Monday, February 17, 2014

Who Are the Caregivers for Elders without Children?

We have periodically reported on the issues of caregiving for elders.  The default caregiver seems to be the adult children of the elder, but what about those elders who have no children?  That's the focus on an article by Abby Ellin in the New York Times on February 14, 2014. The Childless Plan for Their Fading Days.  The article references an August 2013 study from AARP, noting

11.6 percent of women ages 80 to 84 were childless in 2010. By 2030, the number will reach 16 percent. What’s more, in 2010, the caregiver support ratio was more than seven potential caregivers for every person over 80 years old. By 2030, that ratio is projected to decline to four to one. By 2050, it’s expected to fall to three to one.

Unlike China, the Times article mentions, the U.S. doesn't have a law that mandates adult children visiting their 60+ parents. The article reviews the trend of an "expanded family" with ties to "second tier" relationships such as cousins, nieces and nephews rather than immediate family.  The article goes on to note that concerns are not just limited to who will provide the care but include paying for the care, housing, estate planning and agents for decision-making.

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You’ve pointed to a major problem. The assumption is that families look out for their loved ones as they age. That presumption was on display last week at the hearing in Sacramento on assisted living.

But many people don’t have family. And many more who have family, don’t have family that are going to intervene to help them when they need the help.

Continuing Care Retirement Communities (CCRCs) appear to provide a haven for these self-reliant elderly people if they can afford care and are responsible enough to want to provide for their own care before they need it. CCRCs may even market themselves as meeting this need. But as a practical matter, as was evident during last week’s hearing, even CCRCs operate on the assumption that there is caring family to get involved.

As just one example, consent of family members is often needed before an aging relative can be transferred outside the CCRC because the relative’s condition cannot be treated within the licensure of the CCRC. When management scours the country to find a plausible relative, and settles on a second cousin, multiply removed, as the pretext for what seem like an expulsion to the trusting older person, that is hardly protective of the best interests of these older orphans.

People without caring relatives to intervene for them are more reliant on the trustworthiness of the provider organization than other residents. Yet, it’s not clear as a legal principle that CCRCs and their management companies are fiduciaries charged with a high standard of responsibility for the welfare of others. See for a discussion of recent cases.

This is an unrecognized challenge that those in positions of responsibility seem to have had little interest in addressing.

Posted by: Jack Cumming | Feb 18, 2014 8:20:57 AM

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