Uneven Ageing: Supports and levels of care

The Uneven Ageing series concerns the situation where one partner is mostly fit, while the other has a health issue that requires care. This post discusses the supports for both parties, for different situations.

Acute, short-term care

Those caring for a partner or friend who have a short-term issue can look forward to them coming through it. Rising in the night to escort the person to the bathroom, changing a dressing, accompanying them to appointments: that's temporary. The caregiver-partner can become impatient, as weeks stretch into months; often they plan a treat to mark a return to more or less normal life.

Jack's husband, Angelo, had a hip replacement and, hooray, could walk without pain. They booked a trip to Italy, with some celebratory upgrades. Then, the new joint needed an adjustment followed by physiotherapy, and the trip was postponed. Jack, who had been the model of kindness, had been pacing himself toward a June trip that now looked like September—maybe. 

Angelo saw that Jack's impatience wasn't good for anyone, so, post-surgery, he sent Jack on week-long trip to see his friends on Canada's west coast, and booked home health care service for himself. It wasn't Italy, but the break gave Jack the respite he did not realize he needed.

Marc, who had surgery for a kidney ailment, said his best treat was being able to resume the lectures he gave for a local university's continuing education program. He said, "When you're laid up for a while, it doesn't take a trip to Tahiti to make you cherish life again." 

Chronic care

Another type of Uneven Aging involves the fitter partner's support of the partner with a long-term but manageable condition such as diabetes or visual impairment. Constant vigilance becomes embedded in their life. As a couple, they face a loss of freedom—the luxury of being heedless. 

Whether keeping an eye on diet, managing prescriptions, or scheduling tests, the condition is never out of mind. The requirement here is consistency. It's fulfilling to be the superhero in a crisis, but not so rewarding to ride herd on someone who says that carrot cake does not count as carbs, or who insists she can still see well enough to navigate the steps of a steeply-raked theatre balcony. 

Our friends Dr. A. and Mrs. A.

Boredom, apathy, and short tempers are the familiar landmarks of this territory. The partner giving care can usually spot an irritable outburst for what it is—a bad day—but the deeper, more insidious matter of compassion fatigue signals burnout, and requires immediate help from a counsellor or support group. In chronic care situations, professionals advise regular, scheduled breaks, not just when the carer hits bottom. 

Mark is older than Janis by a decade, but she has lupus, and he is a masters' category marathoner. He was embarrassed when he thought he had muted a family Zoom call, and barked at Janis for sloshing tea on the keyboard. Mark's sister called to commiserate, and also sent her daughter, two hours away by train, to cheer up both partners. Their adored niece leavened what had become a tense atmosphere. She told her mother, "Uncle Mark is in a way struggling more than Janis. I'm going to visit every other month."

What else helps? Air out the place, mentally and physically. Borrow the time-tested technique of exhausted parents of young children: get out of the house for a day or more. Seek water, trees, sky.  Even a walk on a river bank revivifies. 

If possible, a companion animal can be another effective support. Dr. A.'s wife, Mrs. A., has middle-stage Alzheimer's. Dr. A., who already owns a mature dog, had wanted a puppy since her retirement a year ago. She said, "At first I was nervous about getting another dog when there is so much to do for A., but playing with Bertie delights and engages her." Bertie is a definite boost to Dr. A.'s morale, too.  

Other assists mentioned by caregivers include playing music (one mentioned Gregorian chant), and tending a garden or house plants. Another uses respite care provided by his wife's extended-care centre to keep a standing coffee date with a friend. 

Marcia bought a subscription series to a dance company, a luxury she decided she deserved. She bought a family plan, so invites a sister or friend. She says having committed to someone else makes her keep her word to have a monthly evening out. 

Palliative care

At no time is the gap between the well partner and the afflicted one more evident, and yet more complex when the goal is comfort rather than recovery.  The wisdom I've received from everyone caring for a partner at the end of life says, Let them lead. Over the summer I saw two friends and their partners make entirely different choices. 

Gerard, who had been ill for over five years, chose a medically-assisted death, for which family and friends knew the date. He asked his wife, Laura, to organize visits, but mostly wanted to sit with her, reading together in a serene natural setting. Two days before the provision, he wished to see only his wife and son, and died holding their hands.

The other couple, Christine and her partner Sam, embarked on a series of two to three-week tours (approved by Sam's health care team). I joined them at a local pub, because our city was one of the destinations, and hoped this last-hurrah effort was as satisfying as they hoped. He complained about the beer, but if it's not his local bitter, Sam will do that. Coached by Chris, I was told not to say goodbye, only "See you later."

Whatever the road to the end of life, the weight on the surviving partner is profound and unmeasurable. I know but one thing: it's important to do your best. We now have more options for end of life care in Quebec, where we now lead the world in per capita rates for medical assistance in dying (MAiD) cases.

When I saw Laura a few days after Gerard's death, she sat across from me, her bare face relaxed after years of effort—she's sad, but is receiving a flow of gratitude from their children, friends and colleagues. But what she cherishes most is his. "Gerard wanted to write me a letter", she said, "though he could manage just one sentence. But it said everything."