They Aren’t Really ‘Just Fine’: Your Aging Parents Who Don’t Live Nearby

How to tell that they need help, even though they won’t ask for it

Journalist Lisa Esposito, a health reporter at U.S. News & World Report, explains how to tell when your parents need help (no matter what they say). She wrote this article with support from a Journalists in Aging Fellowship, sponsored by the Silver Century Foundation, as part of a fellowship program created by New America Media and the Gerontological Society of America. The article—the first of two parts—first appeared in U.S. News & World Report. On March 31, 2016, it was re-posted at the New America Media website. It’s reprinted here with permission. For part 2, click here.

“I’m doing fine.” It’s reassuring to hear when you call a parent who lives far away. But the fact is, seniors living alone in their 70s and beyond may keep serious problems to themselves because they don’t want to worry you or feel like a burden. 

Sometimes it takes a crisis—like a call from the hospital—to realize how far from fine a family member really is. Visiting in person is the best way to see what’s what, experts agree. And witnessing the gaps in a parent’s well-being is the first step to getting the right help. 

Pride and Independence 

Amoke Alakoye of Silver Spring, MD, is a dedicated family caregiver. Alakoye lives with and looks after her mother, a multiple-stroke survivor. She also acts as the long-distance caregiver for her aunt in Philadelphia. The two siblings are in daily contact, Alakoye says, by phone or online. During her own frequent phone chats, Alakoye says, her aunt is more likely to say “I’m fine” than speak frankly about any difficulties. 

It took a weekend family celebration for Alakoye to get a truer picture. In their shared hotel suite, she could see her aunt struggling with arthritis and other health problems, affecting her hygiene and grooming. 

Pressure to Age in Place 

Society sends a strong message that successful aging means living continuously in your own home for as long as possible, says Stephen Golant, a University of Florida gerontologist and geographer and author of Aging in the Right Place (2015). 

It may take a crisis or major upheaval to make people rethink the matter, Golant says, such as the death of a spouse, a serious fall, a bad car accident or repeated hospitalizations. The challenging gray area is when less-dramatic events begin to add up, he says. 

Hired caregivers can fill gaps, Golant says. But it’s hard to substitute for a family member during the vulnerable period after a hospital discharge, for instance, when someone needs to talk to health care providers and make sure the patient receives follow-up treatments and is taking medicine properly. 

There can be a tipping point when it’s clear that aging in place isn’t working. For the older person, Golant says, it’s when the feeling of incompetence and being out of control trumps the familiar comfort and attachment to home—memories, friends and possessions. 

From the perspective of the concerned family member, he says, “It’s when your uncertainty level reaches a point where you dread receiving a phone call at any time of the day or night.” 

“As much as possible, recognize you’re dealing with someone who has had a very rich and competent and wonderful life,” Golant says. “And as much as possible, respect their integrity and desire to age in place.” At the same time, he adds, recognize when living on their own puts parents’ security and quality of life at risk. 

“I said, ‘Oh, we’re going to have a spa day,'” Alakoye recalls. “So she wouldn’t be upset with me. So I could bathe her and show her how, if she lived in an assisted living facility, they’d have a roll-in shower.” But her aunt still lives alone in her home with its standard bathtub, so Alakoye has arranged for a home health aide, who comes in several times a week. 

Alakoye’s personal experiences with caregiving have motivated her to become a gerontologist. But as many experts in helping professions find, Alakoye’s most challenging cases are her own flesh and blood. It requires tact and diplomacy to suggest changes or solutions. “I can’t tell you about the level of cajoling that goes into it at this point, because there’s a lot of pride,” she says. “They cared for you. How dare you tell them now what to do?” 

What to Look For 

Nora Jean Levin, executive director of Caring from a Distance, says holidays are prime times for concerned adult children to notice problems and reach out to her organization. 

“Suddenly they have noticed, as they’re in the house: The mail is piling up; the garden hasn’t been tended to; the laundry is all over the place; the house doesn’t look good,” Levin says. “Or the family member looks very pale; they may not be taking their medications as they’re supposed to be.” 

Sandy Markwood, CEO of the National Association of Area Agencies on Aging, says transportation is a huge issue for seniors and the top reason people ask about elder care. Scrapes on the car door can be clues indicating trouble, she says. Parents may limit driving at night or make excuses not to go to the doctor because it’s raining. The issue becomes how to prevent accidents while keeping parents’ worlds from shrinking.

In the kitchen, ominous signs include charred pots and pans or burn marks on the stove or countertops. Expired food in the refrigerator can signal problems with regular grocery shopping and good nutrition

Unfilled prescriptions or chaotic medicine assortments suggest needed treatments [that] are being missed, or the potential for dangerous drug mix-ups. “The other thing is bruises,” Markwood says, “when somebody is bumping into the furniture or falling.” Taking a tour of the house can reveal fall-related hazards and suggest solutions.

Face-to-face conversations can give you a lot of insight. You could pick up on a parent’s disorientation or confusion, Markwood says. Parents who don’t want to do things they’ve always done, [who] display changes in mood or personality or don’t get out anymore could indicate early-onset depression. 

Caregivers in a couple may be struggling too. “The stress of caregiving can often impact the quote-unquote ‘well’ spouse to the point that they become ill and they’re both in a compromised health situation,” Markwood says. “If you’ve got an 85-year-old caring for an 89-year-old, they probably both need some support.” 

Isolation in Plain Sight 

In a recent study of senior housing, nearly 35 percent of the older adults interviewed were classified as socially isolated but [were] unrecognized as such by staff, says study co-author Harry Owen Taylor, a doctoral student in social work at Washington University in St. Louis. 

There was a strong connection between subjective isolation—when people perceived themselves as isolated—and symptoms of anxiety and depression. Seniors with friends and family living nearby did significantly better, Taylor says. 

“My feeling is that aging in place works until it doesn’t,” says Alice Fisher, founder of the Radical Age Movement. She’s seen several elderly relatives cross that line. 

Until last year, Fisher’s mother-in-law, then 91, lived alone in Delray Beach, FL. During previous family visits, she appeared a bit frailer each time. “The last couple of times we begged her to let us move her to New York,” Fisher says. “She was a very independent, forceful woman who said, ‘Absolutely not.'” 

Parents don’t want to seem needy, and they know their adult children are busy working or taking care of children.

Last October, an alarming phone call changed everything. Fisher’s mother-in-law reluctantly admitted she had fallen on the floor and lain there several hours before somebody found her. After the hospital staff bandaged wounds on her legs and released her, a next-door neighbor brought her home. 

To the couple’s shock, the neighbor later told them there had been several previous fall-related incidents in which Fisher’s mother-in-law promised to inform the family but never followed through. This time, Fisher says, “Her neighbor told her, ‘I want you to call your children now, while I’m here. Because I’m not leaving until you do.'” 

Robin Levine, a retired medical geriatric social worker who worked in New York and now resides in Florida, sees many such situations. Parents don’t want to seem needy, Levine says. “The children are busy; they’re working; they have kids. So [the parents] say, ‘Yeah, everything’s fine.’ And when a child eventually does come down, they say, ‘Oh my gosh, you’re not fine—you’re not fine at all.'” 

Start seeking help when you first feel uneasy. “You will realize, after, that you should have done it a while ago,” Levine says. Her other advice to adult children living at a distance: “Open your eyes. Try and really see what’s going on and not what you want to be going on.

A Stranger Just Called Her ‘Sweetie.’ How Does She Feel?

That’s ageism in action—and it can undermine her health

Journalist Lisa Esposito explores the impact ageism can have on your health as you grow older. She wrote this article for U.S. News & World Report with support from the Journalists in Aging Fellowships program of New America Media (NAM) and the Gerontological Society of America. Her fellowship was sponsored by the Silver Century Foundation. NAM posted her article on Dec. 29, 2015, and it’s reprinted here with permission.

Accomplished, enlightened, learned, sage and wise? Or confused, decrepit, incompetent and declining

The language used to describe aging, the way people talk to and about seniors, matters. Ageism can hurt your health, research shows. Shedding negative stereotypes and embracing positive attitudes now can help make life better as you get older. 

“And what can I get you for dessert, young lady?”

Subtle ageism comes through in the language people use, says Tracey Gendron, an assistant professor in the department of gerontology at Virginia Commonwealth University. It’s a way to treat elders as “others.” 

An ageist attitude can come wrapped as a personal compliment. “When we praise someone for looking or being ‘youthful,’ or having a young spirit or body, that in and of itself is problematic,” Gendron says. 

“Because it’s making ‘young’ the default of what is preferred, what is positive, and ‘old’ the default of what is negative.” 

Gendron challenges well-meaning people, when tempted to describe an older adult as “79 years young,” to consider what they really mean—that the individual is energetic, healthy, lively, vital or engaged. 

Evidence of Harm 

Becca Levy, an associate professor of both epidemiology and psychology at the Yale School of Public Health, and colleagues are compiling evidence on the physical fallout of ageism. In study after study, they connect negative stereotypes of old age to worse health outcomes. 

On the flip side, subliminal exposure to positive age stereotypes can improve how older people function, according to research presented by Levy at the annual scientific meeting of the Gerontological Society of America in November 2015. 

It’s a problem when people conflate aging with being ill or disabled.

Her most recent published study is disturbing: brain changes that are hallmarks of Alzheimer’s disease were much more prevalent in older adults who, decades earlier, had expressed the most negative ideas of what it means to be old. 

The study, which appeared online on Dec. 7, 2015, in Psychology and Aging, looked at 158 people in a long-term study, who responded to a scale of attitudes toward old people. Later, they underwent yearly MRI brain scans, and for some who died, brain autopsies. 

Participants who held more negative age stereotypes had lost more volume in the hippocampus section of their brains. They also had more buildup of amyloid plaques and “tangles” around their brain cells. These signs are biomarkers of Alzheimer’s disease. Holding positive age stereotypes appeared to have a protective effect on the brain, the study found. 

‘Talk to Me, Doctor’

It happens when you accompany an older relative at a health care visit: the doctor talks to you instead of the patient. Alice Fisher, founder of the Radical Age Movement, a national group seeking to raise awareness of and confront ageism, has seen it with her parents’ health providers.

“I would have to say, ‘Could you please talk to my mom? She understands everything you’re saying. I’m not the one we’re talking about,'” Fisher recalls. It was, she says, as if her mother was not even in the room. “That’s absolutely so annoying,” she says. “And it disempowers the person that’s there to be treated.” 

In general, Fisher says, it’s a problem when people conflate aging with being ill or disabled. “It’s a fine line,” she says. “If you’re old and you get cancer, well, then you’re sick. But the normal slowing down of the body is not an illness.” 

“Wow, he’s in his 90s but sharp as tack.”

A study by Gendron, published online in July 2015 in the Gerontologist, analyzes ageism in tweets from health-profession students taking part in a senior mentoring program. After each visit with an older adult, participants posted reactions on Twitter. 

Twelve percent of these tweets contained discriminatory language, researchers found. Some seemed benign on the surface. 

One type of bias is “uncharacteristic characteristics,” Gendron says—referring to certain behaviors as unusual or outside the norm for older people. A study example: “My mentor is truly an amazing woman. She maintains great health and keeps a daily activity that very few people her age are able to accomplish.” 

Another example: “infantilizing” language focused on childlike attributes in older adults. “What a sweet woman! I especially love her little winks.”

Taking Ageism to Heart 

Some ideas of aging are empowering; others are stress-inducing. In Levy’s 2000 study in the Journal of Gerontology: Psychological Sciences, older adults were subliminally exposed to either positive or negative words used to stereotype aging. 

Next, they performed computer tasks involving quickness and accuracy and did verbal and arithmetic exercises under stressful conditions: having a tape recorder placed in front of them, being timed with a stopwatch and hearing a metronome ticking in the background. 

Those exposed to negative age stereotypes had significant increases in blood pressure and heart rate following the challenges, compared with people given positive stereotypes. 

Higher stress causes the body to release more stress hormones, researchers noted. Over time, stress contributes to chronic high blood pressure and other risk factors that may eventually result in heart attacks or strokes. “Positive age stereotypes act as a buffer to everyday stressors and challenges,” Levy says. 

The findings were in line with another study by Levy and colleagues, which found that people holding negative age stereotypes were at greater risk of experiencing cardiovascular events up to 38 years later, compared with those holding more positive age stereotypes. 

“Data show people are happiest when they’re in their 70s and 80s.”
–Tracey Gendron, PhD

Self-efficacy—a person’s confidence in their ability to exert control over their own motivation, behavior and social environment—tends to flourish when people view aging in a positive light. 

“We have found that those with more positive age stereotypes tend to be more likely to engage in preventive health behaviors,” Levy says. That includes taking prescribed medications and wearing seat belts. 

In Levy’s November 2012 study in the Journal of the American Medical Association, people age 70 and older recovering from severe disability were 44 percent more likely to recover fully in activities of daily living—bathing, dressing, transferring and walking—if they had positive old-age stereotypes. 

A 2010 study from France explored how negative attitudes about age create dependency among older adults. Paris Descartes University researchers exposed participants to positive, negative or neutral stereotypes and noted how often they asked for experimenters’ help while completing a task, versus being confident enough to proceed independently. Experiencing negative old-age stereotypes was tied to people taking fewer risks and seeking more assistance. 

“Me, I’m not old. But those old people living around me—they’re so stubborn.”

With internalized ageism, seniors have absorbed the old-is-bad message. “We have ‘othered’ ourselves away from quote ‘old people,'” Gendron says. “‘I’m not old—I’m just mature.'” 

Then there’s Facebook.  A study led by Levy, published in April 2014 in the Gerontologist, looked at 84 Facebook groups focused on age-related topics. Two-thirds of the groups “excoriated” older individuals, 27 percent infantilized them and 37 percent urged banning them from activities such as driving or shopping. The authors note that Facebook community standards don’t address ageist speech. 

Be Kind to Your Future Self 

When it comes down to it, ageism just doesn’t make sense. “Watch that language of saying ‘they’ and ‘those,’ and make it about ‘us’ and ‘we,'” Gendron advises. “We’re all aging, every day. It is about ‘us.'” 

At any age, people can strive to change unhelpful attitudes. “The ideal would be to get rid of them; if we could have a society without ageism and without negative age stereotypes,” Levy says. But until that happens, she says, question negative stereotypes as you encounter them in media, marketing and everyday life, and look for older role models to bolster a positive attitude and promote good health. 

“We’ve made [aging] into this scary, horrible thing,” Gendron says. “We’ve made it into something that you dread, not something that you look forward to.” Yet, she adds, “Data show people are happiest when they’re in their 70s and 80s. Because we don’t care what other people think.” 

Fisher wants you to know she’s about to turn 70. “‘For God’s sake, say your age—it’s OK,” she says. “You should be proud that you’re 83. It’s a ‘you made it’ kind of thing. Don’t hide it.” 

How to Keep Parents Safe and Respect Their Independence

Managing care from a distance for a parent who lives alone

Journalist Lisa Esposito, a health reporter at U.S. News & World Report, suggests ways to help parents who live alone, even though you’re not near at hand. She wrote this article with support from a Journalists in Aging Fellowship, sponsored by the Silver Century Foundation, as part of a fellowship program created by New America Media and the Gerontological Society of America. The article—the second of two parts—first appeared in U.S. News & World Report. On April 1, 2016, it was re-posted at the New America Media website. It’s reprinted here with permission. Part 1 explains how to tell when your parents need help.

Your parent prizes his or her independence and insists on living at home, alone. However, you see signs of vulnerability and a precarious situation with the potential for falls and injury, poor nutrition and your parent becoming neglected or housebound. You want to help, but you live at a distance and don’t know where to start. 

Concerned adult children can build a network of services to keep aging parents safe and restore their quality of life. Read on to discover your many options and how to set them in motion. 

If at all possible, start the caregiving ball rolling with an in-person visit to your parent’s hometown.

Eating healthy meals, taking the right medicine, being safe, talking to other people and getting out of the house for fresh air. When you realize parents are missing out on these basics, it’s time to tap into local resources. 

At Meals on Wheels of Takoma Park, MD, a hot meal of macaroni and cheese, baked beans and spinach is on the current menu. “Comfort food,” says cook Cathryn Pethick on a recent rainy February morning, as she and the kitchen crew filled trays.

Many clients are the “old old” in their 80s and 90s, says Jill Feasley, director of the Takoma Park program. The low-fat, low-salt meals contain two-thirds of needed daily nutrients, she says. While there’s no minimum-income requirement, those who can afford it are asked to contribute $7 a day or $140 a month toward costs. You can find a local provider at the Meals on Wheels America website. 

Driver Kay Behall covers a regular Wednesday route of suburban Maryland houses, with wheelchair ramps leading to the front porch or “No Smoking: Oxygen in Use” signs on the doors. Her clients include Kathy Yowell, 83, who has lived in her bungalow more than 50 years. She loves to chat and Behall is happy to listen. “I thrive on service organizations,” Yowell says, explaining how she manages day-to-day. 

At another stop, Moses and Virginia Rich both receive meals; he has Alzheimer’s disease, and she’s the caregiver. The service is “lifesaving,” Virginia says, since she wouldn’t otherwise be able to provide balanced meals.

Accessing Tech for Care

Personal emergency response systems—which can detect falls, connect to emergency call centers and allow communication with family members—are geared toward people living at home who want to age in place, says Jody Gastfriend, a licensed clinical social worker and vice president of senior care at

The simple cellphone is the best, most-used technology for connecting families, says Andy Cohen, CEO of, a resource for family caregivers. From what his group hears from family members, most seniors don’t like to Skype that much. “They think it’s because it’s not intuitive and it’s difficult,” he says. He believes seniors will be more comfortable with newer-model TVs that offer Skype interface. 

Gerontologist Amoke Alakoye, herself a family caregiver, describes how going online helped her aunt. “She fell in love with the laptop about six years ago,” Alakoye says, “because her world had closed so much socially without her being able to get around without her wheelchair. Now she’s on the Internet and she emails us all kinds of things and she’s talking to so many of her friends.” You can find computer and technology classes for seniors through the AARP websiteTo find a host of area services, the nearest Agency on Aging is a good place to start, says Sandy Markwood, CEO of the National Association of Area Agencies on Aging. You can [also] use the Eldercare Locator to sort out aging programs, services and resources. 

If at all possible, start the caregiving ball rolling with an in-person visit to your parent’s hometown. That gives you a chance to accompany your parent to see his or her primary care provider. You can learn about your parent’s health status, ask questions and streamline and update medications. If your parent has been on the same prescription drugs for years or can’t say why he or she is taking a medication, ask whether the drug is still needed. Your parent’s pharmacist also can evaluate his or her current medications

Meet and talk to neighbors—they represent valuable eyes and ears looking out for your parent’s well-being. Make sure you have their phone numbers and they have yours. To find help with strenuous chores like mowing the lawn or shoveling a snowy sidewalk, Markwood suggests joining a neighborhood listserv. 

Consider Home Care

Companionship services, light housekeeping, meal preparation and help with transfers, hygiene, bathing, dressing and medication-adherence are some of the home care services available to seniors, says Phil Bongiorno, executive director of Home Care Association of America. 

When hiring home health care, especially from a distance, he suggests family members consider the following: Are they going through a referral agency that just places members or a company that has dedicated employees? Will there be a care plan? Is backup care available? Is the company available 24/7 if you need to contact them? Are caregivers licensed and certified according to state requirements? Do they undergo background checks? The issue, Bongiorno says, is accountability. 

You’ll probably have to pay for services out of pocket. Medicare provides limited coverage of home health care that’s necessary for the treatment of illness or injury, such as skilled nursing services by a registered nurse. However, services such as 24-hour-a-day home care, meals delivered to the home, shopping, cleaning and laundry, or personal care like bathing or dressing are generally not covered. 

“We explain, ‘This is not about you losing your independence. It’s about helping you maintain your independence and keeping you safe at home.'”

Jennifer Leeflang, Partners in Care

According to an April 2015 study on regional, private-duty billing rates from a survey done by Home Care Pulse, hourly rates ranged from $21 to $28 for one- to two-hour visits in 2013, the latest year for which data is available. With longer visits, hourly rates drop incrementally. For instance, with care episodes lasting 12 to 24 hours, hourly rates ranged from $17.25 to $21. For live-in care, daily rates ranged from $240 to $315.

If you want to keep your older mother or father in their own home, and their situation is complex, for instance involving dementia, it’s “critical” to arrange care in person, says Stephen Golant, author of Aging in the Right Place (2015) and a University of Florida gerontologist.

“You have to make that one-week trip to interview, very carefully, that caregiver,” Golant says. “You can’t rely, in my opinion, on the home-care-agency approach, where you’re getting someone three or four hours a day. Someone who has early-stage Alzheimer’s more likely needs somebody for 24/7 care.”

Coordinate the Network 

Putting together a network of home and health care providers and other local services—all while keeping lines of communication open—can be complicated, especially from a distance. Care management is one solution, says Jennifer Leeflang, senior vice president for Partners in Care, a subsidiary of the Visiting Nurse Service of New York.

“We send out a registered nurse who completes a comprehensive assessment,” Leeflang says, including evaluating a patient’s medical, psychosocial and environmental status. The provider completes a report and makes recommendations based on individual needs—anything from adding grab bars in the bathroom to having a certified home health aide accompany seniors to adult day care, so they can socialize more.

Services most people might not be aware of include assistance [with] writing checks and paying bills, walking and navigating the city together or even accompanying people to theaters and restaurants. “When the nurse and the aide [go] to visit, we explain, ‘This is not about you losing your independence,'” Leeflang says. “‘It’s about helping you maintain your independence and keeping you safe at home.'”

Online care-coordination sites like Lotsa Helping Hands help families track how someone is doing and improve how members communicate. “Basically, you build a community,” says Jody Gastfriend, a licensed clinical social worker and vice president of senior care at “The community can be family; it can be friends; it can be professional paid caregivers.” It’s a way of being more organized and not duplicating tasks or stepping on one another’s toes.