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Considerations for Caregivers

By Arthur N. Gottlieb

Caregiving is not for everyone. Remember, it’s not about you. If the relationship is too emotionally charged or patience is not your best virtue, find someone else to take over the primary role of caregiver.

It is important to reflect upon your motivations for being a caregiver and to make an honest assessment of your limitations.

As a caregiver you may at times feel powerless and sad. But an experience laden with difficulty may also provide opportunities to strengthen relationships with loved ones, and for the development of one’s own personal and spiritual growth.

About Visits
Focus on the quality of interactions with a loved one, not on the quantity.

Consistency and predictability of visitations are important, especially for the homebound.

Communication Skills
Learn the healer’s art of “bearing witness.” This means listening empathically and suppressing the urge to intervene with solutions.

When speaking to someone in bed or in a wheelchair, sit down or otherwise lower yourself so that you are at the same eye level as they are. This will distinguish you from others who remain standing, essentially looking and speaking down to them with the unspoken but inherent power differential this implies.

Choose your battles wisely. Attempting to address an irrational situation with rationality is generally futile, and will increase conflict with no resolution

The hearing impaired are often too prideful to admit that they haven’t heard most of what you just said, and are hopeful that they can eventually figure it out.

Those with mild cognitive impairment are still quite capable of comprehension, but the thought process may have slowed down a little. Be patient and speak slowly.

Restoring Dignity
Asking for a senior’s opinion about a non-provocative issue may offer them an opportunity to feel respected and still relevant.

At the dinner table when others are present, if a person needs to have their food cut for them, discreetly take the plate back into the kitchen and cut it there. This will add an unspoken but important element of dignity for those being cared for.

Residential and Financial Concerns
The attitudes and behaviors of many seniors are oftentimes driven by an unspoken fear of abandonment.

When parents do not feel that their children have made wise decisions for themselves, they are naturally hesitant to turn over financial control to them.

It was not uncommon for senior women to have deferred to their husbands’ judgment when choices were being made about financial and property issues. If now widowed, they may feel more comfortable acting in accordance with someone else’s say-so for important decision-making.

It may be illuminating to discover what memories a senior has of his or her own parent’s convalescence. What would they, as caregivers, have done differently? Had they promised themselves they would never go to a “nursing home”?

When a senior is facing the prospect of moving to a continuing care or assisted living community, speak to them about what they think this will be like. Many will have a stark vision of facilities from many years ago when options were relatively limited.

About Moodiness
Seniors will experience good days and bad days due to effects of pain, adjustment to medications and or emotional issues.

Seniors who seem short-tempered may be responding to the frustrating lack of control of not being able to think as quickly, and remember as well, as they once had.

Psychology of Seniors
Understand and be prepared to recognize the issues that trigger depression and anxiety for seniors.

Be sensitive to anniversary depressions. Birthdays, anniversaries, and major holidays evoke memories of those who have passed, and independence lost.

For most, losing control of physical functioning is difficult. Experiencing the steady loss of friends and relatives leads to sadness and isolation. For those with dementia, witnessing the gradual loss of one’s own self can be the ultimate loneliness.

If a senior is grieving the loss of a loved one they think died yesterday, even if that person actually died years ago, their grief will be as deep and painful as though it just happened.  This is legitimate suffering and must be handled with empathy.

Oftentimes, a parent will have a set of expectations of how they deserve to be treated by their children based on the sacrifices they made on behalf of their own parents. When children do not meet these expectations, resentment, depression and various forms of acting out behavior are the result.

Some seniors harbor lifelong prejudices that were carefully concealed. It can be quite distressing for a caregiver to discover that their parent has “all of a sudden” developed a shocking taste for racial bias. The gradual loss of mental functioning allows one to become “dis-inhibited”; thoughts, formerly suppressed due to social constraints, are now out in the open. This applies for latent sexual desires as well, especially for men.

Denial
If the person you are caring for continually puts off medical diagnosis, they are using the defense of denial in the service of their fear. If they are never diagnosed, then they never have to face the reality of being sick.

For Senior Men
More often than not, senior men went along with the social arrangements made by their wives. If a man becomes a widower, he may feel out of place socializing with others on his own. Additionally, since women outnumber men of this age group, a man may feel he is betraying the memory of his wife when engaging in social situations involving mostly women.

Religion and Spirituality
It is important to understand what a person’s religious or spiritual beliefs are. Does he or she believe in an afterlife? Are they concerned over what is in store for them when their mortal life ends? Are they disillusioned  or angry with God?

Restore and Maintain Balance
It is essential for you, as a caregiver, to leave time for your own introspection and emotional balance. Engage in activities that serve to cleanse toxins and stress from the body and spirit.

Engage the help of others when necessary to de-stress and achieve perspective.

Rest and relaxation are critical in order to prevent “caregiver burnout.”

Raleigh Geriatric Care Management Aging Life Care Professional  www.rgcmgmt.com

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Geriatric Care Manager—>Aging Life Care Professional

WHAT IS AN AGING LIFE CARE PROFESSIONAL?

An Aging Life Care Professional, also known as a geriatric care manager, is a health and human services specialist who acts as a guide and advocate for families who are caring for older relatives or disabled adults. The Aging Life Care Professional is educated and experienced in any of several fields related to aging life care / care management, including, but not limited to nursing, gerontology, social work, or psychology, with a specialized focus on issues related to aging and elder care.

The Aging Life Care Professional assists clients in attaining their maximum functional potential. The individual’s independence is encouraged, while safety and security concerns are also addressed. Aging Life Care Professionals are able to address a broad range of issues related to the well-being of their client. They also have extensive knowledge about the costs, quality, and availability of resources in their communities.

Aging Life Care Professionals become the “coach” and families or clients the “team captain,” giving families the time to focus on relationships rather than the stress. In Raleigh, Durham, and surrounding area, contact Raleigh Geriatric Care Management, an Aging Life Care member.


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Long Distance Caregiving

Carol O’dell

If you’re a long-distance caregiver, then you know the drill. You call all the time. You coordinate care from 400 miles away. You spend long weekends or vacation time visiting your loved one and hoping before you open that door that they’re OK. Worry comes with long-distance caregiving, and so does guilt, but you try really hard to make it work — and you dread the day that won’t be enough.

You are not alone. According to a recent Caring.com poll, nearly one-third of all caregivers do not live with or, in many cases, even near their loved ones. Here’s a look at a few challenges long-distance caregivers face, and tips to help manage care from afar.

Feeling emotionally connected to your family members.

Sometimes phone calls or visits filled with doctor appointments and home chores don’t allow for heart-to-heart talks. As much as there is to cover, make the time to just sit for a few minutes and allow a natural conversation to emerge.

Set up a weekly phone-chat date for the times that you’re apart. Have it at a time when you both can look forward to it and nothing competes. After you discuss some of your “to-do” list items, begin to share something personal about your own life. Ask their advice on something — anything — from the color shoes you should wear to your cousin’s wedding to whether you should get a bigger car. Let them feel as if they’re a part of your life as well.

Getting shut out.

Many long-distance caregivers, particularly those helping someone with moderate to severe dementia, find that their visits actually aggravate their loved ones — who are confused and want to “go home” or don’t understand why you keep calling them “Dad.”

Remind yourself that you’re not just there to visit. You’re there to make sure Mom or Dad are being cared for properly. (Having a loved one with moderate to severe dementia increases the likelihood that he or she is living in a care facility.) Stay out of sight if you have to, but visit the staff, have lunch in the cafeteria, and walk the grounds. Talk to the people your loved one interacts with to find out how he or she is doing. It’s painful not to be able to connect, but remember that you’re still needed.

Knowing your loved one is safe and appropriately cared for.

Audrey Adelson, author of “Long-Distance Caregiving,” writes, “Often, long-distance caregivers obtain important information from their elder or secondhand from family members who have spoken with a member of their loved one’s treatment team. This makes it difficult to get a clear understanding of what is really going on.” How do you stay in the loop when you’re not in the area?

How to manage? By having lots of eyes. Whether you coordinate care for your loved one in his or her home or an assisted living facility, start to connect with those who interact with your loved one. Call after an appointment and ask how it went. Let them know you plan to be involved, and be sure to send a thank-you card or friendly e-mail.

Managing insurance and financial needs or making sure you can trust those who do.

Trust is a big issue for long-distance caregivers. When you don’t have people who genuinely care for your loved one and communicate with you about what’s going on, then you begin to worry, and worry, and worry.

Take the time to find professionals who can assist you and your loved one. It’s worth the time and effort. Hire an elder law attorney to make sure their financial assets are protected, or check into local resources designed for seniors and their family’s needs.

Make a plan for whatever comes next.

Long-distance caregivers dread getting “the call.” Whether it’s from a concerned neighbor or from the ER at 4 a.m., it’s difficult to know what to plan for when anything could happen. Try to laugh (or scream, or sob) when all of your planning and hard work takes a dive and you have to come up with a new plan. Change is inevitable, and when we fight that it that causes us pain.

Play “what if.” Come up with the three possible scenarios — a fall, a worsening of a condition or ailment, or a refusal to move even when that’s needed. How will you handle it? Can you go ahead and do some online searches? Can you connect with other caregivers and ask how they handled a big change and ask how it’s going now? It’s easier to face the “what ifs” when you know that somehow, some way, you will get through.

Being a long-distance caregiver comes with challenges you never thought you’d have to face. Sometimes you have to let go, just a little, of all that you can’t control. Caregiving isn’t easy, and there aren’t always solutions, so grab your rearview mirror the next time you’re in your car and look at yourself and say, “You’re doing the best you can.”

For a loved one living in Raleigh, NC, contact Raleigh Geriatric Care Management to assist with your family member. www.rgcmgmt.comRaleigh ,NC

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Stress and the Holidays: Coping Strategies to Keep you Sane

By Helen Hunter,

Every year, the media bombards us with advertisements showing the “happy family” gathering for the holidays. People from different generations are together, having a wonderful time, sharing traditions of old and creating new ones as well.

It is not that way, though, for a great number of individuals. For those who don’t have families of their own, or for those who live alone and have relatives living far away, holidays often bring heartbreak and depression. Those who have been used to family celebrations in the past and no longer have that to look forward to cannot accept the “change” in the tradition, especially if they keep hearing about others who are getting together with their own families.

There are two things to remember that can help get you through the holidays. The first thing to realize is that it is okay to cry. This can be a tough time for many. It is natural to feel depressed when your friends are having the ideal family gathering. Allow yourself to express your inner feelings.

The second thing to remember is to control the holidays, do not let them control you. This requires planning. If you know that you will be alone on the holiday, start planning ahead for what you will do. Here are some suggestions for things you can do to sidestep the holiday blues:

  1.  If you cannot be with family, try to spend time with friends or neighbors instead.
  2. Get away from the source of the depression. If your home reminds you of past holidays spent with a loved one, go on a cruise, or take a vacation to another part of the country, or go abroad.
  3. Get involved with an activity. Volunteer at a local senior center, church or community center that serves meals on the holiday, or give your services to a hospital. If you know that someone will be alone and cannot get out for the holiday, visit. If the person lives far away and you cannot physically visit, make a phone call. In helping those who are less fortunate than yourself, you can forget some of your own troubles.
  4. Invite others who are also alone to your home to share the holiday. You can prepare a meal for them, or you can go out to a restaurant. Company always helps ease depression.

Be gentle to yourself, especially if you have recently lost a loved one. If you do not feel like celebrating, don’t! If you do wish to celebrate, keep it simple. Remember the TRUE reason that we celebrate the holidays!

The important point to remember here is that if the old traditions cause heartbreak and depression, change the tradition – start a new one!

Also, be sure to review your expectations and be realistic. Not everyone is jolly, generous and loving all through the holiday season. As Wayne A. Van Kampen from the Bethesda PsycHealth Reporter wrote, “ Somehow (during the holidays) persons feel pushed into hiding, covering over, or denying the reality of sadness, fear and tension. Perhaps what is needed most is simply a more honest embracing of ourselves, others, and the realities of life.” Not everyone will have a happy family gathering just because it is the holiday season. Old resentments are likely to resurface, no matter how hard we try, when people are thrown together for an extended period.

In addition, there are a number of strategies that can be used in planning the holiday celebration.

These strategies include the following:

  • Delegate responsibilities and activities so that one person is not taking on more than can be accomplished without help.
  • Do not assume responsibility for the entire household’s holiday happiness.
  • Work minute by minute on your attitude. Postpone becoming angry and show understanding and calmness. This technique should be used not only during the holiday period, but every day!
  • Any task that you have chosen to do, whether it be the cooking, cleaning, gift wrapping, card addressing, organizing, decorating or shopping, is to be viewed as a choice that you made. Try to have fun in tackling these tasks, which will make the holiday easier and keep your spirits positive.
  • Start traditions that make the most sense to you in your life now. It doesn’t always have to be done the same way every year.
  • Do things together as a family that you all truly enjoy.

Make the holiday season a time for you and your loved ones to have fun and to share special memories. When the entire season is over, sit down, relax and count your blessings. Remind yourself as to how lucky you are. When you make an effort to have a joyous, stress-free holiday, you can avoid the stress. The key is to plan ahead, and to ask for and accept help from others.

Raleigh Geriatric Care Management www.rgcmgmt.com

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Holiday Family Gatherings: A Time for Enjoyment & Meaningful Discussions

Once again we’re preparing for families to come together over the holiday season. We long to see how our seniors are doing, especially those who are far away from us and living independently.

Are they ok? Have they been eating well? Is the house in good repair? Are they paying all the bills on time? Have they been keeping things from us?

Hopefully, during our visit with them to celebrate a time of family sharing we will be able to observe them for any signs that they need a little bit more help. There are many things we should be on the lookout for in their home, their own health and appearance, the car, the home and the yard.

Another important thing we should do while we are visiting our senior loved ones is talk.

“Talk about what specifically,” you ask?

Serious Discussions with Parents & Other Senior Loved Ones

We might find some discussions hard to begin and others may be taboo in your family or culture. Unfortunately, once your parents reach a certain age (and you as well) it is recommended that these uncomfortable discussions happen and the answers clearly brought out into the open.

Whether you want to or not, some things are just better to know.

  1. Do they have any advance directives? Is there a living will created about which you should know? What are their wishes for end of life care? Do they have a DNR or a healthcare proxy to speak for them if they can’t? It is important to hear directly from them what they anticipate their end of life to be. What if they get into an accident or have a medical emergency? If you don’t talk openly about this eventuality it will be more difficult, especially if you are at a long distance, to make decisions in an emergency without prior knowledge. Do they have burial plans already?
  2. If they have executed these documents, where are they kept? Can you get a copy? Does the doctor know about them and do they have a copy on file? Do they need to be updated?
  3. If they don’t have them created, can you do this during your visit so all their wishes are documented in case of an emergency? Now is a good time to get important documents executed while you are there to get the necessary information. These decisions must be made before your senior is no longer competent to make his wishes known legally.
  4. Do they have a will? Who is the executor? Where is the will kept – who is the attorney? Where are the contact numbers for lawyers, doctors, and other people if you need them?
  5. Are they still competent to drive safely? Has the car been damaged since your last visit? Take a ride as a passenger to test them, even if it is without them knowing your purpose for going for an ice cream cone together.
  6. Are they declining in functional status? Does it look like they are having difficulty keeping themselves neat and tidy? Are their clothes clean and in good repair? Are they shaving? Do they have unexplained bruises? Are they appearing thin or weak? Are they having trouble balancing themselves when they walk or get up from sitting? Do they need more help?
  7. Is their home still adequate to age in place? Is it where they want to be or would they rather come closer to you, go to a senior living area or move to a smaller home that is easier to care for alone? Some seniors enjoy living in an assisted living facility where they have less responsibility and more opportunity for social engagement. Is their current home accessible to transportation services if they can no longer drive? Is their home in good repair with adequate safety modifications to prevent accidents? Can you work on some modifications while you visit and schedule other more involved upgrades for when you are not there?
  8. Are they depressed or isolated? Some seniors choose to stay home and reduce their visits to places, people and events that they once frequented for a variety of reasons. Perhaps they are afraid to drive, don’t want to go alone, can’t leave the house for too long for fear of needing a restroom quickly, or have side effects of medications that keep them from being active. Seniors need to be social, mentally stimulated and engaged to prevent boredom and loneliness. It might be a good time to get them reconnected, take them to the senior center and arrange transportation if necessary. Find things for them to be active and involved from home. Set up some technology and teach them to use it so they can use social media, Skype or Facetime to engage with distant family and friends.
  9. What about their finances? Do they have enough money to meet their needs? Are they paying their bills? Do they have a supplemental insurance policy or long term care policy which you should be aware? Are they struggling to make ends meet? Are they getting the benefit of all — well — benefits to which they are entitled?

~by Kathy Birkett

Assistance is offered with Raleigh Geriatric Care Management in North Carolina www.rgcmgmt.com to help you and your aging loved ones navigate the myriad of senior resources and services.  lwatral@rgcmgmt.com for more information. 

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Aging In Place

Aging in place is a term used to describe a senior living in the residence of their choice as they age, while being able to have any services (or other support) they might need over time as their needs change, for as long as they are able. To be clear, though, aging in place is one phase of a person’s life. It is not the answer to anything. Rather, one period of time that an elderly person can enjoy and still get the things that they require. The focus of aging in place, as stated above, is to help seniors ensure they can live where they choose and get any help they need for as long as they can. It is more than that, though. The goal of an elderly person (or anyone) wanting to age in place should be to maintain and/or improve their quality of life. In order to do that, a good plan that focuses on your quality of life and covers your self, home, finances, care and other items should be created as early as possible. This plan should be maintained over time as your situation changes. Aging brings changes to us all. As a person begins their aging in place experience, it is important for them to consider and plan for the changes that will happen to them and what impacts these changes will have on their lives. As we age, our bodies and capabilities change. Examples of changes you might experience are:

  • Reduced vision
  • Decreased muscle strength or endurance
  • Reduced mental processing capabilities
  • Increased risk of falls due to balance
  • Increased risk of illness
  • Reduced hearing
  • Decreased mobility

These changes happen to most everyone in one form or another. Knowing that this is the case and choosing to have a plan to age in place means you will have a greater change to control your quality of life and independence. The impact of these changes can be seen in the daily life of an elderly person. While their physical capabilities lessen and needs change, this impacts many activities of daily living (ADL) and other activities, such as:

  • Getting around their home as easily
  • Driving safely
  • Transportation
  • Socializing
  • Home upkeep
  • Health maintenance

Planning also presents you with an opportunity to lessen the burden on your family by outlining how and where your needs are met. As well as, lessening the need for emergency assistance from community resources. Currently, the majority of senior persons aged 65 and older are living either with a spouse or alone in their own home. Many of these elderly people struggle with everyday tasks, their health care and the lives they lead in their homes. For many, their quality of life goes down as they get older. As of 2000, there were approximately 35 million Americans over the age of 65. According to the U.S. Census Bureau, by 2030 there will be approximately 71.5 million Americans over the age of 65. That number is more than twice what it was in 2000 and represents nearly 20% of the entire projected U.S. population in 2030. The challenge this number of older Americans will bring to the country is unprecedented. Given the facts surrounding the current economic problems, a failing health care system and the lack of local support systems needed to support older people, this is a serious predicament for our country. But, more importantly, it is a very big problem for millions of Americans who are aging in place (or wish to). Issues that families will continue to have to deal with include home remodeling (accessibility, universal design), support issues (finding more time for themselves, balancing work and family responsibilities of caregiving, and managing emotional and physical stress), answers to common problems (home remodeling ideas, long-distance caregiving for those caring for aging parents, lack of a support system), independent living, education and more. All of these issues will need to be dealt with in a way that empowers those aging in place and their caregivers, so people can make informed decisions about their lives and care. Deciding you wish to age in place means you are choosing:

  • how you want to spend your retirement years
  • how you want your home to be set up
  • what your health care choices will be
  • which types of assistance are right for you
  • what your wishes are for major life events (sickness, housing transitions, financial decisions)

Making these choices gives you control over your independence, quality of life and dignity. Most importantly to note, aging in place does not mean you have to do everything yourself; that’s where the plan comes in. It means you get to plan how your needs are met, who meets them and when. It’s for responsible people who want to ensure their quality of life and live it out in dignity, without being a burden to their family or community. Regardless of whether you have retired or not, it’s for you, right now. If you haven’t retired yet, it means you have time to think about your needs, research your options and put together a plan that is good for you and your family.  If you have retired, putting the time in to building a plan will help keep you in control of your life. Building a plan will help you deal with issues you will encounter down the road and ease some of the burden your loved ones will experience. For those caring for an elderly parent or loved one, it’s for you, too. You can be the most help by working with them to ensure their needs are met and wishes are respected. It also will help you provide the level of care that is right for them, and show your respect to them by ensuring their dignity is kept in tact and their needs are met.

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When There’s No Family…

~Paula Span

What if you don’t have a family (to act as health care proxy?)

“The presumption is that everyone has someone available, someone most likely younger or in better health, and better able to carry out one’s wishes or make decisions with your guidance,” Cheryl from Westchester commentedthe last time the subject arose.

But not everyone does. Ten years ago, the American Bar Association’s Commission on Law and Aging looked into this problem and cited estimates that perhaps 4 percent of older adults are “the unbefriended elderly,” a chilling phrase referring to those who can’t make decisions for themselves, have no advance directive or surrogate decision maker, and have no family or friends able to assist.

Most of those aren’t computer-literate Times subscribers trying to plan ahead, like Cheryl. They’re primarily lifelong loners in hospitals and nursing homes, the report found.

But it’s an important question: If you don’t have relatives or close friends who can serve as your health care proxy or hold your power of attorney (which in most states involve two separate documents) are you supposed to resign yourself to whatever the emergency room physician or intensive care staff member decides to do, or not do, when you can’t direct your own care?

 

Even when you’ve written advance directives, someone has to bring those documents to the attention of medical personnel. That person may have to become a forceful advocate on an incapacitated patient’s behalf. If not a sibling or nephew, a friend or neighbor, who can do it?

One solution I’ve discussed before is a care committee: A senior recruits a cadre of friends and professionals, makes her values and preferences clear, and authorizes the committee to handle a variety of eventual decisions.

Steven M. Cohen, an elder law lawyer in Boston, has organized about 20 of these. “I can’t say the idea has taken off, but for the right person it can work really well,” he said.

Though most of his clients haven’t activated their committees yet — they’re still functioning well on their own — one man with Parkinson’s disease has experienced worsening symptoms. “As his illness has progressed and he’s withdrawn, the committee is taking more on,” Mr. Cohen said.

You can also turn to professionals.

You can appoint almost anyone your health care proxy; the exception is that 38 states plus the District of Columbia place some restrictions on treating health care providers or their employees. In some states, “your cardiologist can’t be your health care proxy,” said Charles Sabatino, who heads theAmerican Bar Association Commission on Law and Aging. Neither can a nurse-practitioner who works in your cardiologist’s practice, or a social worker employed by the nursing home where you live. In other states, all of the above could be.

But you can always ask an independent professional: a lawyer, especially an elder lawyer, or a geriatric care manager (generally a social worker who specializes in helping seniors manage their care).

The problem may be finding someone willing to shoulder that task. “Professionals are hesitant to get involved in this,” Mr. Cohen said. “You can’t make a more intimate choice for someone. It’s hard enough for families.” He’ll serve as a client’s decision maker occasionally, if he knows the person well, but doesn’t welcome the role.

Many elder lawyers feel that way, said Craig Reaves, former president of theNational Academy of Elder Law Attorneys. Being someone’s surrogate means being willing to drop everything when a crisis strikes, and to continue monitoring when a client is hospitalized or needs long-term care.

“This is not a job for which an attorney can ethically charge a fee that is anything near the attorney’s normal hourly rate, if any fees are charged at all,” he said in an e-mail. And, lawyers being lawyers, he worries about liability. Mr. Reaves has taken on the role at times, “but I do not seek this job out.”

Geriatric care managers seem a better fit; they’re comfortable in hospitals and nursing homes and charge lower hourly rates than lawyers. Karen Wasserman, director of Your Elder Experts, part of Jewish Family and Children’s Services in Boston, serves as surrogate for a 97-year-old Holocaust survivor with no family, and she’s starting to see healthy people in their 70s putting their paperwork together and asking her staff to take that role.

“I don’t see it as that big a leap,” Ms. Wasserman said. “Often, it’s continuing the work we do anyway, advocating for our clients,” whom the staff has often known for years. “It’s often an honor to be there for these people. It’s part of the deal.”

Yet three of the nine care managers on her staff are uneasy with the responsibility and decline to serve as health care surrogates. At LivHome, a geriatric care management chain with branches in seven states, company rules won’t permit the staff to be proxies. “Somehow, it just doesn’t feel right to me,” said Bunni Dybnis, director of professional services.

Of course, courts can appoint legal guardians or conservators for incapacitated seniors, and guardians — often attorneys or geriatric care managers — can then make decisions on their behalf. But most seniors don’t want to relinquish their autonomy in that way.

If you’re thinking this all becomes a bit of a muddle, I agree. It’s another way in which our traditional cultural expectations for aging — the Waltons-like family nearby pitching in to provide care and guidance – clash with the reality that more than a million older people may lack available family or friends. Extended life spans mean that people may have outlived their relatives, and many of them will suffer dementia.

Given that this situation will likely worsen for the baby boomers — who had fewer children, more childless marriages and more divorces — we may see the rise of professionals serving as clients’ late-life surrogates. How individuals will pay for that is another question.

Meanwhile, people trying to plan ahead for aging without family will need detailed advance directives and a P.O.L.S.T. form as they near the end of life to tell physicians what to do. Then they’re also going to need luck in finding a committee or a trustworthy professional willing to take on this daunting responsibility.

“We’re in this interim period,” Mr. Cohen said. “And we don’t have good answers for people.”

 

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