What we can Learn from "Nine to Ninety"

Lessons on Aging and Planning for End-of-life Care

Phyllis Sabatini, 89, didn’t want to be a burden to her family. Living with her 90-year-old husband, their daughter, son-in-law and young granddaughter, she saw the strain caregiving was having on the family and mulled how she could remain independent while getting the care she needed.

We see Sabatini’s dilemma play out in the new documentary "Nine to Ninety.” The charming octogenarian and her husband Joe spend their days living with their family in a California suburb after moving from the Philadelphia home they’d known for decades. As Joe struggles with increasingly serious health issues, Phyllis tries to make the best of each day, but worries about her daughter having to care from everyone "from nine to 90."

"Where can I go, so I won’t be a burden to anybody?" she wonders aloud.

Phyllis ultimately makes the heartbreaking decision to move across the country to live near her other daughter in an assisted living community while Joe stays in California.

Throughout the film, the Sabatinis and their adult daughters struggle with tough choices about end-of-life care. Their story illustrates the importance of talking about these issues with aging loved ones before care decisions become urgent.

As Baby Boomers age and the 65-plus population surges, more Americans are facing the very same questions, both for their parents and themselves. In "Nine to Ninety," we see how crucial it is to break down cultural taboos and make these tough conversations a priority, before it’s too late.

Here are a few key lessons we can take away from the film.

1. A positive attitude goes a long way

At 89, Phyllis needs a little help with everyday activities. She uses a walker to get around, and she and her husband rely on their daughter to get to doctor’s appointments and for help with meals and other activities. And while Joe is slowed down by various medical conditions, Phyllis remains determined to live as independent and vibrant a lifestyle as possible. "Always keep your mind occupied," she says. "Because if you don’t use it, you lose it."

Her smile, upbeat attitude and frequent jokes are infectious.

At one point she turns to Joe and cracks, "All those years to be married, huh? You deserve a medal!"

Phyllis’s can-do approach to life includes fitting in daily exercise – during the film, we see her doing stretches and taking walks around the block with her walker. "I’m doing pretty good, I take each day as it comes," she told viewers during a live online chat following a recent screening of Nine to Ninety.

2. Don’t underestimate what your loved one can handle

In addition to her cheerful outlook, Phyllis is very realistic about the changes she and her husband are undergoing as they age and their health declines. It wasn’t easy for her to leave her Philadelphia home, for example, but she takes it in stride.

"I was there for 45 years and it was great, but life changes, and that’s the way it goes," she says.

And when it comes to talking with her daughters about tough subjects, like the details of her funeral, she’s not shy about broaching the conversation.

"We’ve got to talk about it!" she insists when her daughter says she feels uncomfortable discussing it. Phyllis’s insistence about addressing these difficult topics reminds us that we shouldn’t underestimate our what our older loved ones can handle.

Unless they’re suffering from dementia or other cognitive impairments, your elderly family members are well aware that they’re living out the last chapter of their lives, and want assurance that their end-of-life wishes are expressed and respected. They’ve lived through a lot, and are probably better able to handle these conversations than you’d expect.

3. Have tough conversations early and often

Imagining a loved one’s final years can be heartbreaking, and talking about their death isn’t easy. But as difficult as these conversations seem, it’s even tougher to face making end-of-life decisions for your loved one when you’ve never discussed their wishes.

While the Sabatinis’ daughters felt that having their parents live with them was the right thing to do, Phyllis often talked about moving into an assisted living community and wondered what could be done to lessen the strain of caregiving for multiple generations on her daughter. Watching "Nine to Ninety," it’s easy to envision a different ending where Phyllis and Joe might still have been able to live together if the family had more support, perhaps via in-home care or respite care, if not assisted living.

"[It’s also important to] focus on how you want to live at the end of your life as opposed to how you want to die," said Kate DeBartolo, national field team lead for The Conversation Project, an initiative dedicated to helping families talk about their wishes for end-of-life care.

"I think it’s always going to be sad to talk about loss, but we can try to reduce some of that grief by talking about it," she said. Does your parent want to move into an assisted living community or nursing home when they’re no longer able to care for themselves, or are they determined to stay at home? How much care is enough, or too much? Who will pay for it?

Juli Vizza, Phyllis’s granddaughter and the producer of "Nine to Ninety," said that once the family started talking more about these types of issues, it became less scary to do so. Having sensitive conversations early and often, not only about your loved ones’ end-of-life wishes, but also your own, can help families prepare for incredibly tough decisions that shouldn’t wait until the last minute.

The Conversation Project provides a starter kit to help you broach these discussions with your own loved ones.

Find out when you can watch "Nine to Ninety" on your local Public Broadcasting Service channel.