DURHAM Clydie Pugh-Myers, one of the states first black licensed practical nurses, once drove a red Cadillac around Durham, sang in the choir at her church, and generally stayed busy.
These days, living with two knee replacements, chronic obstructive pulmonary disease and other ailments, she can no longer drive and sits at home alone a lot. She says even people from her church dont come to see her much.
Since Ive gotten 84, its gotten tough, Pugh-Myers said in her South Durham home.
Like Pugh-Myers, roughly three out of 10 North Carolinians older than 65 live alone, as do 12 million people nationally. As the states over-65 population reaches a million, the percentage and raw numbers of older people living alone will also increase, the result of the flood of baby boomers, many of whom have divorced, never married or will outlive spouses.
Researchers at the Washington, D.C.-based AARP Foundation have pinpointed social isolation as a factor, along with housing, income and hunger, that can lead to catastrophe for older people. Stacks of medical studies tie living alone to increased rates of physical and mental illness, another indication that rising Medicare costs will be even tougher to contain.
Faced with the alternative of long-term care, most older people prefer to live alone, but its not easy and there are emotional and physical risks. The keys to successful aging in community involve support from family and sometimes government, advocacy in health care, keeping up mobility, access to transportation and social involvement.
For example, Pugh-Myers has a background in health care and help from family and government-paid caregivers to protect her from some of the worst consequences of living alone.
I stay alone so far, she said. Its a tough life, but Gods good. Ive got two or three friends. When I was working, I had a whole lot of friends.
Daniel Rodriquez, 87, in North Raleigh, has family members living nearby who check on him daily, and family in his native Puerto Rico he talks with regularly.
Martha Driver, 85, of Garner, also has supportive family and a deep religious faith.
Professionals who work with older people say they need either to have strong advocates for them in dealing with health care and other vital matters. Or, like Clydie Pugh-Myers, an older person can speak up for herself, as she felt compelled to do during a recent hospital visit.
I said, What kind of antibiotic am I on? Ive been on that long enough I would change that, she said. Everything I told them to do, they did it, and I got better.
Thin network of care
The guardianship files on the 11th floor of the Wake County Courthouse are checkered with older people for whom the system didnt work until a crisis arose and the countys Adult Protective Services stepped in.
A 61-year-old Cary man was living alone in June 2011 when he came to the attention of Wake Adult Protective Services after a fall. The stark tale of his struggles with mental illness and substance abuse emerge in his file.
Exam by physician found patient to be disheveled, appears homeless, non-compliant with medications and prolonged alcohol abuse, referred to neurology and psychiatry for patients ability to make decisions, a WakeMed Cary emergency department doctor wrote in admission documents.
A psychiatric examination found the man had memory impairment, poor attention and concentration and could not remember conversations from the previous day.
He has a brother who reportedly takes care of him, but it does not appear the brother is able to take care of the patient and prevent injury, the hospital report said. After a psychiatric evaluation, the man had a guardian appointed and was placed in a Harnett County assisted-living home for safekeeping.
Conditions can turn grim for older people in a society where people are living longer, husbands usually die before wives, relatives arent always nearby and social services are shrinking relative to the growing number of aging baby boomers.
They have no children. Their siblings have died, said Alan Winstead, executive director of Meals on Wheels of Wake County. And they are alone.
Myers, Driver and Rodriquez each get visits from Meals on Wheels or in-home caregivers, part of a set of state, local and federal services that are mostly maxed out and face static or decreasing funding. Federal sequestration cuts have trimmed $1.9 million this year from North Carolina counties ability to offer this help. Meals on Wheels of Wake County, for example, will serve 12,000 fewer meals this year because of sequestration cuts.
Gov. Pat McCrorys budget calls for no increase for such services, despite waiting lists of more than 13,000 people statewide.
I used to have a good time
Daniel Rodriquez is one of the more fortunate solo seniors, practicing what experts call aging in community. He lives alone in North Raleigh and no longer drives, but remains close to family, with one daughter in the same apartment complex. Rodriquez spent his career as a plant manager in New England, then came to North Carolina after his adult children moved here.
My daughter comes every day, Rodriquez said. Ive got another one in Wake Forest; she comes every Saturday.
For daughter Lydia Menzel, 57, the weekly trip from Wake Forest is a Saturday reward as well as a chance to fix food and prepare medication for Rodriquez.
Im finding it to be a blessing, Menzel said. Its great every week.
For exercise, Rodriquez takes his dog, constant companion Tess, out for a walk three or four times a day. He used to go to church, but doesnt go as often now because it involves a trip to Wake Forest. Neatly dressed in jeans, a flannel shirt and flip-flops, he spends much of the day in his tidy apartment thinking of his late wife, Rosa, who died in August 2011 at 83.
Since my wife died, Ive been with the feelings that I would like God to take care of me, Rodriquez said. Ive got friends here, but not friends too close. Not like I had when I was working.
Its a lot different. Its kind of tough.
Rodriquez has a colorful life to reflect on he spent his teen years in Puerto Rico, then moved to New York City in the 1940s. Before he started climbing the ladder to success in manufacturing, he got a job making brushes for 75 cents a day.
I used to have a good time, he said of his days working and partying in lower Manhattan, then raising a family. Now I am suffering myself a little. Sometimes I think I am getting my daughters to work a little bit too much.
I ask God to let me be with him and stop this type of life.
A new normal
Rodriquez used to supervise dozens of workers in factories. Clydie Pugh-Myers led a crowded life between her family, work in hospitals, in private-duty nursing and in church.
Martha Driver, 85, worked for BellSouth until she was 65, then stayed on past the typical retirement date because the company needed her. Many of todays older seniors have rich lives to remember, but may lack the resources, ability or will get out of the house to shop or see friends and family.
I think its up to the person how involved you want to be with activities, Driver said. I havent been able to go to church in a little over a year.
I did real well until the last year and a half. I had double pneumonia and had side effects from that. It seems like I dont have the same energy I did.
Like Rodriquez and Pugh-Myers, Driver has strong religious faith. But like many people living alone, she sometimes finds it hard to keep an even keel. The fatal shooting of 20 children in Newtown, Conn., came as a particular shock, she said.
There are ways that older people living alone can reduce the harmful effects that this life situation can bring. But they often require changes in lifelong habits, acceptance of new ways of doing things and higher levels of dependence.
Use it or lose it
Although Raleigh, Durham and Garner all have senior centers, older people need the will as well as the means to get to the activities.
If you dont stay active, you start losing your ability to be active, said Winstead, with Meals on Wheels of Wake County.
The agency serves thousands of residents daily, both with home visits and at senior centers or other sites where dozens of seniors can dine and talk together. Meals on Wheels is largely funded through home and community-care block grants.
If youre going to a congregate meal site, you get to do a few activities with your new friends, Winstead said. Its very simple if youre at your apartment to say, Nah, I dont feel like it.
Dan Blazer, a Duke University psychiatrist, said the proximity of other people, particularly a spouse, is typically a sign that an older person will be healthier, physically and emotionally.
Often you need somebody there to say, Did you take your pills tonight? he said. When a spouse dies, with men especially, their mortality increases in the year after their spouses death.
When you lose somebody really close to you, like a spouse, not only do you miss the person emotionally, there are routines that you go through, like what you do in the morning. When that other person is gone, that routine is gone and that can be very disruptive.
Even when family members visit regularly, older people can be discovered with quickly developing medical conditions.
Its certainly something you see not infrequently, a family comes in and sees something that is very disturbing, Blazer said.
Changes in social services and the mental health system mean that more people living alone may see their lives spin out of control, said Craig Burrus, Wake Countys program manager of senior and adult services .
Its on the increase and likely to continue based on the state of the mental health system and the dwindling of services and personal interaction with the people that need help, Burrus said.
Among other county functions, Burrus oversees Adult Protective Services, the staffers who get called in when an adult such as the Cary man can clearly no longer maintain an independent life.
If the person is living in a seniors-only complex such as Capital Towers in North Raleigh, management can alert the county that the tenants situation is desperate.
They happen to go into somebodys apartment to do a routine check and its a mess with feces all over the place, Burrus said.
A push to participate
With the increase of solo seniors, the importance of remaining engaged will also grow, whether through senior centers, adult day cares, informal gathering places or churches.
Blazer pointed to telemedicine as a means to bridge gaps between people living at home alone and medical professionals. A physical therapist could, for example, monitor via Skype the progress a patient is making as he learns to use a walker or crutches in a home setting. But the up-close personal visit remains best, whether for professional or personal contacts.
The most advantaged people can escape isolation they go into retirement communities, Blazer said, referring to places such as the Forest at Duke, where residents can start in independent cottages and wind up in skilled-nursing care.
Healthier or more mobile acquaintances can help isolated folks by actively encouraging those living alone especially with memory or hearing problems to get out and make their customary rounds.
They tend to say, I dont want to do that, Blazer said. Its a matter of really saying something: Youve been going to the Kiwanis Club for years and years; somebody will come to pick you up.
Hazel Logan, 84, works with the senior ministry at Martin Street Baptist Church in Raleigh. Many members of the congregation from the World War II generation, Logan said, keep active and reach out to members living alone who can no longer make it to church.
But they also have an active ministry to younger people in the historically African-American neighborhood around the East Raleigh church.
We grew together, we had children together and now we are old together, Logan said of her peer group. We were satisfied with the church membership, but that is not altogether what church is about. We are focusing now on whats outside the walls.
Thomas Goldsmith wrote this article with support from the MetLife Foundation Journalists in Aging Fellows program, a collaboration of New America Media and the Gerontological Society of America.