The role of a personal assistant in the life of an older adult.

Written By Kelli Pylant

I recently spent about two hours at a client's kitchen table, working through his to-do list with him. It was an ordinary list. Nothing on it, on its own, was a crisis.

One item was his Medicare Advantage coverage. He wanted to confirm what was happening with his plan for the coming year. A simple question. But once we had member services on the phone, before the representative would simply help us resolve it, the conversation turned to enrolling him in an incentive program that came with a $100 benefit.

On paper, $100 sounds like a nice perk. To someone trying to simplify his life, it meant something else: potentially another program, more mail, more information to keep track of, and possibly another account and another password.

He did not want another program. He wanted an answer to his question.

So I advocated for us to stay focused on his goal. Eventually, we confirmed what he needed to know: he did not need to find new insurance.

He sighed. Then he smiled.

We kept going. We reviewed old bills to determine whether anything was actually outstanding. We updated the payment method in his Uber account, because a credit card had been retired. One by one, things came off his list.

As they did, I watched his demeanor change. Stress gave way to relief. Relief turned into smiles, then jokes, then laughter.

I keep coming back to that progression, because it shows what the little things actually cost, and what happens when that load starts to come off.

Nothing on the list was a crisis

A phone call. A stack of bills. A setting in an app. Taken one at a time, none of those tasks was hard, and that's exactly the point.

Each one asks for a little: time on hold, a login you haven't used in months, a decision about something you didn't ask for. Add them up, and keeping an ordinary life running can start to feel like a part-time job.

Researchers have language for this. In healthcare, a framework called the Cumulative Complexity Model describes what happens when the workload placed on a person, including what the authors call the demands of "life in general," grows larger than their capacity: the time, energy, money, and support they have to meet it. The model was built to understand people managing chronic illness, not everyday paperwork, so I use it here as a lens rather than proof. But it describes what I saw at that table. The problem wasn't any one task. It was the pile.

Public policy researchers have a name for the pile, too: administrative burden. Dealing with institutions costs us in three ways. There's the cost of learning (figuring out what's required), the cost of complying (the calls, forms, and documents), and the psychological cost (the frustration, the worry, the sense that one missed step could become a problem). That last cost is easy to overlook, and it's the one I watched lift off my client's shoulders.

Sometime the person didn't change. The world did.

This is what I most want families to hear: my client had not suddenly become incapable. He knew exactly what he wanted from that phone call, and he knew what he didn't want.

What has changed is the world around him, and around all of us. Insurance questions route through member-services scripts. Bills arrive in formats that make it hard to tell what's actually owed. Retire one credit card, and it ripples into every app and account it was attached to. This isn't an "older adult problem." Most older adults are online; according to the Pew Research Center, about 78% of Americans 65 and older own a smartphone. Keeping up with constant updates and changing systems takes effort at any age.

Gerontologists have described this dynamic for half a century. In their work on what's often called person-environment fit, M. Powell Lawton and Lucille Nahemow proposed that how well we function depends on two things: our own abilities and how much our environment demands of us. Turn up the demands, and the same person who was managing fine can start to struggle, without losing a thing.

That distinction matters. If we read every struggle with a modern system as a sign that someone "can't manage anymore," we risk taking over parts of their life they're fully able to run. At the same time, a trusted person who's around regularly is often well placed to notice when something genuinely new seems off, and to gently suggest a conversation with a doctor. Both things can be true.

Whose agenda is it?

The most important moment at that table wasn't when we got the answer. It came earlier, when the call started to drift.

Offering programs is part of a member-services representative's job. But in that moment, the company's agenda was beginning to take the place of my client's. He had called with one goal. The conversation was turning toward someone else's.

In social work, we call the principle at stake self-determination: the person's own goals drive the help. My role wasn't to decide whether a $100 program was a good deal for him. It was to notice whose agenda was steering the call, and to bring it back to his.

That, to me, is what good support looks like. It isn't about taking over. Researchers have found that when helpers reflexively do things for older adults, even with the kindest intentions, it can quietly encourage dependence. The late psychologist Margret Baltes called this a "dependency-support script". Help that's built around the person's own goals tends to protect their independence instead.

In practice, support comes in different shapes, and the person gets to choose what fits each task:

  • Teach: show how, then let them practice.

  • Coach: they make the call; you're there on speaker.

  • Set up the environment: adjust phone settings, organize accounts, write a simple step-by-step guide.

  • Do with: sit side by side and work through it together.

  • Do for, with permission: handle a task they'd rather hand off.

That afternoon at the kitchen table was mostly "do with": his list, his priorities, worked through side by side.

Independence doesn't have to mean doing everything alone

There's a gap I see families fall into all the time. On one side is "I don't need any help." On the other is "I need a caregiver." Plenty of people live somewhere in between. They're capable and independent, and they're also carrying a growing pile of calls, portals, passwords, bills, appointments, and paperwork that the modern world keeps handing them.

That in-between space is what our Senior Life Concierge service at Heart to Soul Solutions is built for: trusted, non-medical support with organization, navigation, advocacy, technology, appointments, paperwork, and phone calls. It's not about running someone's life. It's about helping them keep running it, with the right amount of support in the places where today's systems create unnecessary friction. And when a question belongs with a doctor, an attorney, or a licensed Medicare counselor, part of good support is recognizing that and connecting to the right person.

This kind of help can matter for families, too. Adult children, especially those coordinating from out of town, often spend their visits and phone calls on logistics. When some of that load is shared, there's more time left for the relationship.

Independence doesn't have to mean doing everything alone. Sometimes it means having someone beside you at the kitchen table while you work through your own list, on your own terms. I've seen what happens when that load starts to come off: a sigh, then a smile, and eventually, laughter.

Sources and further reading

 

Kelli Pylant
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