Americans Will Struggle to Grow Old at Home

At 6 a.m. on a winter morning in Ridgewood, N.Y., a woman I’ll call Valia leaned on her kitchen counter, drinking black tea and packing a giant purse. She wore her blond-gray hair in a bun and pulled on an ankle-length brown puffer coat. “OK, I’m taking my medication, I’m taking my telephone, my tablet,” she said, going down her checklist. She whispered goodbye to her cat and her 26-year-old son, who was still asleep, and lit a cigarette to smoke on her way out.

Valia took the L train to the end of the line in Brooklyn, then switched to a crowded bus. Her fellow commuters looked as tired as she did, some dozing upright in their scrubs or steel-toed boots or polo shirts embroidered with fast-food logos. I was following Valia, a Ukrainian immigrant, on her hourlong trip to the apartment of an elderly, low-income woman with advanced Alzheimer’s disease. Valia had been assigned the case, the latest in her long career as a home health aide, a few months earlier. The woman depended on her for virtually everything. “Showering, washing her hair, feeding her,” Valia said. “She’s bedridden, she’s not walking, so I have to transfer her from the bed to a chair. She’s using Pampers.”