We all rely on friends for so many things: social engagement, support during a difficult time, encouragement when we try something new, feedback for new ideas and so much more. You, like so many others, require at least one friendship to feel emotionally happy, connected to caring people, and socially fulfilled. For the last 10 years Friendship Month – highlighting the importance of friends and celebrating what friendship brings to our lives – has been celebrated throughout September.
Friendship Month is something you can acknowledge by spending more time with friends or connecting with people with whom you have lost touch. We’re never too old to make new friends. For the senior or infirm, maintaining, reviving or establishing friendships can be challenging. Fortunately, 21st century tools – Facebook, facetime, skype, texting – can ease the lack of live interaction. Yet, for some, more signs of friendship are necessary, even when not immediately appreciated. The friendship you deliver to the beloved seniors in your life will most likely take new forms of expression; at their stage of life, new priorities take center stage and while they can be difficult, there are ways your friendship will become even more precious.
During the last quarter of the year, we commonly start a planning process on behalf of declared goals; you and your family may want to engage this process for the seniors in your life on behalf of their physical, financial, emotional and mental health as well as helping them shift into many changing situations. Patience will be a strong way to express friendship for the senior whose life is changing so quickly.
Friendship can be expressed through advocacy. Taking on the role of fiduciary, power of attorney, or guardian may come as your loved one’s ability to manage their own care and funds declines. However, much earlier, you may wish to communicate with their physicians, attending appointments when possible. Seniors, older than boomers, have been raised to respect authorities, such as doctors, and may not bring the questions that need to be raised on their behalf:
- Why are they on this medication?
- Are you aware of another doctor’s prescriptions?
- What family member has been describing mom’s changing behaviors?
Sometimes, as a friend to your loved one, you need to make difficult decisions. Being able to determine when forgetfulness has drifted into the beginnings of dementia can be most painful. Or, convincing an older adult s/he is no longer capable of driving or handling their affairs. Added stress to this, making your role as friend even more critical, is when your loved one is resistant to having you take over; it’s a loss of their independence and a huge life change. Here’s a simple way you can assist with their desire to continue participating in their life decisions as you gradually get more involved: place a large bowl where all mail – bills, bank statements, advertisements, reminder notices, etc. – will be collected by the senior. During your visits you’ll review them all for the necessary actions. Be a friend by continuing to respect their need to express their dominion over their own life until they gradually come to see you as a capable partner rather than a bulldozer.
And, even if others have been assigned legal roles for your loved one, they may not have the time to manage some of the day to day needs – shopping, preparing meals, handling laundry – so you might pick up that role as ‘team leader’ among those who’ve stepped up to handle the varied and necessary tasks of a continued life of quality.
Speaking of new roles, as a friend to your senior you may need to decide to bringing in a member of a growing profession, the Aging Life Care Professional or Manager. Often known as Geriatric Professionals, the size of our current aging population has brought this profession to the forefront of care. And, whether minor issue or crisis, this profession is capable to help in a range of needs: it’s a holistic approach that provides answers for worried families, healthcare management, guidance to make choices that will reduce time needed away from working. Often, at an advanced stage of life the senior might have married more than once and has a blended family where priorities and stresses make clear decisions difficult and fraught with conflict. The Aging Life Care Professional is an objective and unemotional voice to help make the difficult choices easier.
Perhaps the most involved form of expressing friendship for your aging parent is when you decide to have them live with you, bringing into your family nucleus a new set of problems and needs which may overwhelm your love for your parent and bring conflict to your own siblings or other involved family. How can you best handle this?
Margaret “Peggy” Graham is an elder law attorney who firmly believes that families should get their agreements about their parent’s care in writing. Typically, family caregivers run into problems because they don’t know what their parent needs now, what they will need down the road, or what their parent or other family caregivers expect them to do.
It is best to have open and honest talks about this, even though it is often an uncomfortable subject. To start, have a transparent meeting where you seek to understand what your parent will actually need, depending on their conditions and cognitive ability. Discuss how your expectations, your parent’s expectations, and other family members’ expectations match up to those needs.
Once you have that understanding, you can start to make a plan that will suit everyone, or at least your parent and the family members who will act as caregivers. Don’t shy away from the financial aspects of this discussion. Talk about if and how the caregiver will be compensated for their time. Then discuss how mom or dad’s money will be managed.
Ideally, getting these details in writing ahead of time will mean that you avoid family conflict, resentment, and financial stress down the line.
Michael Ferraina, CEO of JEV’s Care at Home in Philadelphia advises that families should be patient and take time to get comfortable with one another. Schedules take time to get right, too. He argues that the demands of home care expand as people age. Typically, family caregivers don’t know what they don’t know, which means there are areas of their loved one’s health that they could better support, but recognizing the gap is a challenge. To address this, you should reach out to resources available in your community; examples are:
- Home care agencies: They should be able to answer questions and give referrals to other experts, too. Home care agencies may help you get the right medical equipment, or even help you handle insurance claims.
- Doctor: Your parent’s doctor can help, especially if they are a geriatric doctor.
- Other family: Not only can they provide moral support; family members can step in with unique perspectives to help your parent.
- Medicaid: Through Medicaid there are programs that can help manage your parent’s care.
- Veteran’s Affairs: Veteran benefits include some support for elders in home care.
Before any of this, you obviously must have a conversation with your parent, one that will be extremely difficult. Yet, with the goal of maintaining or expanding your friendship, you’ll need to call on skill: patience, direct language, planned remarks, prepared for a difficult response. Whether it’s about giving up the car, moving from their home, turning their legal and financial affairs over to another, there’s so much underlying emotion here, for you both. You’ll want to express your concern for them, the risks you believe they’re now likely to experience. ‘Ammunition’ that will assist making your case will be observed evidence, doctor’s notes, mistakes in their recent banking, decline in the state of their home or personal appearance. If the most difficult of decisions – to move your parent from her/his home – is what’s necessary, it makes good sense to have that discussion before their decline puts them in a crisis mode; a professional residence with healthcare will be better able to provide ongoing care if they have a history with you and a patient and got to know them in a healthier or more tranquil state.
Friendships come in so many expressions; yours on behalf of a beloved senior as they approach end of life may be the most difficult and most heroic at the same time. There are, as mentioned throughout this article, many resources available for you. Perhaps the easiest way to access them and learn of others, relevant for your situation, will be a phone call to our office.
DECADES: the 40’s
During World War II many seniors came out of retirement to help with the war effort. Their employment income probably kept many of them off the welfare rolls during the war, but they had to retire once again when servicemen returned home and needed jobs. The war also added to the size of the disabled population who needed long term care, and created many new widows and orphans who needed financial assistance. In 1939, the Social Security Act had been expanded to include survivors and dependents benefits, and the war greatly increased the number of people covered under the system. After the war, the Veterans Administration added new benefits for newly-disabled veterans or surviving spouses.
The size of the elderly and disabled population was growing, and many of them were now eligible for government payments of one kind or another, including veterans benefits, old-age assistance, Social Security, and unemployment assistance. Many of those payments could be used to pay for nursing home care, further encouraging the development of care facilities. In fact, Old Age Assistance benefits doubled to over $400/month by 1947.
Catherine F. Rowlands, MBA, NHA, CMC, FL-RG, MT
Sue Fernandez, Community Educator for the Alzheimer’s Association
Liz Barlowe, MA, CMC, former president, the Board of the Aging Life Care Ass’n
Michael Ferraina, CEO JEV’s Care at Home
Margaret Gram, elder law attorney
Library of Congress