Caresharlng: Hiding frailty in a Florida retirement community

[This paper was originally published in Health Care for Women International, 19:423439, 1998 and is reprinted here with the kind
permission of the publisher, Taylor & Francis.]

Eleanor Krassen Covan, PhD

Abstract

This paper presents research findings generated from a
study of the structure of a caresharing system for the
elderly who reside in a Florida retirement community
during the last decade of the twentieth century. A
caresharing system is a combination of strategies employed
in order to maximize pleasure and minimize losses that
might otherwise be associated with communal and
individual aging processes. In this instance, the caresharing
system entailed a series of conscious efforts to hide frailty
in the community. Consequences of such caresharing
systems and implications for future retirement communities
are discussed.

Introduction

Many Americans have begun to take notice of
increased life expectancy, but as yet behavioral
expectations for those who survive their seventh decade
are quite varied. They are growing old without models from
previous generations to teach them how to spend their
time. The demographic shift raises sociological questions
both for the aged and the rest of us. What should we do
during this additional life stage? The current cohort of
aging septuagenarians has several choices to make not the
least of which is where to spend this period of their lives.
The gerontological literature reports that most of the
current group of older people has chosen to “ageinplace”,
to live in the communities where they spent most of their
working lives. This paper, however, is about a community
of elders who have opted to change their location by
moving to the sun belt, a region where most people in this
study had vacationed years ago. In their judgment, the
area offers them the greatest probability
of a rewarding golden age, i.e., the opportunity to live life
to the fullest.

A Note on Methods

I am a sociologist as well as the daughter of a resident
of Hollywood Fall 2 , Florida. During the past 15 years I have
made several trips to the community as a visiting
participant observer. A few years ago, funding was
available for a more formal field work experience with
residents of Hollywood Falls. During the summer of 1992,
face-to-face interviews were conducted with residents of
Hollywood Falls, followed up by hundreds of brief
conversations and telephone calls to others who were
involved in their caresharing networks. Since that time I
have continued to visit the community in the dual roles of
daughter and research professor.

Grounded theory data analysis reveals caresharing as a
core variable explaining most community interaction.
Caresharing is a combination of personal and communal
strategies employed by residents of Hollywood Falls in
order to maximize their pleasure and minimize their losses
as they continue the aging process together. I planned to
interview women to learn of their social networks, but
theoretical sampling led me to interview men as well. I
conducted extensive face-to-face interviews with more than
fifty residents, in particular those in leadership positions. In
addition, interviews were conducted with nonresident local
politicians, attorneys, and professional service providers
including those paid by Hollywood Falls Retirement
Community and those paid for by individual residents.
Family members of Hollywood Falls residents including
spouses, siblings, and adult children were added to the
theoretical sample when their input seemed necessary. A
few interviews were also conducted with older people
similar to the Florida population with the exception of
having chosen to age in place.

Historical Setting

Like several other condominium retirement
communities in Florida, Hollywood Falls was planned for a
healthy population of elders. The community was
constructed in the early 1970s. Twenty-six buildings, each
house 36 to 40 individual one-and two-bedroom
condominium units, ranging in size from 900 to 1300
square feet. Lower middle class, married couples in their
early sixties, from the northeast and Midwest areas were in
the marketing population chosen by developers. The
condominiums were affordable to the targeted residents;
they would be easy to manage, and thus they were sold
quickly. Developers either did not anticipate or chose not to
concern themselves with the future needs of this population
as they continued to age. Glossy brochures pictured older
adults in perfect health enjoying the pool, dancing in the
community center, and enjoying a round of golf. In the
early life of the community those who were dissatisfied
were able to resell their units quickly. Most who opted to
remain, were Jews or Italians, attracted by the active
physical lifestyle and the chance to make new friends. The
absence of snow was an added bonus.

Those choosing to relocate to Hollywood Falls found a
country club-like Eden, a place to enjoy their “last hurrah”,
a locus where everyone “lived life to the fullest”.
Respondents report that previously they did not luxury.
Quotes from the interviews include such comments as,

Who would have thought that I could have this now?

Look how busy we are. And we get to do exactly
what we want to do.

You can interview me, but I go for my walk at 6:00;
then I play shuffleboard then I work out at the gym.
If it’s not too windy I’ll be at the pool. You’ll have to
get me after that. Before I never had such things.
There [in New York] I had cold and work and crime
and noise. Here I everything good.

Cohort and period effects governed the lives of
residents earlier in their lives. The two most significant
period effects were the Great Depression and “the War”.
They experienced the former in poverty while in early
adulthood. Many left school at this time, in search of any
source of income. “The War”, of course, was World War II.
Many of the men served in this war. Men and women
experienced personal losses of friends and family, yet this
was also a time to fall in love. Many married hastily and
had their first child. Others birthed baby boomers
immediately following the war. Doing what was expected is
a common theme in their biographies. A few respondents
were self-employed, but the vast majority of men assumed
working class or lower middle class occupations. Most
women stayed home and raised their children, although
most worked at least part-time for some portion of their
married lives. In middle adulthood respondents discussed
working to make ends meet, of sacrificing their own needs
in order to assure better lives for their children, although
they also revealed a tendency to try and acquire the
material markers of the middle class. Their success in these
endeavors perhaps had more to do with the talents of
union negotiators than their individual labors.

Today, many are the beneficiaries of negotiations
conducted by unions. In particular, it is their retirement
pensions and insurance programs that permit them to
enjoy their current life choice. A sizable minority never
owned their own homes before moving to Hollywood Falls
and would not be able to do so without these pensions.
This population seems to have moved through middle
adulthood doing what they felt they had to do, i.e., what
was expected of them. They had little practice for the
choices they faced in retirement, but they seem quite
satisfied having made the move to Hollywood Falls.
Currently, residents believe they are doing well both
socially and financially. They love to show off the grounds
of their community to visitors. They rave of their good
fortune, taking pride in discussing their postretirement
investments and in their daily routines.

Caresharing in an Aging Community

Not only do individuals age, but communities also grow
older. Hollywood Falls is an aging community and its
residents are beginning to notice the changing
demographic characteristics of their community. First,
according to archives kept in the Hollywood Falls
Condominium Association Office, the average age of
residents has increased from 64, when the development
was first sold, to the current age of 80. Second, most of
the original buyers were married couples who had
anticipated several golden years of retirement together.
Now many have been widowed. All but one of the males
whose spouses have died have remarried, although many
of the women are now living alone. Third, residents
describe themselves as less healthy than they were when
they moved to Florida. Many speak of the need to adjust
their lifestyles to limitations they associate with the aging
process.

Often individuals within the community need help to go
about the routines that have become so important to them.
In the past, when individuals became ill and incapacitated,
their problems tended to be impermanent. Residents either
recovered quickly of acute infections or they died suddenly
of circulatory failure. If they experienced periods of
infirmity, they tended to have a spouse help them out
through the illness. The illnesses were considered to be
problems that the couples could handle on their own. As
long as they were reasonably healthy, widows and
widowers also could manage their own illnesses by slowing
down some o f their activities or eliminating them from
their daily routines. Now, however, many people are frailer
at the same time, and individuals find it less feasible to live
with more chronic conditions without some help.

I this context, caresharing emerges as a system of
communal efforts to cope with changing demographic
characteristics in a manner that is helpful. The caresharing
process maximizes pleasure and minimizes loss in the
presence of inevitable social change. The process involves
strategies employed by residents as they attempt to cope
with changes they see as characteristic of their community
as a whole as well as well as changes they see in
themselves and other individuals. Caresharing is thus a
process in which aging residents may become dependent
on others who are also aging and becoming dependent on
them.

Denying Frailty

The Hollywood Falls community had heretofore not
anticipated dependency, and residents appear to be
reluctant to contemplate such a stage of life. As a
consequence, it is ironic that some caresharing strategies
Include very obvious efforts to deny the existence of frailty
in the community. Thus a property of caresharing is the
tendency to avoid reminders of frailty by masking signs of
infirmity whenever possible. This is becoming increasingly
difficult as today, a walk through the community means
that one will encounter several reminders of morbidity,
such as ambulance sirens, wheelchairs and walkers, and
personal care assistants on one’s route, even though
residents go out of their way to avoid such reminders. The
absence of medical services is indicative of how important
it is to minimize reminders of frailty. If recognized as such,
medical services would be inconsistent with a healthy
population. Other than periodic blood pressure and
cholesterol screenings, Hollywood Falls does not offer
medical services on the premises. A few years ago the
condominium board discussed promulgating rules
prohibiting nurses from living with residents. Sometimes
residents redefine medical treatments as “health
maintenance behavior” and avoid confronting frailties in
themselves or their neighbors. Thus massages are
performed by physical therapists at Hollywood Falls.
“Taking a massage” is encouraged and even viewed as an
expensive treat, while receiving physical therapy for
arthritis is not acceptable on the premises. Similarly cardiac
rehabilitation often involves physical workouts using
exercise equipment available in the weight room, but in
discussions residents redefine this cardiac rehabilitation as
an “exercise workout”.

Keeping busy training in several of the planned
activities is one rather obvious strategy to avoid reminders
of frailty. Many of these activities involve what I refer to as
stamina displays, physical and emotional dramatizations of
stamina when in the presence of others. The range of
planned activities involving physical stamina displays is
enormous: residents rehearse and perform Broadway
shows, they play golf, tennis, shuffleboard, and bocci ball,
they attend classes in line dancing, aerobics, and weight
training. Of course they can swim in the Olympic size pool.
There are less physically strenuous activities which instead
stimulate the mind, such as classes in Yiddish, ceramics,
acting, and singing. Then there are card games such as
pinochle, poker, and bridge and there are tile games such
as mahjong and rummy cube. They can also check out
books from the library, etc. The community also boasts of
its nightly entertainment – movies, dances, Borscht Belt
comedy groups, and its ethnic clubs – Jewish Men’ s Club
and Hadassah, the Italian American Club, and so on. In
addition to the activities sponsored on the grounds of
Hollywood Falls, five community papers, free to residents,
describe activities going on in the neighborhoods
surrounding the development. One favored activity is
eating out at one of the numerous cafes that serve 99-cent
breakfasts, $3 lunches, or $7 early bird dinner specials for
elderly diners. Upon settling in Hollywood Falls these
activities were engaged in for their intrinsic value. Today,
extrinsic enjoyment is also evident. Participation in the
activities is a symbol to others in the community that
residents are still capable of stamina displays.

Residents share responsibility of assuring that their
neighbors participate in stamina displays. Residents are all
encouraged to show off their stamina. Each resident
participating becomes a healthy role model for others as
stamina displays are performed. As encounters with
reminders of death and frailty become more frequent,
strategies to maintain an identity as one having stamina
may intensify. The strategies may include engaging in
comparative benchmarks with one’s neighbors. Residents
compare themselves with others around them especially
with regard to personal limitations, in order to convince
themselves that they are still capable of physical or mental
exertion. Physical stamina may be shown by walking a
given distance every day in the company of others. Mental
acuity can be demonstrated by completing a crossword
puzzle. Like other such acts, these are defined by residents
as preventive exercises, as well as displays of potency.
Survival itself, when neighbors have died, offers a
fundamental benchmark. On the occasion of a neighbor’s
death one may inherit property of the deceased when such
property has been used for stamina displays. One woman
likes to play golf thus mentioned her several sets of golf
clubs, boasting, “They’re mine now as several people have
died around here.” Being medically better off than one’s
neighbors is also an identity benchmark, motivating one to
do more and more to recover if one does happen to
experience a health setback. Thus, although residents
engage in some rather spirited competition in their stamina
displays, the competition often encourages others whose
stamina is impaired. One neighbor may choose to help
another partly because the ability to help another then
becomes a stamina display, an indicator that one is better
off. It is ironic that receiving help can also demonstrate
stamina if one has the opportunity to show off making
one’s own decisions about the help accepted. Thus if one’s
physical health deteriorates, neighbors may form
caresharing alliances with others. They may continue to
perform mental stamina displays if they are able to retain
autonomy over the conditions in which help is accepted.
Even the frailest of residents is capable of stamina displays
some of the time, and thus stamina displays seem to be
mandatory at Hollywood Falls. Neither acute nor chronic
ailments excuse one from their performance. Thus they
may display mental stamina in preparing their living wills
and in preplanning their own funerals. Finally, even those
who have died are often eulogized in terms of stamina
displays.

Caresharing Arrangements

In response to the aging of the Hollywood Falls
community, people do the best that they can to maximize
their pleasure and live life to the fullest. Individuals and
groups share the responsibility of maintaining the stamina
of the community. When problems do occur, caresharing
occurs in a variety of arrangements. These are described
below in order of the residents’ preferences.

Managing Self

It is not surprising that those living in Hollywood Falls
spoke commonly of asking no one for help if they could
manage on their own. Independence from family and early
adult friendships had in the past distinguished Hollywood
Falls residents from their peers who age in place. Deciding
to manage on one’s own results in an autonomous
caresharing arrangement of a single individual who cares
for him/herself. At times managing alone means stockpiling
food by one’s favorite chair or bedside, crawling to the
toilet or positioning oneself so that a makeshift potty is
available. One resident reported using a recycled three
pound coffee can for such purposes. Managing alone can
also involve just plain waiting out the pain that one is
experiencing. More often, managing means not asking for
help until it is offered. Not needing to ask for help is an
indication to residents that they are doing as much as they
can for themselves, and thus not asking help is an indicator
of stamina. Even those residents who are fortunate to live
with a spouse request help as infrequently as possible.

Couple Alliances

As Hollywood Falls was designed as a retirement
village for healthy couples, it is not surprising that couple
alliances are the preferred caresharing network. A couple
alliance consists of a man and a woman who are living
together and who are committed to cooperating with each
other so that both parties in the relationship can enjoy the
best possible life, consistent with their shared values. Most
commonly, couple alliances consist of a wife and her
husband, although a few couples have formed alliances
with persons to whom they were not married. When one
member of the couple experiences a problem, the other
considers it his or her responsibility to help out. While
much of the literature on caregiving reports an
overwhelming preponderance of female caregivers and
different styles of caregiving for men and women (see, for
example, Brody, Kleban, Johnson, Hoffman, and
Schoonover, 1987), at Hollywood Falls couple alliances
reflect a more equal distribution of caregiving and care
receiving on the basis of gender. Although women at
Hollywood Falls tend to outlive their husbands and many
widows had nursed husbands before they died, surviving
couples included as many healthy men as they did women.
Perhaps this is due to selection. Obviously, it is the
healthiest of men who do survive. Many healthy men have
survived into old age with wives who are also healthy.
These couples fare very well in long-standing couple
alliances at Hollywood Falls. Those males whose early
partners were less healthy than they, might become
widowers, but a widowed male finds no shortage of women
to remarry. At Hollywood Falls, there were no healthy men
who were not in long-standing or reconstituted couple
alliances. I was quite surprised to find so many women
receiving help from their mates, leading me to wonder
whether my generation would be so fortunate.

Consider the case of Mr. and Mrs. Nathanson, a Jewish
couple who have been residents of Hollywood Falls since
1975. In 1992, he was 81 and she was 77 years old. Mr.
Nathanson has emphysema. He admits that he has been
smoking for more than 60 years. Mrs. Nathanson has
Alzheimer’s disease. Although Mr. Nathanson is himself not
very well, he is his wife’s primary caretaker. They often
take long walks together, a pattern of activity they began
some years ago when Mrs. Nathanson felt the walks would
help Mr. Nathanson’s emphysema. Mrs. Nathanson has on
occasion soiled herself when out for such walks and when
in other public places such as the supermarket with her
husband. Mr. Nathanson states that he doesn’t mind his
wife’s incontinence when they are alone. He diapers her
when he believes it to be necessary, but he is embarrassed
by public “accidents” and does what he can to hide them
from others. Mr. Nathanson stated that he is soon planning
to go to a nursing home. He and his wife “must go
together”. He would not consider sending her alone and
remaining in the condominium himself. Their son, who
lives in Detroit, Michigan, has found a nursing home there
that the son feels is suitable. Mr. Nathanson had partially
completed the entrance application at the time I met him.
He reported, however, “I am less sure that it’s the right
place for us. I am checking out other nursing homes right
here in Florida where I feel more at home”. Note the
importance of autonomy in Mr. Nathanson’s decision-making
style.

Mr. and Mrs. Singer, each of whom are in their late
seventies, are also in a couple alliance. Until recently Mrs.
Singer considered herself to be very healthy. She had
found employment after moving to Hollywood Falls. She
reported that she had “never even thought about health
problems, but some problems I must have had caught up
with me”. She didn’t, at first, want to talk about her
health, but then she couldn’t be quieted. She has been
treated for two separate cancers with both surgery and
radiation treatments. Doctors state that both cancers have
been arrested, but she doesn’t feel well and she expected
to have more tests at the time she was interviewed. She
was obviously afraid that the tests would reveal a
recurrence of cancer. Mr. Singer has been Mrs. Singer’s
caregiver. She turned down the help of professional nurse s
whose salaries could have been paid for by the couples’
private health insurance policy. Mr. Singer was reluctant to
talk about his help. He did say, “I take care of her because
I am expected to; I won’t consider doing otherwise”.
Neighbors say that it is very hard for him as she is
sometimes hard to get along with. He complains, in jest,
about how difficult it is (“She’ s an old battleaxe”, he says),
and then he carries on. Mr. Singer is a U.S. Navy veteran
and currently reports that he is healthy, although he has
had two heart attacks. Mr. Singer embraces the role as
caretaker and stated, “There is really nothing to talk about
concerning it. Professional help would be our absolutely last
resort!” “Friends and neighbors can’t help with this kind of
problem, either,” added Mrs. Singer.

I cannot overestimate the amount or importance of
caresharing present in couple alliances. Partners often
cleaned up one another’s bodily wastes. They assisted with
the management of colostomies and catheters. They
assumed all household chores at times and “maintained
face” for one another at Hollywood Falls community events.
Nevertheless when interviewed about caregiving burden,
little if any of such burden was discussed. Most mates
simply consider it their responsibility to help one another.
Charmaz (1993) has discussed the implications of
camouflaging caretaker burden noting that unquestioned
obligation can be a way of refuting suspicions that one’s
mate is dying; it relieves one’s fears about self-care after a
mate dies, and it may protect a spouse’s self-image as he
or she is able to do progressively less. My Hollywood Falls
interviews reveal that the community’s image as a whole is
similarly protected by unquestioned instances of
caregiving.

Camouflaging the burden of caregiving is, perhaps, to
be expected among those who were fortunate enough to
survive in relationships which encompassed 50 or more
years in marriage. Caring for a mate is perhaps more
surprising when found in more recently established couple
alliances. Mr. Butello, a widower, has been living with his
friend, Marie, to whom he is not married, for the past
seven years. The couple are both about 70 years of age.
Mr. Butello reported that Marie got sick recently with
diabetic and heart problems. He ascribed his situation with
Marie:

Before she got sick we were equally healthy and
equally under the weather. When Marie got sick I
had no legal ties to her and it was a real problem.
We’re Italian and these things aren’t supposed to
happen. Her daughter just came and got her and
took her to Illinois. For one month I didn’t call, and
then I went to Illinois and tried to stay with her and
her family, but they wouldn’t let me be with her and
I had to come home. Now she is a bit better and she
has come back to me and I can care for her and she
can help me again.

In another conversation Mr. Butello described getting
to know Marie, following his hernia operation, and told me
that Marie had volunteered her services as his caretaker
because he lived alone.

Couple alliances obviously work best when partners are
not too needy at the same time. For example, consider Moe
and Lil Green. When Moe required heart surgery several
years ago, Lil reported doing just about everything for him.
She bathed him, dressed him, fed him, and read to him. “I
did whatever was necessary”, she said. Moe reports, “She
loved, loved, loved me till I got well”. More recently, Lil was
hospitalized with cancer of the esophagus. When she came
home, Mel said, “It was my turn. I took over the cooking,
shopping, dressing, bathing, and processing food for and
then feeding Lil”. The couple has been able thus far to
manage their care by themselves.

But Mr. and Mrs. Nathanson, discussed above, had to
call on their sons some time ago when Mr. Nathanson
became ill, experiencing a weight loss and difficulty
breathing. His sons came to help, first together and then
one at a time, but Mr. Nathanson hated to call them. “In
the past my wife would have cared for me”, he said, “but
now” Mr. Nathanson was too overwhelmed with emotion to
finish his thought.

Informal Caresharing Networks

The residents of Hollywood Falls have established
informal caresharing networks which include themselves
and friends and neighbors at Hollywood Falls. Such
networks range in size from small groups of widows to
larger groups which include some who are also in couple
alliances. As noted above, members in caresharing
networks help to assure that their neighbors participate in
stamina displays. Friends may arrange dates to engage in
stamina activities together. Thus Harry and Izzy call on one
another every morning to share a health maintenance
walk. When Harry had open heart surgery a few years ago
Izzy visited daily, encouraging Harry in his exercises and
reminding him that Izzy needed Harry to complete his own
health routine. Later when Izzy took a fall and could not
walk, Harry provided Izzy the same kind of
encouragement. Other caresharing dates involve
recreational activities such as shopping and dining out or
games of shuffleboard. Thus when Herb, a shuffleboard
regular, was recovering from a stroke, his teammates took
turns driving him to the clubhouse so he could
practice. “We’re grateful for whatever he does even if he
doesn’t play so good”, said Henry. “At least he plays, and
he can only get better. Without him, we don’ t play either”.

Mrs. Trilling is an 85-year-old widow who lives alone in
her Hollywood Falls one-bedroom condominium. She would
probably not be able to remain at Hollywood Falls were it
not for her caresharing network. Mrs. Trilling moved to
Hollywood Falls in 1977 with her spouse who had recently
retired. Although the spouse was not ill at the time of the
move, he died two years later.

Mrs. Trilling today relies more on friends and neighbors
in Hollywood Falls than she does on her family. “Neighbors
take me to the doctor, shopping, and the library”, she
admitted. Neighbors indicate that they do quite a lot for
her. About her experience recently when she broke her
ankle as the result of a fall and then fell again a neighbor
said, “I accompanied her to the hospital and remained with
her into the wee hours of the night until she was released”.

Mrs. Trilling stated that although she lived in the
community for many years (she’s one of the oldest
residents), she relies on only a few people. Mrs. Trilling
said she relies on herself the most in response to the
question, “On whom do you rely the most if you need
help?” She describes herself as a loner who enjoys life that
way. She says, “My favorite activity is reading and I am
willing to ask friends and neighbors to take me to the
library [about 2 miles from the condominium] when they’re
going anyway”. She also plays canasta with her friends.
Her case shows the limits of informal caresharing networks.

Neighors say that because of her personality it is hard
to want to help her. She is described by many as “not a
very nice person”. They also say, however, that in earlier
years Mrs. Trilling was one of those who always helped
others, taking them to the doctor or shopping and so forth,
and one or two who help her say she deserves to be paid
back for what she used to do for others, even though she is
mean and demanding today. It is interesting that
caresharing paybacks are not performed by residents who
Mrs. Trilling helped but by others in the community who
perhaps recognize that if they help others they may one
day receive help themselves.

Hollywood Falls as a Community Caresharing
Network

That the community as a whole functions as a
caresharing network is evident in the caresharing
leadership positions that have emerged at Hollywood Falls.
The community structure includes three condominiumassociation
boards of directors and one Hollywood Falls
recreation board. In addition, each of the 26 separate
buildings has a building captain. The condominium boards
have several responsibilities: assuring that all residents are
treated fairly, assuring that the grounds around the
condominiums are adequately maintained, and, perhaps
most important, lobbying local government officials
concerning the needs of Hollywood Falls residents. It took
several years, but the condominium boards credit
themselves with regard to the local community’ s decision
to provide “retrofitted” public transportation linking
Hollywood Falls residents with amenities offered in
neighboring communities. The recreation board is
responsible for maintaining most of the physical stamina
equipment (the pool, weight room, stage, piano,
auditoriums, card rooms, and so on). This board also
schedules entertainment (“living life to the max” events).
Service on caresharing boards brings a fair amount of
prestige within the Hollywood Falls community. 3 There is no
obvious difference in prestige between the two kinds of
board memberships.

The building captains have several responsibilities
concerning the maintenance of common areas immediately
surrounding the condominium residents. They are also
called upon to admit repair persons when residents are out
of town. Sometimes they deal with other caresharing
problems as well. Their status as captains may encourage
neighbors to call upon them for more personal problems.
Often they must resolve disputes that arise between
residents in their specific building. In one instance a
building captain was asked to intervene after a resident
had experienced what his neighbors called a “nervous
breakdown”. Mr. Lewis, who had at one time or another
owned three or four different condominiums at Hollywood
Falls, began to behave bizarrely after his spouse died
suddenly in her sleep. He appeared to be disoriented, and
after a few months he became uninterested in grooming;
he was described by neighbors as unwilling to take a bath.
A female neighbor called the police one evening after Mr.
Lewis had entered her apartment without knocking.
Eventually, the building captain researched Mr. Lewis’
family connections. Finding no immediate relatives, he
contacted various social service agencies until he convinced
a representative of the State of Florida to appoint a
guardian who then moved Mr. Lewis to another residence
where he could receive needs.

Sometimes a building captain must intervene when
efforts to ignore caretaker burdens get out of hand. Mr.
Pearl had been caring for his wife who had Alzheimer’s
disease for some time. Mrs. Pearl was becoming more and
more disoriented, but most residents of Hollywood Falls
noticed only that Mrs. Pearl was still displaying stamina, as
she took long walks through the grounds with her husband.
One night Mr. Pearl telephoned his captain in anguish. He
begged the captain for help because he had
attempted to smother his wife with a bed pillow. The
building captain went immediately to Mr. Pearl’s apartment
and discovered that Mrs. Pearl was still alive. Together Mr.
Pearl and his captain called 911. The police arrested Mr.
Pearl, and the rescue squad took Mrs. Pearl to the
police station where she was able to convince the officers
to release Mr. Pearl. Although similar cases have been
publicized in Florida, this incident never received media
attention. According to the building captain, only he and
Mr. Pearl know the events immediately preceding Mrs.
Pearl’s hospitalization.

Professional Service Networks

Some residents of Hollywood Falls establish
professional caresharing networks when informal alliances
are not successful. Mr. and Mrs. Cramer, approximately 70
years old, are each hard of hearing and suffer from speech
impediments. Mrs. Cramer has several ailments that are
aggravated by a long-term diabetic condition. This year she
underwent a quintuple bypass and vascular surgery in her
leg. She and her husband agree that she is “not a good
patient”. She doesn’t do what her doctors tell her to do.
The Cramers state that none of their neighbors help them.
They have excellent insurance, however. Currently both a
physical therapist and a nurse come three times a week to
help Mrs. Cramer. These services are covered by Blue
Cross and Medicare. Asked who would help them if Mrs.
Cramer became incapacitated, Mr. Cramer stated, “She is
hard to get along with and doesn’t socialize well. She would
have to go to a nursing home”. He quickly added that, “So
far, we can take care of each other without the interference
of our children or anyone else”.

It is very important to the Cramers that they decide
when they need help and when to le the help go. An
additional area of concern is affecting the Cramers at this
time. Mr. Cramer’s mother is still alive at the age of 96.
She currently lives in New York City with her sister who is
also more than 90 years old. They have discussed moving
together to a retirement community that offers continuing
care, but, according to the Cramers, “the time for that has
not yet come”. The sisters rely on a daughter to take them
shopping. Mr. Cramer explained that he and his wife have
considered moving back to the New York area so he could
help his sister assist his mother, but then he would be
caring for both his wife and his mother, which might be too
difficult. He stated that he and his wife have made their
home in Florida and intend to stay there.

Professional networks may require choosing among
professional services for which one must pay and those
which are community entitlements. To Hollywood Falls
residents, autonomy is valued even more than money.
Several whom I interviewed told me that they must control
who will help them and when help will be dismissed. At
times, maintaining control over help is more important than
whether or not they have to pay for services.

Networks Including Adult Children

Adult children of residents of Hollywood Falls expect
that one day their parents may turn to them for help if they
should become incapacitated, but Hollywood Falls residents
show great reluctance to accept such offers of help. I asked
Mrs. Trilling, mentioned above, if she considered asking her
daughter to come and help her for awhile when she broke
her ankle. Her reply was, “Absolutely not. My daughter is
60 years old. She works for National Geographic. I don’t
want or need to bother her with something so insignificant”.
“ If I need help I prefer to call someone in [rather] than
to have my daughter come”.

Several conditions may lead to the rejection of adult
children as caretakers on either a short-term or permanent
basis. First, as in the case of Mrs. Trilling, the elderly may
not wish to interfere in their children’s lives or to burden
them. Second, older persons and their adult children and
grandchildren may have established lifestyles that are
incompatible. Mr. and Mrs. Green went so far as to decide
not to tell their children of Mr. Green’s bypass surgery until
he was well on the way to recovery. Mrs. Green said that if
she couldn’t have handled the caretaking she would have
hired a nurse before asking her children for help. Mrs.
Green said, “It would have been more stressful for him to
have the children underfoot and having to worry about
their worrying about him and what the [grandchildren]
were going to get into”.

Third, older persons may be somewhat estranged from
their adult children. The elders who migrated from the
Northeast to southern Florida have chosen a lifestyle
physically and socially removed from that of their adult
children. Migration is not the modal life choice for the
current cohort of older people. The migration choice may
indicate that this particular group of retirees is somewhat
more socially, psychologically, and physically removed from
their adult children than is the group of elders who age in
place. In lower middle class Jewish American and Italian
American families, prestige in old age is commonly
associated with the accomplishments of one’s children.
These accomplishments come from the acquisition of
wealth, success through prestigious career choices,
marrying well, investing intelligently, and so forth. It is
therefore relevant to note that many in this sample had
become displeased with one or more of their children
before choosing to move to Hollywood Falls. Some of this
displeasure developed as their children moved into
adulthood, disappointing their parents perhaps in marriage
(by choosing the wrong partner or no partner at all), in
reproductive decisions (by choosing to have too many or
too few children or in raising them in a manner inconsistent
with the elders’ beliefs or values), choosing the “wrong”
occupation – one that did not lead to wealth or that led to
unemployment, and so on. In other instances it is the
elders who disappointed their children by beginning second
marriages that threatened the children’s potential
inheritance. Such estrangement not only has an economic
impact, but it also means that each generation is unfamiliar
with the other’s lifestyle.

A fourth reason for rejecting their adult children as
caretakers may be that the elders know their children well
enough to be certain that the adult children would not
approve of the psychosexual or recreational habits elders.
The elders’ behaviors may be inconsistent with their
children’s views of who their parents are. This was
especially apparent for those in couple alliances who were
not married to their mates.

Fifth, choosing one’ s adult child as a caretaker usually
requires leaving the community of Hollywood Falls and thus
separating from one’ s friends. Sixth, adult children may be
rejected simply because the act of depending on one’s
children is likely to trigger a “mortality alarm” not only for
the individual involved but for the entire Hollywood Falls
community. Being dependent is viewed as unfortunate, but
being dependent on one’s children is an indicator that at
least for one individual, stamina is gone forever. It is a sad
day for the entire community when a resident is taken
away, to be cared for by his or her adult children. For this
population, choosing one’s adult children as caretakers
could require that one relinquish autonomy over one’s
physical, recreational, sexual, and economic resources and
choosing to rely on some with whom one has had an
uneasy past.

When Community Networks Fail

Unfortunately, communal caresharing networks do not
always succeed. Residents die and others require care that
they reject or that the community simply cannot provide.
Spousal alliances break down when both spouses are infirm
simultaneously. Other residents require “continuous
coverage” 4 caresharing as they become totally dependent
on neighbors who are struggling to care for themselves.
For limited periods of time, informal networks can provide
continuous coverage, but neighbors tend to give up after
four or five weeks of caring for those who are totally
dependent and who seem to have little or no potential of
recovering their stamina. When a resident realizes that
informal systems will not function independently, a choice
between two last resorts must be made. The choices are
really more varied but tend to be articulated as the choice
between professional services such as those found in a
nursing home or choosing an adult child as caretaker.

For these persons, the country club lifestyle is no
longer ideal even though most want to stay well beyond
their initial period of total dependence. The fact that so
many are troubled simultaneously makes stamina displays
march harder for individuals in the community. Strategies
formerly engaged in to maintain their lifestyle do not
always work. New strategies are more centered on
caresharing than on recreation. The biggest problem is that
although Hollywood Falls in its entirety is a caresharing
community, it lacks one essential ingredient of a vibrant
community. Members are often unable to replace
themselves with healthier residents who could help care for
others in the community. As members age and some die, it
has become difficult to resell condominiums in recent
years. At least four conditions contribute to the vacancy
rate. First, many more condominium units have been built
in southeast Florida during the past 20 years. The supply of
such apartments far exceeds the demand. Second, retirees
who migrate to Florida today can purchase a brand new
condominium in a retirement community for less money
than it cost to buy one in Hollywood Falls 15 years ago. The
price of new units is also competitive with that of existing
units at Hollywood Falls. Third, new developments are
again being planned and marketed to a healthy “young old”
population. When the recently retired are choosing a home,
one reason they may reject Hollywood Falls is that the age
group they see at Hollywood Falls is considerably older and
frailer than they consider themselves to be, which, in fact,
is the case. Fourth, although there are many young families
in need of housing, Hollywood Falls and other retirement
communities in southeast Florida have developed their own
policies limiting the sale of condominiums in retirement
communities to persons over the age of 55. Without such a
policy it is conceivable that some younger people might
purchase an apartment and eventually enter the
caresharing networks, but this possibility is prohibited by
the community itself. Although this policy clearly
discriminates on the basis of age, and although younger
people might help the community to remain viable, the
policy ironically has held up in federal court.

Without a change of course one might predict that
Hollywood Falls will experience a relentless aging of
residents who will all succumb to death in 10 or 15 years.
Condominium boards, in their efforts to camouflage
caregiver burden, may lose sight of the real social problem
the community faces. If they exercise their minds as they
did recently on mundane problems such as how to hide
trash bins behind arbors, they may not discover in time
that the grounds can be restored much easier than can the
people. Although today most residents still enjoy the
country club, taking care of themselves quite well, and
although others can rely on functional caresharing
networks, it won’t be very long before Hollywood Falls will
need a major social structural overhaul. All the cooperation
of others in hiding frailty won’t be able to hide the fact that
a community of 85-year-old widows has different needs
than does a community of younger couples.

Note

This research was partially supported by a College of Arts
and Sciences, Faculty Summer Initiative Grant, University
of North Carolina, Wilmington, Summer 1992. An earlier
version of this paper was presented at the 1993 North
American Congress on Women’ s Health Issues, Toronto,
Ontario, Canada.

2. Hollywood Falls is a pseudonym I created to describe a retirement
community in southeast
Florida.

3. Union involvement at an earlier stage of life might prepare one for a
position caresharing leadership at Hollywood Falls. Indeed, any earlier
involvement in activities that celebrate the importance of community is
likely to prepare one for leadership roles in Hollywood Falls. Several
caresharing leaders were very committed to fund-raising
activities for their religious or ethnic communities.

4. Ralph and Maureen La Rossa explain continuous coverage systems in
their discussion of infant care in America. Caregivers must be on duty 24
hours each day, as someone must be available to the person needing care
constantly (see La Rossa and La Rossa, 1984).

Author

Eleanor Krassen Covan, Ph.D.
Director of Gerontology and Professor of Sociology
Department of Health and Applied Human Sciences
University of North at Wilmington
601 South College Road
Wilmington, NC 284033297, USA
Email: covane@uncw.edu

References

Brody, E., Kleban, M. H., Johnson, P. T., Hoffman,
C., & Schoonover, C. B. (1987). Work status and parent
care: A comparison of four groups of women. The
Gerontologist, 26, 273±381.

Charmaz, K. C. (1993). Shouldering the burden. In
B. Glaser (Ed.) Examples of Grounded Theory, pp. 6785.
Mill Valley, CA: Sociology Press.

La Rossa, R., & La Rossa, M. (1984). Transition to
parenthood. Beverly Hills, CA:SAGE Publications.