top of page


By Fred Dickey

Sept. 7, 2015

Rose Terranova looks over at her mother and wonders how much of her is still there. Her mother sits in a chair a few feet away, but her eyes are a mystery.

With good reason. Josephine Patinella is 108 years old. That in itself is on the outer edge of unusual, but the situation facing Rose is not.

Josephine can hear only a half-shouted voice in her ear. She rarely speaks except to softly utter groans that Rose can interpret. She moves almost bent double with the aid of a walker, and slowly, with assistance. She spends most of her time in a wheelchair.

However, Josephine is not senile. She knows what’s going on around her, if she’s made aware of it. The doctor says she’s in good health, but that’s obviously relative.

Rose loves her mother. That’s why she’s temporarily staying in Josephine’s La Mesa home, filling in for the regular helper and waiting to respond to the next need. Rose, though, is 74, and her body and mind bend under the heavy work of caring for her mother, maintaining this residence and, most of all, paying for 24-hour attendants.

Josephine’s extreme age is a rarity of nature, but were she 80, the problem could be just as daunting and just as perplexing.

Lest we objectify her mother, it’s important to say that Josephine has led a good life and met every challenge. She was born in Sicily in 1907 and survived the deprivations of World War I, the family deaths of the world flu pandemic and the steerage passage in a tramp boat at age 14. She was a homemaker for many decades. She was a widow for many years.

This is a woman who has honored every request that life made of her. Now she waits, surrounded by family love.

Josephine lived by herself until three years ago — amazing in itself — but then she had a fall and required full-time care. She couldn’t get public assistance so long as her money held out, which it did until early this year. In February, after scraping her bank account of more than a quarter-million dollars, Josephine was broke.

Let’s do some math here: If Rose goes home and a full-time attendant is back on duty, that worker will cost $4,800 per month plus change at $10 per hour. That’s after Medi-Cal contributes about $2,000 for home health care. Add to that about $800 per month for housing, food and a hundred incidentals, including Pampers (no small cost there). That’s about $5,600 each month. The only offset is Josephine’s Social Security check of $1,688.

Moving her mother to a nursing home with Medi-Cal assistance would give a helium lift to Rose’s financial burden.

Piled atop Rose’s other problems is one she definitely doesn’t need: the bureaucratic maze of getting answers (not to mention help) from government agencies at every level.

A case in point: In February, Medi-Cal started paying more than $2,800 per month for home health care. However, it recently lowered the amount by more than $800 because of what it describes as a rise in Josephine’s income. But Josephine’s only income is from Social Security, and that hasn’t changed.

“I’m very unhappy. Endless phone calls and put on hold. I’ve exhausted every avenue possible, and no one seems to care. Other than Medi-Cal and Social Security, there is zero help for the elderly. There aren’t any other services that I have found.

“I called her caseworker several times, and he didn’t call (back), and didn’t call until the office asked him to.”

The “Someone will be with you shortly” people have Rose about to tear her hair out, but that would only leave her bald and them still fully hirsute.

Rose is also disappointed and a little surprised that she has not heard recently from her mother’s Seventh-day Adventist Church, of which Josephine has been a member for many decades.

She slowly chooses her words, but bites them off. “We have not heard from them.” Out of sight, out of mind is more than a cliché. It’s the human condition. How easily we can disappear and not be missed.

Rose is a widow of three years whose residence is in Santa Ana. She works as a school tutor less than full time. She lives primarily on the savings she accumulated with her late husband. Like any protective mother, she is loathe to turn to her children for financial help.

“They have their own lives and their own families. I don’t want to burden them with this catastrophe.”

Hers is an increasingly common circumstance that makes the middle class realize the vulnerability of its lives. We can talk critically about “welfare” and “the public dole,” but the cold-hard-cash fact is that it’s a rare family that can absorb the costs that Rose is facing without ending up in bankruptcy court.

It’s been a long time since we could stash the old folks in the “back bedroom” of the farmhouse and wait for them to die.

Rose was raised with two sisters. One is deceased, and the other is disabled and lives in a facility. So, in a practical sense, Rose is alone with her burden. But in a larger sense, she is not. She is in the same crowded room with many thousands of adult children who also “inherit” the financial burden of elderly parents.

If Rose exhausts her own savings, then she could become a financial burden on her children when the time comes that old age makes her also dependent.

There are two plausible options: One, move to La Mesa and take over the 24/7 job of caring for her mother. The other is to place mom in a nursing home (or whatever P.R. types now call them).

Rose’s health makes the first unlikely. She is a petite woman and suffers from scoliosis, a debilitation of the spine that makes lifting or any heavy work painful and even impossible. The same would apply to moving mom to Santa Ana, plus that house is ill-fitted for Josephine’s needs.

The other option? The nursing home.

Oh, God. ...

A nursing home makes all the sense in the world if her mother would welcome it or at least accede to it. But Rose remembers how strongly her mother spoke about “one of those places.”

“She’s gotten quieter. She’s now in her own little world. She does sleep a lot, but she would be aware if there was nobody she knew around her. I think she would be unhappy and feel abandoned.”

At the thought, Rose swipes at tears that begin to flow. “Her own sister was in a nice nursing home, but mother said, ‘I never want to be in a place like this.’ ”

Rose has been satisfied with the job that Josephine’s caretaker has done, but she knows that jobs eventually have turnover, and a replacement (or plural) might be a disaster. On the other hand, she’s also heard stories of unmotivated, ill-trained nursing-home attendants neglecting the elderly.

Increasingly, older people are conditioning themselves to understand they might end their days in some sort of residential or nursing facility.

But when that day comes, preconditioning doesn’t always make it easier. And if you’re quite old and raised in a culture of family nurture, it has to seem like abandonment, especially if you remember back when nursing homes were often hell holes.

Although Rose’s remaining sister urges her to put mom into a home, she cannot bring herself to make the call.

The interview is stopped when, across the room, Josephine begins to softly groan with some insistence.

“She needs to go to the bathroom,” Rose says, then busies herself getting her mother out of an easy chair and steadying the walker for the trip across the room and down the hall. Rose is back in about 15 minutes, but the procedure has to be repeated about an hour later.

This is a new experience for Rose, and she hungers for people to talk to, either in the same situation or with professional knowledge that can give her insight or guidance. She would also like to know if any other financial aid is available from whatever source.

Some children look at elderly parents as though to say, “How dare you get this old and feeble?” Rose is at the other end of that spectrum.

Rose can look with love at Josephine in her chair, but at the same time know that her mom represents a duty that Rose feels physically and financially unequal to.

“I’m trying to carry this load to care for my mom and to make her happy for whatever she has left of her life.”

She knows that one day soon that chair will be empty, and she dreads having guilt for not doing the right thing.

What to do? What to do? ...

Fred Dickey’s home page is

His webpage is

© Copyright 2015 The San Diego Union-Tribune. All rights reserved.

bottom of page