Eighty-seven-year-old Billie Salsman is one in a group of 6 million Americans aged 85 or older. She has no children and has lived alone since her husband’s death in 2008. Salsman has a multitude of health issues and has recently suffered from three strokes that have affected her speech, mental processing and the ability to swallow. She continues to live in her home, alone, rather than in an assisted living facility or nursing home, due to her limited retirement income. Salsman is dependent on neighbors who drive her to the grocery store and doctor’s appointments. Therapists provide her with in-home services. To combat her loneliness, Salsman passes the time reading the Bible and researching her family’s genealogy, as Salsman no longer attends in-person church services. She credits her longevity to her Christian faith, “You must remember the word ‘joy.’ Put Jesus first, then others, and then yourself.”

After washing dishes from her evening meal, Billie Salsman, 87, peers out the kitchen window of her Hodgenville, Kentucky, to check on her neighbor. “It’s hard living alone as far as not having my husband or other people here, but I’m never really alone because the scripture teaches me God is always with me.”

In preparation for a doctor’s appointment, Salsman selects a necklace to wear before being picked up at her home. Salsman said her husband gave her jewelry for birthdays, anniversaries and holidays over the years. “I enjoy dressing up on occasion, but it’s hard for me with my arthritis.”

Salsman takes a moment to reflect while visiting her late husband’s grave in Hodgenville, Kentucky. “My companion, James Salsman, and I married in my parent’s living room on December 12, 1959. He died on September 17, 2008. He was a good Christian husband, and I thank God that he chose such a good person for me. I miss him. I miss him bad,” Salsman said.

A photo of Salsman and her husband, James, is displayed above a pair of Beanie Babies in her living room in Hodgenville, Kentucky on April 23, 2023. The couple began collecting these plush toys in the 1990s and amassed a collection of over three hundred Beanie Babies. Salsman stated that the pink and blue Beanie Babies featured in this photograph are symbolic of the couple and remind her of the many weekends they spent traveling together in search of new ones to add to their collection.

To stay close to God and to combat loneliness, Salsman reads her Bible at her home daily. “God is the word,” she said. “I feel close to him when I read my Bible.”

Salsman feeds one of her two adopted stray cats in her kitchen. She adopted these pets after her husband’s death. “Gray Baby needs me to feed him, and I need him to keep me company.”

To alert any visitors who may come to Salsman’s door, she posts this note to let them know she is hard of hearing and cannot hear their knock if she is in her bedroom.

Every night Salsman has to sit on her bed then use an assistive device to pull her leg onto the mattress. It is the only way she can get into bed by herself, and the process is painful. “I sleep with my Bible, and sometimes when I hurt bad I beg God to relieve the pain. I take my Bible and lay it on that spot. And you know, I soon doze off to sleep.”

Dr. Wesley Moore, Salsman’s primary care physician, makes a house call to her home so he can rebandage her injured leg. “Dr. Moore comes to my house and charges me nothing,” she said. “He’s that kind of person. I am very appreciative of him. I thank him very much for coming to my home and doctoring me, so I don’t have to go to a nursing home.”

Salsman is distressed while sorting through multiple days worth of mail in her bed at Baptist Hardin Health Hospital in Elizabethtown, Kentucky two weeks before Christmas. Salsman was hospitalized after a fall in her home that resulted in a concussion and a fracture in her left hip. This was Salman’s second recent hospitalization, as her right hip was fractured after falling at her home earlier in October 2023. “The pain in my head and my hips is unbearable, and I’m worried about trying to keep my bills paid and making sure that someone feeds my cats while I am in the hospital. My health insurance company doesn’t want to pay for me to attend a rehab facility after I am released from the hospital to help me walk again. How can I go home in a wheelchair and take care of myself in this condition?”

With the aid of a walker, Salsman carefully makes her way down the ramp in front of her home, on her way to her neighbor’s vehicle to ride to the doctor’s office and the grocery store. She noted that church members built the ramp for her husband when he became wheelchair bound. “I can’t walk down the steps anymore. I never dreamed this ramp would be the only way I could get out of the house, too.”

Salsman, left, shops for groceries as her neighbor, Carol Marcum (center), talks with a customer at a Save-A-Lot store in Hodgenville, Kentucky. “Carol is always there. She helps take me to the doctor and to the drugstore to pick up medicine.”

In a rare and cherished moment of interaction with others, Salsman laughs with her neighbor, Carol Marcum, left, her diabetes physician, Dr. Brian Brill Jr., right, and Dr. Brill’s nurse at Brill’s Hodgenville, Kentucky, office. “Dr. Brill always knows what to say to make me smile. Going to his office for check-ups is the only positive thing about diabetes,” Salsman said.

April Wells, the pharmacy technician at Smith’s Drugstore, gives Salsman a hug after bringing her prescriptions out to her car and replacing the diabetes monitor on her arm. “I don’t feel right to go to any other pharmacy. They show you they care about you, and that’s what I need. I need to know that people really care about me.”

Back from her hospital stay, Salsman reflects on her loneliness and failing health as she lies in her bed at her home. “The days are long now that I am alone. I miss my husband and my loved ones who have gone on before me. My body hurts, but I will have to tough it out until the good Lord calls me home.”