LIVE BY DESIGN | The good death debate: Retirement homes vs. family care

Our choices about how, where, and with whom to spend our elderliness are not always straightforward—economics and relationships impact decision-making.

My friend Fifi is trying to identify a carer for her mum, who lives in a rural village. If she were to want to bring her mom to live with her in Johannesburg, currently, there are just too many challenges to navigate. As a single mom without a great support system, she already juggles complex logistics.

I sympathised with my mother’s prejudice towards retirement homes. I have heard these comments in my circle: “I’ve stopped taking nice clothes for my mother to the retirement home. The next time I visit her, they’ve been shrunk in the wash or gone missing.” OR “When my mother died, I realised just how much of her jewellery had gone missing.”

Another acquaintance who moved into a retirement village with her frail husband, who wanted to support for the situation she found herself in, said how hard it was to read the regular death announcements on the notice board.

So Mapi surprised me when we had the time to chat for long hours on holiday. She is saving, she said, so that she can spend her elderliness in a retirement village. She explained that her bottom line is that she does not want to depend on family members for support.

I respect that she has a lot of experience within her own family about how problematic it can be for the younger generation to support an elderly relative financially, emotionally, and health-wise. People with full-time jobs do not have time to transport parents, aunts, and uncles and sit with them in long queues at a clinic. Or they make time, at a cost to themselves and even their performance at work.

I have discovered that, at their best, retirement villages can be fabulous for all concerned. I visited a friend who’s just moved into a bungalow in a high-end village. She is surrounded by her carefully chosen mementoes of a long life. I know her adult children are relieved that she is no longer living alone – especially when they no longer live in the same city. She commented cheerfully, “I have come here to die. I’ve told my children that I want to die here, in my own bed.”

I am not sure whether that last wish will come true. And there might be a better option for all concerned. This is a story recently shared with me.

“We are three siblings, and none of us are living full-time in Johannesburg any longer or are able to have my mother live with us. My mother agreed the family home would be sold, and together with my siblings, we chose a retirement home.

During Covid, many of us put our affairs in order. For my mother, this included completing her Do Not Resuscitate document (DNR).

I was in Cape Town when I got the call that my mother had had a stroke. I got on the first flight I could. When I arrived, my siblings and aunt were with my mother. There was an ambulance parked at reception.

The head nurse asked to speak with me. Your mother’s condition is serious. She has a Do Not Resuscitate order in place. We have the ambulance at the ready to take her to hospital, but we want to know if you want the DNR to prevail?

I responded that I needed to speak alone with my aunt and asked that she be called to join us. My aunt, sad and stoic, said, “It’s bad.” She supported that the DNR should prevail. The ambulance would not be needed. My siblings were angry. They treated me as though I was the witch from hell.

The family took turns entering and out of the retirement home’s high-care nursing room. Management asked to speak with me. “Your mother isn’t going quickly. We have a designated bungalow. If you like, we could move your mother there, and you’ve got two bedrooms available for sleeping over.” It was a godsend to have this space.

And it was true; my mother was taking her time. Death, to us, did not seem imminent. To my lay eyes, there was no sign of deterioration. On the third day, the nurse, taking most responsibility for my mother’s treatment, making sure she was comfortable and free from pain, asked if I would come with her for a walk on the grounds. I went.

“I want you to be ready. You realise that today may be the day.” I looked at her with surprise. “Your mother’s hands and feet are cold. She is wearing socks,” she continued. If you roll down her socks, you’ll notice that her skin is purplish.”

My mother died that day. As a family, we were all ready. It was beautiful. I will be forever grateful for the nursing and the psychological support we received.

This story has challenged some of my assumptions. I assume I would prefer to die at home and find it hard to make the transition to living in a retirement village. I have not considered the support such quality nursing care can offer a family. I am questioning my assumptions, and I am looking at my finances. What might be affordable?

More to come!