People with family often assume that aging is pretty much the same for everyone – gray hair, memory lapses, aching joints, etc. The assumption of family involvement is so fundamental to both elder law and elder care that specialists in these fields are almost completely oblivious to the special concerns of those without family, though they’ll tell you otherwise. For example, a lawyer with whom I’d requested a pre-estate planning meeting gave me a ten page form, at least eight pages of which asked about my spouse, ex-spouses, and children. And an elder care specialist I spoke with couldn’t manage to say a whole sentence without the word “family,” though specifically asked about options for people without family. Even Nolo.com, a wonderful source of ordinary English legal information, provides the following definition of estate planning: “the process of getting your affairs in order so that you make things easier for your surviving family members when the time comes.”
For people without spouses or children, the differences are underlined in every encounter with the topics of estate planning and health care surrogacy. Both workshops and print materials so much take the presence of family for granted that they rarely even mention the most important issues for people without family, namely, finding appropriate people to name as medical and financial surrogates, and as executor.
But even more important than these legally essential roles are the advocate and personal assistant roles played by family members. Family also play a key role in noticing early symptoms and intervening if necessary (e.g. seeking medical advice; taking away the car keys).
Of course, the early monitoring function depends on proximity, and in our widely dispersed society often fails. All too often, an adult child first learns of a parent’s medical condition via a call from an emergency room, Adult Protective Services, or a concerned neighbor. At that point, however, family members typically intervene. Those without family are more likely to be in denial about symptoms, less likely to stick to medical regimens, and more likely to delay seeking help. People without family are also more likely to be preyed on by scam artists of all sorts.
Family members provide numerous small but important services that are hard to replicate, from taking the time to buy special food and other treats to standing firm if a facility wants to move their relative to a less desirable room. And elders with family often receive better treatment in facilities, since family members will complain about poor treatment. Without family, who will complain on your behalf? (There are ombudsman programs, but there are many ways for people to slip through the cracks.)
As health deteriorates and physical powers wane, people with family usually end up relying on their family (for better or worse). Even children in distant locations will step up to manage their parents’ affairs and help them as they lose the ability to live independently. A 2011 AARP report (PDF) estimates that the “economic value of [family caregivers’] unpaid contributions was approximately $450 billion in 2009, up from an estimated $375 billion in 2007.”
The list of services families render is long and various. In addition to serving as advocates and providing practical assistance of all kinds, family members provide (above all) love and a sense of connection to the living. Also, because they remember their relative from before they became old and infirm, they see their elderly relative as something more than, well, elderly.
What if you have neither responsible children nor a competent spouse nor self-sacrificing friends? If you’re wealthy, you can hire surrogate children, in the form of Geriatric Care Specialists (referred to by one specialist as “rent-a-daughters”). If you are not … well, no one really knows.
People without family quickly learn that “preparing for the inevitable” means choosing one’s surrogates. Key decisions in dealing with advancing decrepitude are typically made by surrogates in the middle of a crisis, with the help of care managers. Care managers are so unaccustomed to people trying to learn their own options for a possibly distant future that it’s actually difficult to get general information about hypothetical future circumstances