1That Phone CallMy mother was excellent at handling her own affairs—until she wasn’t. Even though her health had been bad for a while, it still seemed to happen all at once that she could no longer manage running her household. The call finally came—the one with bad news that changes everything—in the fall of 2022. My mom had a date for a major back operation, and it was sink or swim.
My mom was seventy-six at the time and not old in any way except physically. She was the treasurer of her condo building, which had more than three hundred units and a staff of dozens. She followed politics and pop culture and could keep up with all the drama of four grandchildren on the phone without missing a beat. She texted memes. She never forgot a birthday and could still recite from memory her childhood best friend’s phone number; she had me call Rozanne one day from the car to prove her point. She was that quintessential Jewish grandmother, the Bubbe to everyone, who made amazing chicken soup and brisket and was the keeper of all the old family stories.
She clocked in at about four feet, ten inches tall by that point, down three inches over the years as her spine collapsed. The grandkids liked to take pictures with her in the middle as they towered over her. She kept her silver hair cropped short—she stopped coloring it because she couldn’t lean back to have it washed at the salon. She had kidney issues, congestive heart failure, diabetes, arthritis, and puffy eyelids and then developed some kind of undiagnosed swelling issue after a car accident at the start of the pandemic (which was not her fault, she always pointed out). She used a walker, and even that was hard. She could barely get out of a chair and teetered dangerously once she was up. The summer before the surgery, she ramped up her household help to full-time, which by that time involved a regular daytime caregiver, one at night, and a patchwork of their friends to cover weekends.
Surgery was risky because of all those health problems, but my mom was prepared for a potentially bad outcome. Unlike me, she was never a person who seemed plagued by doubt or anxiety or second-guessing. I preworried, worried as I went, and then hashed over things endlessly after they happened. I wasn’t sure about surgery at all, but I wasn’t in charge yet. My mom said repeatedly that she felt that surgery was worth the risk because it could keep her walking, and that was everything to her. She said she didn’t want to live out the rest of her life in a wheelchair, which sounded defeated and depressed to me—couldn’t she have enough of a life and be with us still?—but it was clear for her: She had lived with pain for so long that she knew what she could tolerate and what she couldn’t.
For years, surgeons had refused to touch her complicated spine, which was like a line of dominoes that kept falling. She already had three back and neck fusion surgeries. That wasn’t because of an accident, but rather some congenital weakness in her discs that toppled them one after another. My grandmother suffered a similar condition and spent the last years of her life wheelchair bound. I had my own first back surgery ten years prior, when I was in my early forties, with my mom sitting by my side. I was fighting against having a second operation while going through the process with my mom.
If my mom could no longer walk at all, she would have to change her living and caregiving situation. She loved her condo in Fort Lauderdale, which had a balcony overlooking the ocean. The building was full of older people, what’s called a naturally occurring retirement community, or NORC. She had a lot of friends, even if some of them had lately turned on each other like a senior citizen version of Mean Girls. If she left, she’d likely have to move to a facility of some sort. Maybe that would entail moving near me in Brooklyn or near my brother in Pennsylvania, and she was unsure if she wanted to do that. She also knew that being immobile would exacerbate the rest of her medical conditions. That simply wasn’t the life she wanted.
Not many people knew how much she struggled behind the scenes. Even the close friends she updated honestly about her health didn’t really know how bad it was to live inside her body all those years. She wasn’t a complainer. You could see pain flash across her face at times, though. And if you were in the house with her, it was hard to miss how much she struggled and yet still pressed forward.
So my brother and I gave our blessing for surgery—reluctantly—because it was her decision. I made plane reservations, shifted my custody time with my two teenage children to my ex-husband, and got my boyfriend to stay at my house with the dog. I braced for whatever would come, but I hated everything about the situation. This time was different from past visits I’d made over the years for medical emergencies. When my dad fell ill eight years prior, I showed up for moral support and to help in whatever way I could. My mom was firmly in charge, and everything functioned normally in the household. In the four years since my dad died, my mom was ill, but none of her hospital stays were long or serious. It was always a day or two here and there. Things always went quickly back to normal, and we put aside our worry.
This time, I was taking charge. Or at least taking half charge. My mom named my brother and me co-trustees and co-proxies on everything. But I had the financial training as a certified financial planner and my day job as a personal finance columnist, so I took the lead on the paperwork and the details. She asked me to come there a few days early before the surgery to hand over control of her bills and whatever else needed to be done around the house, both of us hoping that it would be a temporary assignment. It wasn’t easy on either side, because she was proud and had never needed that kind of help before, and I thought she was superhuman and that I could never live up to handling anything as well as she could.
This call happens differently in every family, but eventually everyone can see that something is wrong. In my case, we had a distinct moment when my mom needed a risky surgery. She had all her faculties at that point, but she needed significant help. My father’s moment came when he had a fall in the summer of 2014 at a pool in New Jersey. What seemed like a scraped knee suddenly turned into a serious heart infection called endocarditis, which in turn caused a stroke. My mom called me from the hospital to come quickly for what we thought were his last moments, and I jumped into the car and drove for two hours. That was the beginning of four years of ups and downs, which fell mostly on my mom to manage as his full-time caregiver, with some help from private aides in the end.
My mom’s father, on the other hand, slipped slowly into dementia, with my grandmother caring for him at home with an aide until finally he went to a nursing home. When my grandmother was on her own, she moved into an assisted living facility and stayed there for the next twelve years, with a full-time aide and my mom and uncle handling her finances, including paying for everything. My father’s parents both died when I was little from illnesses that took them quickly.
Any illness can lead to the need for help from a caregiver, but some of them come with specific known challenges. Cognitive decline and memory issues usually require constant supervision, while with Parkinson’s disease and other neurological disorders you might focus more on safety in the house to prevent falls. Other conditions that often lead to long-term care include cancer, diabetes, heart disease, stroke, arthritis, other musculoskeletal issues, multiple sclerosis, mental illness, and intellectual disabilities. Many of these overlap. My mom didn’t have any of those big ones, but she was still very ill and needed full-time assistance.
Warning Signs by Condition That Help Is NeededDementia
Wandering off
Parkinson’s Tremors or stiff walking
Heart disease
Unusual swelling of legs
Cancer
Fatigue or weight loss
Stroke
Sudden weakness or numbness; loss of vision
Diabetes
Weight loss, frequent urination
Multiple sclerosis
Balance and eyesight issues
Mental illness
Changes in appetite and sleep
Musculoskeletal issues
Falls
Source: National Council on Aging
These conditions also do not affect only the elderly or just your parents. Health issues cross all gender and economic lines. The person you may end up being responsible for could be an extended family member, neighbor, friend, or sibling. They may have long been disabled but outlived their primary caregiver, so you’re next on the list. About 28 percent of older adults are solo agers, according to the United States Census Bureau in 2024, which amounts to about 22 million people. These are people who were never married, previously married, or widowed but who have no other living relatives, and they have to form a community of care around themselves. The LGBTQ+ community, whether married or unmarried, faces some unique challenges, because there may be family estrangements and because laws that protect the right to marriage are constantly in jeopardy.
Copyright © 2025 by Beth Pinsker, CFP®. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
