My friend Cynthia, who works as an independent home care aide in Northern California, told me about her latest client, a 93-year-old widow who broke a hip in a fall and underwent replacement surgery. After two months in a hospital and in rehab, she returned home with instructions to hire home care four hours a day, seven days a week — a reasonable-sounding compromise between safety and independence.
Her family lucked out in hiring Cynthia, a caring and competent helper who now makes the woman’s breakfast, helps her shower, empties the bedside commode, walks the spaniel, does the laundry, leaves her a bowl of homemade vegetable soup for lunch. For this Cynthia charges $18 an hour, much less than agencies would charge in the pricey Bay Area.
But the woman will hire Cynthia only 10 hours a week, instead of the recommended 28, and is balking at even that. Cynthia doesn’t have time to really clean the house, cook meals or read to her elderly charge, who has glaucoma. “She claims she can’t afford to pay me,” Cynthia lamented.
She also doubts that’s true. Her client sold a big house on several acres at the height of the real estate market and pocketed perhaps $300,000 on the transaction. But while she buys high-quality dog food, Cynthia said, “she’s resistant to spending money on herself.”
We know that many older Americans — about 17 percent — live in poverty and that Social Security provides the primary support for nearly half the elderly population. And we know that for virtually any kind of paid assistance, the price is shocking.
But we also know this: Some seniors can afford to pay for what they need, but won’t.
Take the prosperous couple that moved from out of state to an independent living community in Boston with the help of a local geriatric care manager, Suzanne Modigliani. The husband remained hale at age 90 and had plans to visit bookstores and religious services; his wife, 82, had early dementia and a variety of other medical problems and couldn’t dress or bathe without assistance.
The man worried constantly that the law firm he’d retired from would have a bad year, resulting in lowered income for partners. When Ms. Modigliani suggested hiring a driver to help ferry him around and a home care worker to care for his wife, he debated every expense, hired piecemeal or not at all, and expected his devoted daughter — who had a full-time job and teenage children — to handle routine matters.
“If you looked at how much they had and how much this help would cost, there was no possible way they could have run through their savings,” Ms. Modigliani recalled. “At one point his daughter, who rarely got angry, actually swore at him, because her mother wasn’t being adequately cared for.” But not until the wife grew very ill and the need for help became undeniable did the husband consent to a live-in aide.
What’s this about? I’ve searched for some credible research on how attitudes towards money vary by age cohort, and I’ve come up empty. So it’s hard to know the extent of this unwillingness or inability to spend money on one’s own comfort and care.
It’s not universal. A January survey by the nonprofit Employee Benefit Research Institution found that
two-thirds of retirees over age 70 are confident that they have enough money to live comfortably, though that percentage drops to less than half where annual household income is below $35,000 and when a respondent reports fair or poor health. Still, these retirees are more confident about their finances than those still in the workforce.
While a social scientist would call these stories anecdotal evidence, a lot of gerontologists, social workers and family members find them familiar.
One explanation is historic. People over age 80 knew firsthand the hardships of the Great Depression. “Anyone who lived through that era realized the contingencies of life and the vulnerabilities,” said Andrew Achenbaum, a historian of old age at the University of Houston. Even for people who’d climbed into the middle class, “there was always this lurking fear that everything could turn around in a second,” he added. “It made them edgier than they would have been otherwise, and it has persisted throughout their lives.”
This cohort effect may fade, therefore, as the baby boomers grow old. We’re used to spending money, for better or worse, and to hiring helpers for everything from child care to dog-walking.
But wrangles about money are rarely only about money. The desire to leave a legacy, such a potent force at older ages, can hold sway even when the potential heirs don’t need such largess.
“What motivated these parents to save all these years? To provide for their families,” said Barbara Moscowitz, senior geriatric social worker at Massachusetts General Hospital. “I don’t think they grow out of thinking that way, even when their children are 57 or 60.”
Perhaps they’ve promised to pay a grandchild’s tuition or to underwrite a wedding. Meanwhile, their children may be begging them to spend their savings on things like grab bars and ramps, aides and physical therapists, new air-conditioners or assisted living apartments.
Sometimes, Ms. Moscowitz said, resistance couched in financial terms has little to do with money at all. Maybe a parent can’t accept his need for help, dreads dependency and loss of control, fears mortality itself. “I can’t afford it” provides a good all-purpose excuse.
Or maybe, Ms. Moscowitz points out, what connects busy children to their parents are tasks and obligations, leaving the elders to wonder: “If I hire someone to do what my daughter does for me, will I see my daughter?”
Having money and not spending it may be a problem lots of caregivers wish their families had, but it’s a problem nonetheless. “Money is a very emotionally charged issue,” Ms. Modigliani said. “It’s hard for rationality to rule.”
Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.” 
