We meet Brenda Kay Messer at a Hardee's off Highway 25E in eastern Tennessee, halfway between two of her client visits. It's early March 2035, and she's just finished a morning shift with Mrs. Dockery, whose daughter in Nashville keeps calling about "options" now that the county announced it won't repair the bridge that washed out last October. Brenda Kay orders a biscuit and coffee, apologizes for eating during the interview ("I've got Mr. Patterson at one and the Kowalski sisters at three"), and settles into a booth by the window. Outside, the parking lot shimmers with heat that would have been unusual for March a decade ago but now arrives reliably in late February.
She's 45, has been doing home health care for seventeen years, and currently manages care coordination for eleven elderly clients across three counties. What makes her job different from most home health aides is that she's become, in her words, "the person who has to tell families their parents can't stay here anymore." It's a role nobody trained her for.
How did you end up in this position?
Brenda Kay: Well, I didn't set out to be the climate migration coordinator for eastern Tennessee, I can tell you that. laughs I was just doing my job. Helping folks bathe, managing medications, making sure they eat something besides white bread and mayonnaise. Then around 2030, 2031, I started noticing the phone calls were changing.
Used to be families calling to check in, ask how Mama's doing. Normal stuff. Then it became, "Do you think she could handle a move? What would it take to get her to Nashville? Could she fly to Denver?" And I'm thinking, your mother has lived in the same house for sixty years, she knows every person at the Piggly Wiggly, and you want me to tell her she needs to move to Denver where she doesn't know a soul?
But then the floods got worse. We had three hundred-year floods in four years, which I'm pretty sure isn't how that's supposed to work. County started making noises about which roads they could actually maintain. Insurance companies started pulling out. The hospital in Middlesboro closed. So the families weren't wrong, exactly. They were just asking me to do something impossible.
What's the impossible part?
Brenda Kay: Okay, so take Mrs. Dockery. She's 83, has lived in that house since 1978. Her daughter Amy lives in Nashville, doing real well. Works in something with computers, I don't know. Amy wants her mother to move to Nashville, has a nice assisted living place picked out, the whole thing. Mrs. Dockery says absolutely not. Says she'd rather die in her house than live in a building where nobody knows her middle name.
Now, here's what I know that Amy doesn't, because Amy comes to visit maybe four times a year: Mrs. Dockery has a whole system. She's got Jean next door who checks on her every morning. She's got the boy from church who mows her lawn and won't take money for it. She's got me, obviously. She's got the woman at the pharmacy who knows all her medications and calls if something seems wrong. She's got the prayer circle that comes by Wednesdays.
That's not just being stubborn. That's infrastructure. That's what's keeping her alive and, more importantly, keeping her wanting to be alive.
But I also know the bridge is out. I know her well is starting to taste funny, probably runoff from upslope, but she won't let me test it because she doesn't want to know. I know the volunteer fire department is down to three people and the nearest hospital is now forty-five minutes away if the roads are good. I know the heat is getting dangerous for her. She doesn't believe in air conditioning, says it's wasteful, but last summer I found her passed out on the kitchen floor at two in the afternoon.
So Amy sees the infrastructure collapsing. Mrs. Dockery sees the social infrastructure that's holding her up. And somehow I'm the one who has to figure out which one matters more.
How do you figure it out?
Brenda Kay: long pause I don't, really. I just try to keep people alive long enough for them to make their own choice, or for the choice to get made for them. Which sounds terrible when I say it out loud.
What I've learned is there's no good answer, just different kinds of bad. Some of my clients, their families moved them out. Sometimes it works, sometimes the person just... fades. Mr. Chen, his son moved him to Seattle in 2033, supposed to be this great climate haven situation. Mr. Chen was dead in eight months. Not from anything medical, really. Just gave up. His son calls me sometimes, still, asking if he did the right thing. What am I supposed to say to that?
Then there's folks like the Kowalski sisters. I'm seeing them this afternoon. They're in their seventies, never married, lived together their whole lives in the same house their parents built. Their niece in Michigan has been begging them to move up there since 2032. They won't do it. But here's the thing: they're thriving. They've turned their whole yard into this garden situation with all these drought-resistant plants, they're part of this community food share thing, they've got solar panels they bought used off Facebook Marketplace. They're adapting. They're not victims.
And then there's people like Mr. Patterson, who I'm about to see. trails off His kids are fighting about him. One daughter wants him in Arizona near her, one son wants him in Virginia near him, and they're both mad at the daughter who stayed local because she "isn't doing enough." Meanwhile Mr. Patterson just wants to stay in his house, but he's got congestive heart failure and the heat is literally killing him. Last summer I was going by twice a day just to make sure he was drinking water.
What happened with Mr. Patterson?
Brenda Kay: Still happening. He's still here. His house has a window unit now—the local daughter finally put her foot down about that—but it only cools one room, so he basically lives in his bedroom from June to September. The kids are still fighting. He's still declining. And I'm still showing up three times a week, managing his meds, making sure he eats, listening to him talk about how the mountains used to be.
You want to know the really messed up part? I've started keeping notes. Like, detailed notes about every client's situation, their family dynamics, what works and what doesn't. Because there's going to be more of this. This isn't an unusual situation anymore. This is the situation. And nobody's training home health aides how to handle it. There's no protocol for "your client's entire region is becoming uninhabitable but they have deep roots here."
What patterns have you noticed in your notes?
Brenda Kay: The biggest one is that the people who do okay with moving are the ones who move toward something, not away from something. Mrs. Henderson moved to North Carolina to live near her granddaughter. She's doing fine. She didn't move because of the floods; she moved because she wanted to see her great-grandkids grow up. The climate stuff was just the thing that finally made her do it.
The people who get moved by their kids "for their own good"? That goes badly more often than not. There's this grief that happens, and I don't think families understand it. They think they're saving their parents. What they're actually doing is taking away everything that gives their life meaning and replacing it with safety. And sometimes people don't want to be safe if safe means being alone in a place where nobody knows them.
The other thing I've noticed is that it's always the daughters. Always. The daughters are the ones calling me, asking questions, trying to coordinate care from three states away, feeling guilty. The sons show up for the big decisions, but it's the daughters doing the daily worry. And usually it's the daughters who stayed local who get blamed for not doing enough, even though they're the ones actually here, dealing with the reality.
What do you wish people understood about this?
Brenda Kay: That there's no good guys in this situation. I've seen families tear themselves apart. Adult children who haven't spoken in years because one wanted to move Mom and the other didn't. People feeling guilty because they left, people feeling resentful because they stayed. Elderly folks feeling like burdens because their children's lives would be easier if they'd just agree to move.
And the thing is, everybody's kind of right. Yes, this region is becoming harder to live in. The infrastructure is crumbling, the heat is dangerous, the floods are worse. But also, yes, these communities are what's keeping people alive, and you can't just transplant an 80-year-old like they're a houseplant and expect them to thrive.
I wish people understood that this isn't a problem you solve. It's a situation you navigate, and sometimes you navigate it badly, and you still have to get up the next day and keep going.
She checks her phone
I need to get to Mr. Patterson's. But here's what I'll leave you with: I've been doing this job since I was 28. I've seen a lot of people die. And I can tell you that the people who die at peace are usually the ones who got to choose. Not choose whether to die—nobody gets that choice—but choose how they lived until they died. Where they lived, who they were with, what they held onto.
This whole climate migration thing, it's taking that choice away from people. Either the weather takes it away, or their kids take it away, or the insurance companies take it away. And I'm just here, trying to give people back whatever scraps of choice I can. Some days that feels like enough. Most days it doesn't.
One last question. Are you staying?
Brenda Kay: laughs You know, my sister moved to Asheville three years ago. Keeps telling me to come up there, says there's good home health work, better pay. And she's right, there probably is. But all my clients are here. And I keep thinking, if I leave, who's going to be the person who knows Mrs. Dockery's middle name is Lorraine, or that Mr. Patterson likes his coffee with exactly two sugars, or that the Kowalski sisters need someone to check their blood pressure who doesn't make them feel old?
So yeah, I'm staying. For now. Ask me again in a year and I might give you a different answer.
She stands, gathering her bag
That's the thing about this. You make the best choice you can with the information you have, and then the information changes, and you have to choose again. Nobody's choice is permanent anymore. We're all just doing the best we can until we can't.