The Long-Livers
Johnnie & Roy Crosslin, Wartrace, Tenn. 1990.
Aging in Place in Rural America
By Monica Potts
Photographs by Sheron Rupp
Sheron Rupp is a photographer who for thirty years has photographed people living in rural areas and small towns across America. Her photographs were published by Kehrer Verlag in the book Taken From Memory, now out of print.
In the five years that my partner, Samir, and I lived in my hometown in rural Arkansas, we grew accustomed to hopping over to my mom’s house whenever she needed anything. My mom, Kathy, lived just a few minutes away in the same house she’d lived in since we built it in 1994. It was the home my parents had dreamed of building their entire marriage, and my dad did a lot of the work himself. I spent my high school years there. It was the final home of my sister Ashley, who died when she was 17, and my youngest sister, Courtney, grew up in it. My dad spent his last years mostly ill in the bedroom upstairs before dying of lung cancer in 2006. It’s full of memories for me. But for my mom, who stayed through all the tumult to settle in as a quiet empty-nester there for the past few decades, it’s just home. We are the only family who’s ever lived in it.
The house is a farmhouse style with a wraparound porch overlooking a natural pond, surrounded by trees, outside of Clinton, Arkansas, a town of roughly 2,500 people. From the start, it was too big and expensive for our working-class family to maintain. Thirty years on, it’s picked up more and more signs of disrepair. Some of the tile flooring, which was laid throughout the first floor, has cracked and come apart. The counter around the kitchen sink is falling in from water damage and needs to be replaced. The garage door and trash compactor both regularly break. Momma mostly spends her time in one of three rooms: the kitchen, the living room, and her bedroom. The air in the other rooms, especially the spare bedrooms, has a cold, mausoleum quality to it, and all of the unused rooms, to one degree or another, have had to make space for storage boxes.
But none of these big-ticket items are what we helped Momma with. Our tasks were more quotidian. We’d regularly replace her air conditioner filters, hang curtains, and repair the garage door. We took her recycling to the county dump and pulled her trash can back from the curb whenever we visited and found it there. We helped with auto maintenance. On Sundays, we brought dinner to her house so she didn’t have to cook; I’ve realized as an adult that she hates cooking. If her computer or phone needed an update, or she got logged out of Facebook and couldn’t get back in, we helped with that, too. For doctor’s appointments, which started to happen with increasing frequency, she often had to travel an hour or two away to a bigger city, and we’d usually drive her.
Pineville, Ky. 1990.
Now in her early seventies and healthy, my mom still works. She’s incredibly independent. I never thought of myself as her caretaker. Still, it helped that we were around, which I’m starting to realize even more now that we aren’t. Last fall, Samir and I moved halfway across the country to rural central New York. In the few months that we’ve been away, we’ve had to help make appointments and help restore her internet security after she was hacked, and we’ve had to learn how to do it all from afar. While the worries so far have been small, we can clearly see all the ways that helping her will only become more difficult as time goes on.
Nearly everyone my age is now facing the same questions about how to be there for our aging parents. The Baby Boom generation was so massive it reshaped American life, creating new concepts of teenagehood and adulthood and parenthood as its members moved through those life stages. Now this behemoth of a generation is sitting at the top of US demographics like a boulder teetering on the edge of a cliff, not quite ready to face their final years. And we, as a country, don’t have the systems it will take to support them, their children, and their grandchildren. That’s especially true in rural areas and small towns.
• • • •
This year, more Americans will hit the retirement age of sixty-five than ever before. Baby Boomers were once the largest generation in American history, fueled by 76 million births between 1946 and 1964, and this year they’ll be aged sixty to seventy-eight. Their lives began during a mid-century golden age of federal and private investment when the middle class expanded, bought homes, built highways, unionized, and sent their children to college. By the time their own children came of age, the Reagan revolution had dismantled or privatized most of that. Pensions gave way to 401(k)s, the costs of healthcare soared, and the housing market became too expensive for nearly everyone.
By and large, Americans haven’t saved enough for retirement, and that includes a surprising 40 percent of younger Boomers who hadn’t saved enough for retirement in 2022, according to a Federal Reserve survey. Inequality persists among that generation, as it does through most of America, so even though significant numbers of older Boomers were able to amass retirement savings throughout their working lives, there are still many aging in poverty. The generation just below them and best able to help take care of them, the Gen Xers, is much smaller and often still caring for their own children. It’s a squeeze many adults are starting to feel, especially in rural areas where a disproportionate number of aging Baby Boomers live.
“The Baby Boom generation was so massive it reshaped American life, creating new concepts of teenagehood and adulthood and parenthood as its members moved through those life stages. ”
More than 20 percent of older Americans lived in rural areas in the middle of the last decade, according to a survey by the Census Bureau released in 2019, and nearly 18 percent of the rural population was sixty-five or older, compared to 14 percent of the urban population. Those trends have likely only become more pronounced in recent years. Rural America is already disproportionately home to those living with disabilities and in poverty, and is likely to be even more so as the Baby Boomers continue to age.
That’s especially true because the vast majority of adults want to stay in their own homes as they reach retirement. As much as 77 percent state that as their preference, according to polls from the AARP, a share that’s mostly unchanged in the last decade. People don’t want to move, and they especially don’t want to move into a nursing home or an assisted living community. For many, the cost of such a facility is simply unaffordable. Even for those who could foot the bill, the thought of a retirement home seems dreary and unappealing. The Covid-19 pandemic made the prospect even less tempting, because safety protocols kept family members from visiting many elders, and the virus hit nursing homes hard. People are choosing to stay put.
And housing numbers already show the effect. A survey from ApartmentList, a rental listing organization, found that seniors aging in place own a growing share of owner-occupied houses. This is helping to lock the housing market in an unaffordable spiral: even if they sold their homes, the seniors living in them would struggle to afford a new one. In short, so many older Baby Boomers choosing to stay in place, even as they reach the end of their lives, is forcing younger Boomers and those with smaller retirement savings to do the same. It’s a nationwide problem—but for rural America, aging in place poses particular challenges.
• • • •
Zoe Moffitt, a care manager who works in Ulster and Dutchess counties, in the Hudson Valley, in New York, says her region is home to many retirees who leave New York City to settle down in quieter, smaller towns. “There are a whole lot of people that start a whole new rural life in their sixties,” she told me. And many of those people live for decades after retirement. “I just think that people are working outside and walking and hiking and feeling at peace and gardening and eating good food, and all that is probably really supportive of a lot of people’s good health up here… I think there are a lot of amazing long-livers.” And, not surprisingly, many of those people want to stay in the Hudson Valley and in their own homes as they age. Most of Moffitt’s clients have the financial resources to help manage their care, and Upstate New York is in better shape than many communities. Even so, some problems are unavoidable.
Logan, Ohio 1985.
Mr. Davidson, Waldon, Vt. 1990.
First and foremost, 4 percent of rural hospitals closed between 2011 to 2020. Another 30 percent are at risk of closing. Rural Americans, on average, live twice as far from a hospital as their suburban counterparts do—and rural hospitals are smaller and less resourced with wait times that are longer. There are fewer primary care doctors, dentists, and specialists, and patients often have to travel to larger cities to see them. The increasing health needs that come with age make staying in a rural area challenging, especially when the elderly have to cover wider and wider distances. Though there’s some public transportation Upstate, it’s sparse and spread out, forcing residents to drive their own cars, something that becomes more and more difficult as people age.
Eventually, Moffitt says, nearly all of her clients who decide they’re going to stay in place need someone to come into their home to help them. That can mean medical care, but for younger elders it most often means simpler things, like helping with laundry, food, and groceries. But there’s a shortage of home aides around the country, especially after many left the field during the Covid-19 pandemic. Advocates have long asked for better pay and improved working conditions to help ease the shortage, but a Health Affairs paper in 2022 found the problem was getting worse—and was particularly acute in rural areas. “Especially for the people who live… on the side of a beautiful mountain,” Moffitt said. Home health aides who are already overworked and underpaid are reluctant to drive long distances. “For an aide to come for a short stint,” Moffitt said, “that also means the transportation of getting there, either driving or finding somebody to take them.”
Jim and Wendy Blair, who live in the hamlet of Stone Ridge in Ulster County, saw friends struggle with this very problem. Their friends had to arrange care for an aging mother and couldn’t find help locally. “They had to get help for their mother through an agency in New York City,” Wendy said. When they finally found someone, the aide didn’t drive. “So my friend would be doing all the shopping, and taking the [aide] to where she needed to go. And it was a lot of work for her. It’s very, very hard to get people.” It’s a concern that now weighs on Wendy, 82, and Jim, 83, whose only daughter died of breast cancer in 2021.
The Blairs spent their working years in the ’70s, ’80s, and ’90s in Manhattan. In 1984, they bought the home they live in now as a weekend retreat because they both loved the outdoors. They called it a handyman’s paradise, and at the time the Hudson Valley community was unfashionable and affordable. It was just what they wanted, and they spent the next several decades fixing up the house, gardening, and making it their own. They formed friendships and joined community groups. By the time, they were ready to retire, moving there full-time was a no-brainer.
Utica, Ohio 1984.
But now, after watching their friends struggle to get the help they needed as they aged, the Blairs have come to a decision: they’re going to move into assisted living. Jim’s parents spent their last years in a Continuing Care Retirement Community in northern Virginia, a type of community that provides a continuum of care for the rest of their clients’ lives. It worked well for them and helped the Blairs decide to seek out such a community for themselves. They’re attached to their home in Stone Ridge, but trying to stay in it was starting to feel impossible. “It isn’t sustainable forever,” Wendy said.
Still, moving out will cost them. They’re on the waiting list for the nearest facility, where they can stay near friends, and they will pay $650,000 to enter and $6,000 a month thereafter. “Not everybody has the opportunity to make choices like that,” Jim said.
• • • •
When Birdie Condon’s mother-in-law started preparing to die, the entire family thought she had a solid plan in place. Condon owned a second home near her own that she used as an office, and her mother-in-law moved into part of it about eight years ago. Condon could help her with anything she needed while she was there for work, and it was also just a short drive away from where Condon and her husband lived. Condon’s mother-in-law made many arrangements in her eighties and was matter-of-fact about death. “This is somebody who, ten years before she died, she taped her DNR to the refrigerator,” Condon said. “She was really extraordinary that way. I can’t imagine a better role model for how to confront death.”
By the summer of 2022, when she hit her nineties, Condon’s mother-in-law became weaker and struggled to do basic household duties by herself. “It would be hard for her, for instance, to fill a pot with water in the sink, and then lift it and carry it to the stove to boil for pasta,” she said. The Condons tried to find help, but they couldn’t find an aide, and also struggled to take advantage of a program where Medicaid pays a family member to provide help to disabled and elderly relatives. “Nobody wanted to do that kind of work,” Birdie said. “It just felt like it was too cumbersome for them, so we kept trying to get an aide.”
“Rural America is already disproportionately home to those living with disabilities and in poverty, and is likely to be even more so as the Baby Boomers continue to age.”
As time passed, Condon’s mother-in-law became weaker and weaker. The family was approved for an aide to come for two hours a day, but they felt like they needed more help and asked for more time. They were eventually approved for an extra forty-five minutes per day, which they felt was a uselessly small amount. Moreover, Condon’s mother-in-law remained independent-minded and was frustrated that she needed the help, and often didn’t get along with her aides. Condon got frustrated with the aides, too. “They just didn’t really seem to care all that much,” Condon said. “She didn’t have any difficulty hearing. She didn’t have dementia. [But] they would yell at her and talk to her like she was a child, and it was just so annoying. She would say, ‘I can hear you. You don’t have to yell at me.’”
Her wishes had always been clear, however, and she’d always wanted to die at home. In the fall of 2023, when she was ninety-two, she had a debilitating stroke. “She was just sort of lingering,” Condon remembered, “and the doctor said, ‘You know, it could be hours or days, we really don’t know.’” But part of the reason her mother-in-law had always wanted to stay in a home and not a facility was that she had a deep connection to nature and wanted to be outside. One of Condon’s children reminded her of that during his grandmother’s final illness. He had an inkling that she was holding on because she hadn’t been outside in months. “Is there any way you can take her outside?’” Condon remembers her son asking. The family put a massage table outside on the deck and picked up her mattress and carried her outside. “And my kids stood around her and held her and talked to her,” Condon said. She couldn’t tell whether her mother-in-law was aware of her surroundings, but she felt it was good for her kids. “They really spent time honoring her in this transition,” she said.
The Condons consider themselves lucky.
• • • •
It’s in this environment that I’m trying to help my mom decide where to live. We don’t have the kinds of resources that make the decision easy. Momma spent most of her adulthood as a stay-at-home mom and only started working full-time after my dad had a series of strokes after my sister and I had left home. At the end of my dad’s life, my parents lived partly on his Social Security Disability Insurance. My mom’s Social Security survivor’s benefits would not cover much. She has minimal savings. She would need to sell her home to be able to buy or build a new one and then try to live on what’s left over. The fact that her home is in rural Arkansas and in need of repair keeps its value modest, and it is all the wealth that she has.
Both Samir and I would like my mom to live near our new home in central New York, but it’s not clear how we can make that happen. It’s also not clear to me that she wants to. When we have conversations about her potential move, we’re always using the future tense. But at 74, she’s well past retirement age. The future is now.
Mary, Mansfield, Ohio 2001.
