When a Friend Becomes the Person Who Helps You Grow Old

More older adults are reaching their seventies and eighties without a spouse, without children nearby, or without children at all. When driving becomes difficult, shopping becomes tiring or a medical appointment is too much to manage alone, the person who steps in may be a friend or the neighbour across the street.

We still tend to speak about care in family words: a husband looking after his wife, an adult daughter taking her father to the doctor, children discussing whose turn it is this weekend. But the family available to older adults is changing. Deborah Carr, a sociologist at Boston University in the United States, points to more people who have never married or are divorced, more who are childless, smaller families and relatives living far apart. The old assumption that family will be there has rather a lot hidden inside it.

Care beyond the family

A recent study in JAMA Network Open, an open-access medical journal, gives this informal care a number. Researchers at the University of Michigan used information from more than 2,600 older Americans with health limitations, whose average age was 79. Family members still provided most of the help, but about 14% of the older adults named a friend or neighbour as a caregiver. The researchers estimate that this represents 2.4 million caregiving friends across the United States.

What do these friends do? Two-thirds drive the older person around. They shop, cook, help someone get outside and go along to medical appointments. These are ordinary tasks until you can no longer do them alone, and then they can be the difference between living at home and not managing there.

What care between friends looks like

The examples in a report by Paula Span for KFF Health News, a nonprofit health newsroom in the United States, make the numbers easier to see. After Patricia Wood, 93, broke her neck in a fall, her neighbour Nicole Straight began visiting weekly, bringing food and picking up groceries. In rural California, Ann Greenwater, 84, has no close family and relies on friends from a Zen Buddhist centre for laundry, shopping and rides. You can read the full KFF Health News report in The Virginian-Pilot here.

When policy has no box for friendship

And the law still sees family more clearly than friendship. Karen Fingerman, a gerontologist at the University of Texas at Austin who co-wrote a commentary on the study, says friend-caregivers receive very little recognition or support. The U.S. Family and Medical Leave Act generally offers eligible workers job-protected leave to care for certain family members with serious health conditions, but not for a friend.

By the Contemplative Elder Blob, ages 73 to 78, the support network around a person may look very different from the one their parents had. Perhaps care planning should include more than savings, housing and medical wishes. Who has a spare key? Who could come after a fall? Who is allowed to speak to a doctor? And what support would that person need in order to keep helping?

Family will remain central for many people. But for millions of others, growing old already depends partly on relationships for which forms, workplaces and public policy barely have a box.