and bookkeeping,” my mom says. Gigi loved to help her older friends with tasks the Lytton employees did not tackle. Still healthy and capable of caring for herself, she would cook, clean, and keep up with the Palo Alto art scene. She even spent many summers flying solo to visit family on the East Coast.

Now, thirty years later in the same tiny apartment, her life is very different.

Rachel Neville, a nurse from Martha’s Vineyard, used to watch this health progression—or progression out of health—every day. At Windemere Nursing and Rehabilitation Center, the geriatric care facility at Martha’s Vineyard Hospital, Neville worked as a staff nurse for forty-or-so residents. During her evening shifts, she cared for people like Olga, who had no idea she was living in a hospital. 

“She would scoot around in her wheelchair,” Neville says with a laugh. Olga loved the “call light” in her bedroom, which connected to the nurses at the front desk. “She would press the bell all the time and go, I’d like to make a deposit. She thought she was at the bank!” Neville and her coworkers would pretend to be bank tellers, never wanting to upset Olga.

With old age comes myriad health concerns, but sometimes the scariest one is realizing what you have become. Coping with this realization can be hard to handle on your own.

When Gigi left her divorce and adult children behind in New York, she entered California completely on her own. And with no intentions of remarriage, there was no family next door to hold her hand as she grew old.

Lytton and its care are affordable due to government-subsidization, but also because medical visits and personal aides are optional. Gigi’s grown children did not have to scramble to fund “a five-star hotel room without the five-star hotel room experience” (which is how Wice describes the average nursing home). When Gigi’s application was accepted at Lytton, she was assured a better chance at an uncommonly comfortable life, for the rest of her life.

At most care facilities, residents and their days are run by the routines of employees. Nurses like Neville plan daily activities, schedule appointments, and administer medications. They help residents dine, listen to their life stories, and phone the families who aren’t visiting enough.

For Lina, the Memory Care Director at a residential facility in East Providence, her job is to tackle “difficult behaviors so that residents can experience the most positive outcomes that they can possibly feel.” She says she is dedicated to not simply nursing the physical health of residents, but to maintaining their happiness throughout the ends of their lives. Professional caregivers see residents come and go constantly. Meeting a new patient, they know how fleeting their time together will be. So they work hard to make the hospital feel like home.

Gigi knew about this kind of care at Lytton when she first moved in. Even when she was fifty and healthy, there was a full staff of caregivers waiting in the wings. Until she needed them, the facility was simply home.

But somehow, when she finally did ask for help, it still wasn’t enough.

As she organizes social events for her residents, Lina notices the impact of family participation. The “lucky” few patients whose family visits regularly benefit from it emotionally and physically.

When it comes to family, presence can be medicine.

Neville recalls one man named Russell who would visit his mother at Windemere every day, twice a day. He would sit down with her for lunch, leave for work, then come back again for dinner. At these meals, Russell’s mother would eat and smile more than other residents who did not have family to sit with. He kept her nourished, happy, and motivated to stay healthy.

Now in her nineties, Gigi has fewer friends to dine with and no energy to make more. The new residents of Lytton who have moved into her late friends’ apartments tend not to speak English or host fun dinner parties.

Her daughters have recognized this loneliness and take turns flying out to Palo Alto a couple times a year. Rather than becoming full-time caregivers for Gigi, they instead care in small doses. This way, their concern for her seems fun—like the trips are vacations, not medical visits.

When my mom visited Gigi this past October, she brought a list of chores to complete rather than sights to see. In her sixties and sleeping on the floor, mom spent afternoons building Ikea furniture and reorganizing the cramped studio so Gigi could better navigate with her walker. Mornings were full of doctor’s appointments. When the time came to grab dinner or run to the hardware store, she went alone.

My mom is not there to just spend time with her own mother—she is there to curate an environment that Gigi can survive in once she’s left. And as much as she would like to bring Gigi along on excursions, she says that Gigi would only slow her down.

Gigi struggles to hear, see, and understand what people are saying to her. This is especially frustrating when doctors prescribe medicine for her pain and she can’t read the tiny letters on the bottle. So at the doctor’s appointments she sat in on, my mom would transcribe each conversation into large, explicit instructions. She quickly filled up an old sketchbook with routines and dosages to follow once Gigi was alone again. 

Because Gigi would be alone again. She already is.

My mom is back at her home, working her real job and walking her dogs on the beach. Without her, Gigi is once again the driving force of her own routine. It is up to Gigi to check in with her doctors, take the correct number of pills, and use her walker for daily exercise rather than a dining table while she watches the Warriors on television. 

But it’s stressful, being alone, now that she remembers what it’s like to not be. There are still weekly Zoom calls with all of her daughters (or as my dad calls them, “the loud family”), but without my mom there as a filter the doctors let Gigi choose how to approach her medical needs. My mom says she knows Gigi is afraid of this autonomy, even if she’ll never admit it.

Independence, the illusive idea she held so steadfastly onto when choosing Lytton as her place to live and die, is now scary. It is more reassuring to maintain this independence with her daughter by her side than all alone in a studio apartment with neighbors she can’t understand.

But this incapacity to navigate independence is inevitable with age, and Virginia Deeds in some sense saw it coming. She set herself up to be self-sufficient for as long as possible, not drying up her family’s energy or financial resources prematurely. She stayed just “mom” for as long as she could, so now that relationship is preserved even when her daughters must help tuck her into bed.

When her kids fly out to see her a few times a year, it is not because a doctor prescribed them to do so or because Gigi’s house is inhabitable. It’s because they love their artistic, independent, tough-as-nails mom.

Author Commentary

Obstacles, lessons, and continued interest

I began writing this piece with an entirely different topic in mind, wherein I hoped to delve into the issue of misdiagnosis among the elderly. Yet as I sourced experiences from my own family to begin this journey, I grew emotionally attached to their perspectives. Growing up, I knew that my parents were taking care of my brother and I, and that their own parents did the same as they were growing up. But now that I've reached an age where we all are no longer growing up but growing old, I see this care in a different light. And I decided I wanted to learn more about what has happened to my grandmother so I may see what might happen next for my own parents.

There is much research regarding the topic of familial caregiving in terms of finance, insurance, and estate planning, and I did not get to sort through it all for this project. But this is a sociopolitical issue that is ever-changing, persistently important to follow, and geographically diverse. I figured, with so many differing studies and statistics, the primary common thread throughout it all was the real 'heart' of the issue: the love, the anecdotes, the qualitative research, an actual family. 

It was difficult to separate my familial connection and my investigative purpose, so I did not do so. This issue is one regarding family at its very core, so that separation did not seem necessary. I also did not know how to address this topic without inserting my own concern because this is an issue my family is very actively facing right now. This did create a bit of confusion about how exactly to address my grandmothers, what names to call them, and how much backstory was sufficient and not invasive. I did not include myself in the story, but perhaps a sequel would necessitate this: when my own daughterly role changes like how my mother's has, I suppose.

Source List

Interviews conducted with . . . 

Virginia Deeds, grandmother

Nancy Leport, mother

Nancy Tripp, grandmother

Dr. Mitchell Wice, asst. prof. of Medicine, Brown University Division of Geriatrics and Palliative Medicine

Rachel Neville, Geriatric and Maternity RN, Mass General Brigham, Martha's Vineyard

"Lina" (anonymous), Memory Care Director 

Research gathered through . . .

World Population Review, "Nursing Home Costs by State 2024"

RI Gov Milliman Report, "Rhode Island Medicaid Nursing Facility Rate Development" (2024)

Federal Reserve Bank of Richmond, "End-of-Life Medical Expenses" (2018)

University of Missouri Library, "Prices and Wages by Decade: 2020-present" (2024)

National Library of Medicine, National Center for Biotechnology Information, "Size and Demographics of Aging Populations" 

US Census, "Demographic Turning Points for the United States: Population Projections for 2020 to 2060" (2020)

Disclaimer: the structure of this accompanying video project was inspired by Cameron Crowe's Almost Famous (2000)