Mrs. Bouvier says her friends, Zelda Fitzgerald, Frances Farmer and Sylvia Plath, were jealous of her good looks and it drove them crazy. All three women were known for having been institutionalized, Fitzgerald and Farmer for schizophrenia and Plath for a breakdown that resulted in suicide.
The episode was inspired by the fact that the show has many elderly characters, which the writers felt was unique for network television, so they sought to highlight those characters.
David Mirkin said the episode was also a tour de force for Julie Kavner. He added that even though she enjoyed the process, it was tough on Kavner's voice because those characters talk with "gravelly voices".
Originally, the episode was supposed to be about Misery (1990). One of the ideas was that Grampa would get injured on Mr. Burns's property and get stuck there, leading Grampa to think that Mr. Burns would kill him when he was discovered there. However, this idea was cut out in production because the script was over 85 pages long.
Maggie turns a year old in this episode (she used to be in her first eleven months for the first 101 episodes of the show, and for seasons 1-5), and has been a year old since this episode.