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Chapter 3. The Role of Adult Children in the Life of an Elder

“Blood relatives have always been the only source of morally obligated support in later life.”

—Robert Rubenstein, Social Scientist

Let me start this chapter by telling you the story of Fred and Hildy, a couple without children who did not plan for their later years, but got very lucky at the end. My colleague and friend, Andrea Gallagher, shared their story with me and offered to let me use their real names. She and her husband Peter, who do not themselves have children, learned some great lessons from it … and so did I.

Hildy and Fred in their home in 2005

Andrea and Peter had recently moved into a new home and invited a few of their closest neighbors over to introduce themselves. Fred, eighty-six, and Hildy, eighty-nine, were the oldest couple on the block, having lived in their home since the neighborhood was developed, over forty years earlier. They arrived at the party a little early and stayed throughout.

As they got to know Fred and Hildy better, Peter and Andrea started helping them with small chores like putting up holiday decorations. They also learned Fred and Hildy had no children and no close relatives. Early one Saturday morning, about eighteen months later, Hildy called and asked if one of them could take Fred to the hospital for a minor procedure. Hildy did not drive. She was mostly wheelchair-bound because of macular degeneration and crippling arthritis in her legs.

What was to be a quick outpatient surgery for Fred turned into a weeklong stay at the hospital. Frustrated and concerned about the turn of events, Fred asked Andrea and Peter to sleep over at his house so Hildy would not be afraid. How could they say no? Every day they took Hildy to see Fred and either Peter or Andrea stayed with Hildy each night. One of those nights Hildy came down the hall in her motorized chair at three o’clock in the morning, fully dressed, and announced she wanted to “take you kids to breakfast.”

After a week, Fred was able to leave the hospital and return home. At about that point, it became clear to Andrea and Peter that Fred had been acting as a caregiver to Hildy in recent years as she became more and more disabled, both mentally and physically. Many other neighbors shared their relief that Peter and Andrea “came along” when they did. They had all known Fred and Hildy would need help, and no one knew who was going to help them.

Andrea and Peter began to prepare meals, take them to doctor appointments, and over time saw both of them through several more of Fred’s hospital stays. Over the next few years, watching over Hildy and Fred became part of Andrea and Peter’s lives. With the help of an aide, they oversaw all of the older couple’s daily needs.

When Hildy was medically confirmed with dementia, Fred was devastated. They had been married for sixty-three years and his life partner was slipping away before his eyes. A few months later, Fred developed sepsis and ended up in intensive care fighting for his life. Upon recovering from that episode, he recognized that he and Hildy could no longer depend solely on each other for their safety and well-being. He asked Andrea and Peter to be their legal agents, with permission to take over medical and financial decision-making for both of them, and ultimately to be executors of their wills. This was a huge responsibility, yet they felt honored to be able to help these two people they had grown to love.

Hildy died in 2009, and Fred, a year and five days later. Peter and Andrea often tell people of how they “adopted” their elderly neighbors and, though they were often overwhelmed by the work it entailed, they were glad to have been there to help avert a crisis.

Fred and Hildy were extremely lucky to find, at the eleventh hour, two trustworthy and caring people. We can all imagine what might have happened to them had Andrea and Peter not been so charitable and accommodating, or if they had seen their vulnerable neighbors as easy prey and taken advantage of a chance to siphon funds from their accounts or, worse yet, been abusive in their treatment of them.

Thankfully, the story of Hildy and Fred had a happy ending as well as an added bonus: Andrea and Peter learned, through their relationship with Fred and Hildy, that intergenerational relationships are one of the keys to survival for those without children. The experience motivated them to expand their social sphere to include people of many ages, and spurred them to do some additional planning for their own future.

What else can be gleaned from the story of Fred and Hildy? They were “aging in place” and they went into crisis. Their story gets repeated over and over, throughout cities and towns across America. Aging in place is a crapshoot. You may do well for a long time, but things can go downhill very quickly. When the body or mind of an aging parent deteriorates to the point where they endanger themselves by living alone, an adult child usually steps in to help them make a change. Those of us without children need to anticipate the possibility of this kind of trajectory and prepare others to step in when we need help and care.

Having children has never provided a guarantee of emotional and physical support in later life. However, as social scientist Robert Rubinstein and others have concluded from their research, “blood relatives have always been the only source of morally obligated support in later life.”6 That’s a strong and sobering statement. As the baby boomer generation moves into the later decades of life, those of us without children will need to take a hard look at what we might need and who will be there to help us.

Studying what adult children today are doing for their aging parents is an excellent way to better understand our potential needs in later life. Mary’s story gives us a good example of some of the ways adult children are assisting their aging parents, and demonstrates the complicated emotions involved, the creativity required, and the time-consuming nature of the support role:

Mary, who is sixty-three, has a ninety-three-year-old mother, Virginia, who still lives in the two-story house in which Mary grew up. Mary, however, has a good job and many friends in another state and has no plans to uproot her life to move back to her hometown. Although they are on good terms today, Mary and Virginia had a somewhat rocky relationship in the past, and vestiges of the old animosity remain. When Virginia was in her late eighties, Mary tried to convince her to sell the large family home and move into a retirement community, but Virginia was unwilling to move. Mary visits as often as her demanding job will allow, but her trips are still fewer than once a month.

About five years ago, Mary was able to convince her mother to pay for some modifications to her home. Mary and Virginia interviewed contractors together, ultimately hiring a local construction company to enlarge a bathroom, install grab bars, erect a ramp from the front door to the street level walkway, and reinforce a railing on the interior stairs. Virginia insisted that climbing the stairs to her bedroom each night was “good exercise,” and Mary was unable to convince her otherwise.

As an alternative to more frequent visits, Mary has taught her mother to use Skype on her computer. Mary and her mother talk several times a week, and Skype allows Mary to monitor her mother’s facial expressions, general pallor, and get a glimpse of the kitchen where Virginia keeps her computer. Mary always asks to see the pill bottles and watches her mother take her medication.

Though still mentally sharp, Virginia knows she doesn’t do as good a job managing her financial affairs as she once did, so she allows Mary to help her remotely once a month. They go online together and pay the bills on the bank’s website. This generally takes them about an hour because Virginia has lots of questions and tends to forget from one month to the next how the system works.

Mary and Virginia share a financial advisor and Virginia has grudgingly given her consent to allow Mary to speak to the professional about both accounts. However, Virginia is still reluctant to give Mary full access to her finances, so there are aspects of Virginia’s life Mary knows nothing about.

To Mary’s great relief, Virginia has remained active in her church and in her bridge club. Members of both groups visit her regularly and often bring her food she can heat and eat for several days. Mary has also arranged for a young woman to come in three times a week to do some light housekeeping.

Similar stories are playing out everywhere today with parents who are aging in their homes and in retirement communities with limited services. Even in residential care communities, substantial involvement by adult children is evident. In 2010, a national study found 90 percent of men and women in nursing homes and assisted living communities experienced regular and frequent visits by loved ones.7 The casual observer in a nursing home or assisted living community can see immediately that these visits are overwhelmingly from children and grandchildren. Adult children play a significant role in the lives of their aging parents. In fact, adult children are sometimes the ONLY source of emotional support available to the aging parent, especially one who has isolated himself or herself from community contacts or has a life-limiting disease.

Lisa’s mother, Alice, was diagnosed with Alzheimer’s disease when she was seventy-four. Since Lisa’s father had died two years earlier and her brother was a barely functioning alcoholic, Lisa was left to see her mother through the debilitating disease. For a couple of years, Alice lived on her own in a large, age-restricted mobile home park in Palm Springs. She had long-time friends and neighbors there who checked on her and reported back to Lisa if there was a problem. Lisa was a three-hour drive away, so she and her mother stayed in touch by phone.

After those first two years, Lisa grew increasingly uneasy with her mother’s living alone, especially since Alice was no longer driving and had to depend on friends for rides to doctor appointments and shopping. Lisa found herself spending most weekends in Palm Springs. The six-hour round-trip was exhausting and took a toll on Lisa’s own family and job.

The following spring, Lisa decided to move Alice into assisted living with memory care in Palm Springs. She used the proceeds from the sale of her mother’s mobile home to finance the move. Lisa chose to keep her mother in familiar surroundings and near her doctors rather than move her closer to her own home in suburban Los Angeles. However, the move further isolated Alice from her old friends and neighbors, which put Lisa front and center as the only support person in her mother’s life.

Although she knew her mother was safe in assisted living, Lisa continued to spend most weekends in Palm Springs, taking Alice out for meals, supplying her with her favorite snacks, picking up medications, buying her clothing and shoes, and talking to her about things she was still able to remember from the past.

After five years, the round-trip journey became too hard, both emotionally and physically. Lisa finally made the decision to move her mother once more, this time to an assisted living facility nearer to her own home.

Today, Lisa is sixty-five and Alice is eighty-eight. After fourteen years with the disease, Alice no longer recognizes Lisa, but that hasn’t stopped Lisa from visiting, staying in touch with her doctors, and checking with the staff in the memory care unit to find out what her mother needs. Lisa has had her own health challenges to deal with, which have limited her ability to visit her mother as often as she used to, but she continues to act as her mother’s support system, staying in touch with the staff, and visiting as often as she is able.

Lisa’s and Mary’s stories are being repeated all over the developed world, with boomers as the caregivers for their aging parents. The current cohort of aging parents—those living in their own homes as well as those occupying beds in nursing homes and apartments in assisted living communities—are composed of the two generations preceding the baby boomers. Will there be a different picture in 2040, when boomers are the ones in their eighties and nineties? One in five of them will not have adult children to provide the kind of emotional, physical, and logistical support that Lisa and hundreds of thousands of others are doing today.

Intergenerational relationships are something people with children take for granted. This is less often the case for those without children, who may never have gotten close to anyone outside their own age group unless they come from large, tight-knit families.

In order to fully understand what child-free people will need later in life, consider the variety of roles adult children play in their aging parents’ lives:

Emotional Support

No matter where parents reside, the adult children and grandchildren are usually the ones who visit, discuss family issues, share pictures, take the parent for an outing, and generally stay in close contact with parents as they age. They do this on a regular basis, in person, on the phone, via video conferencing, and in letters and emails, with the women in the family typically taking the lead.

When an older parent has maintained ties to a strong social network (e.g., friends, a place of worship, a senior center, a health club, a bridge group, etc.), additional support may be available when they need help with transportation, a task, or simply need some companionship. This can ease the burden on the adult children, especially if they do not live close by.

Residential Decisions, Real Estate Transactions, and Help with Moving

Very few childless adults reside in assisted living and continuous care communities today. Why? There were no adult children to convince them to make the move. Here is a typical scenario: The adult child or children become convinced mom and/or dad, typically in their late seventies or eighties, should no longer be driving or navigating the stairs in their multi-story home, and the time has come for them to live in a safer place. The adult children then help them “shop” for a new community—often closer to where they and the grandchildren live. Once the new home has been identified, the adult children assist in the difficult and emotional task of downsizing, which usually involves sorting through a lifetime of accumulated “stuff.” Once the cherished possessions and memorabilia have been given to family members, sold, or thrown away, adult children help their aging parents move what remains into the new, smaller space. Following the transition, the adult children often handle the real estate transaction to sell or rent the home in which the parents resided. Evelyn had to do all of these things for her mother:

For five years, Evelyn had tried to convince her widowed mother, Jean, then eighty-seven, to move out of her multi-story home. Evelyn had been raised in the large, multi-story house near downtown Buffalo, New York, and her mother had been living there for fifty-six years. Jean was adamant about not moving until one night she became dizzy and disoriented, lost her balance and took a fall in the bathroom. She hit her head on the edge of the sink, passed out for a couple of hours and woke up in a pool of her own blood. She managed to make her way to a phone and call Evelyn, who lived several hours away. Evelyn called for an ambulance to take her mother to the nearest hospital, then quickly dressed and started the three-hour drive to the hospital. When she arrived in Buffalo, she found Jean in the emergency room where she had required nine stitches in her forehead and an elaborate bandage for a badly bruised knee and foot. Fortunately, she had no broken bones.

After the accident, Jean reconsidered her position on staying in her own home. Waking up in pain and alone had scared her, and she didn’t want to risk another fall. A week later, Evelyn again talked to Jean about moving to a safer place, closer to the town where Evelyn and her husband lived. This time Jean agreed to look at a few possibilities.

Evelyn began spending her weekends researching and visiting assisted living facilities in her area. When she found two she thought her mother might like, she brought Jean down for a weekend and they visited them both. Jean didn’t like either one. She thought they were too institutional feeling and she didn’t want to eat in a dining room with “a bunch of old codgers and biddies.”

Evelyn kept looking, this time with the help of a senior care manager (SCM) who was more familiar with all the options for senior living in her area. The SCM introduced Evelyn to an alternative she had not been aware of: a spacious, one-level, suburban residence that had been converted into a board and care home. The man and woman who owned and ran it were both licensed practical nurses and they seemed dedicated to their calling. They also had several part-time aides who came in to assist in the cooking, cleaning, and care of the three residents they could accommodate. The house had a homey and comfortable feel. Evelyn met the two current residents, who seemed happy and well cared for. She also contacted their families, who told her they were very impressed with the kindness and attention their older loved ones were receiving. Like Jean, the other residents needed supervision, but otherwise were relatively independent, still mobile, and required no intense care. They were happy to be living in a comfortable home with no responsibilities for cooking, cleaning, or household upkeep of any kind. Everyone had their own bedroom and bath, and could have privacy or companionship, as they chose.

To Evelyn’s delight, Jean agreed to “give it a try.” Together they spent the next six months getting Jean packed and moved. She was reluctant to get rid of anything, but in the end agreed to give most of her prized possessions to her grandchildren and give the rest to charity. She moved into the board and care home with her own bedroom furniture, sheets, towels, and her many family pictures, which were re-installed on the walls of her new bedroom.

There were a few setbacks in her adjustment to the new life, but after two years, Jean finally agreed to let her daughter and son-in-law sell the old family home—a major milestone. Jean, now in her mid-nineties, is happy and well cared for. She gets frequent visits from Evelyn and her two nearby grandkids, one with a new baby—her first great-grandchild.

Where there are no adult children to push the issue, most older people simply stay where they are and cope as best they can. In fact, even when there are adult children in the picture, many, like Mary in our earlier story, are not able to convince the parent to move to a safer location. For many elders, the challenge of learning to navigate a new home (even a much smaller space), meet new people, give up familiar surroundings, and relinquish their treasured independence seems loathsome, insurmountable, or both.

Investments and Other Financial Decisions

As time goes on, some older adults begin to feel they are gradually losing touch with the ever-changing realities of the outside world. Adult children in the prime of life may have a better grasp of the current economic challenges or financial realities of the day. At eighty-five or ninety, a person’s mental faculties are often not all they once were. When an older person is aware of this, they might decide to let a capable and trustworthy adult child take over some or all of the financial decisions—maybe handling the investments and doing the income tax calculations—sometimes in conjunction with a fiduciary or financial advisor.

As with a residential move, some older parents see financial help as “interference.” There may be strong denial their behavior has changed, even with clear evidence such as an unfiled tax return or the purchase of a peculiar item. The parent’s denial makes monitoring the situation more difficult for the adult child who must find a way to check up on the parent without causing too much conflict.

Legal Representation

Children are most often named first on durable power-of-attorney documents (DPOA) for financial matters and health care decisions. A DPOA allows them to have legal proxy for all decisions in one or both of these domains, meaning their signature is treated as the parent’s own. Barring a lack of trust among family members, the child named on the document may be the one considered by the parent as the most competent in that area, the one living the closest, or the one considered the most astute or fair.

Bill Paying and Handling Money

An adult child often takes over money management when a parent requests help or starts displaying diminished cognitive abilities. This kind of decline shows up when a person discovers the parent has not been paying bills on time or has been writing checks to unknown recipients. The adult child then takes over the checking account and begins to shift credit information, redirecting bills and financial statements to himself or another of the adult children. Adam’s mother, in her late eighties, was aware of her diminishing capacity to handle her own day-to-day financial affairs and asked him for help:

Adam took over his eighty-nine-year-old mother’s finances after she had a debilitating stroke. Even before the stroke she had started to talk about giving up her driver’s license and was asking Adam to help her with household tasks on a more frequent basis. When the stroke occurred, she became unable to speak or write for four months. Adam recalls having her legal power of attorney a “Godsend.” The POA allowed him to get his name added to all her accounts, manage her income, pay her bills, file her taxes, and wade through the mountain of medical bills and statements that arrived daily. He was also able to arrange for her in-home long-term care and to pay himself and his other siblings for out-of-pocket expenses that occurred in the first few days of her hospitalization. After his mother recovered most of her mobility and some of her speech, Adam continued to manage her finances, and his mother expressed relief and gratitude that she had someone to take over for her.

To a great extent, involvement like Adam’s in the life of his mother will also protect her (and the estate) from financial scams by those who prey on older citizens.

Medication Management and Help With the Activities of Daily Living

Managing and monitoring medications, ensuring there is food available, and help with personal hygiene are all areas where assistance is often needed as aging parents progress into their final years. In elder care residential communities, staff provide many of these services, yet the adult children continue to take their parents shopping (or shop for them), accompany them to medical appointments, pick up prescriptions, help them put on a nice outfit for a family visit, etc.

Who will be there to help us with these things as we age? The many responsibilities and activities adult children undertake on behalf of their aging parents provide clues to how we should prepare for a later time—a time when we may not be quite as mentally sharp or as physically able as we are today.

The Social Network

As we age, our social network plays a very big role in our well-being. Parents, no matter their age, may include in their social network their children, their children’s friends, the parents of their children’s friends, their children’s in-laws, their grandchildren, and so on. One can imagine how easily and organically this network grows, even with just one or two kids. Those without children, on the other hand, create their social network by design, often including friends, colleagues, neighbors, church members, and other like-minded people as well as any siblings and those offspring interested in staying close.

During the years when parents are changing diapers, helping with homework, and playing chauffeur, those of us who are child-free are developing outside interests, deepening friendships, building their careers, and sometimes playing a role in developing their communities.

The following diagram illustrates the make-up of a typical older parent’s social network. The stronger the tie, the darker and wider the connector:

Where does this leave the rest of us? Ties with friends, siblings, nieces and nephews and even community tend to be (and should be) more prominent for us. During the years when parents are changing diapers, helping with homework, and playing chauffeur, those of us who are child-free are developing outside interests, deepening friendships, building careers, and sometimes playing a role in developing communities. Of course, parents also may have strong ties with friends and others who are unrelated, but they are rarely the primary connections in their lives.

Isolation and loneliness are the two biggest risks for poor mental health in later life.

The following diagram illustrates a typical social network for an older adult without children. As in the diagram of the older parent, the heavy, bold lines illustrate strong ties; the lighter ones illustrate looser, more tenuous connections.

Your own diagram may differ from this one. Everyone has a unique network because no two families are exactly the same, nor are any two individuals.

Research studies over the past twenty years tell us that older adults without children are no different in psychological well-being than those with children.8

Child-free adults have found ways to develop healthy social networks as well as methods for coping with difficult situations and solving thorny later-life problems. This healthy psychological make-up bodes well for our ability to cope with the challenges of being older … if we plan well. These studies also find adults without children are no less satisfied with their lives than older parents.

Isolation and loneliness are the two biggest risks for poor mental health in later life, but again, older parents can be as isolated and lonely as those without children.9 In fact, some parents reported greater loneliness than those who are childless when their expectations of their adult children went unfulfilled.

Life satisfaction, well-being, and good mental health in later life are all dependent on a social support system of one sort or another, and not necessarily from adult children.10 In the end, adult children are not a guarantee of safety and security in later life. At best, children are a safety net, which may or may not hold up under the weight of the many obligations that can be incurred.

What does all this mean? Those of us without children are as likely as our friends who are parents to be successful and satisfied throughout our lifespan. However, we need to figure out in advance how we will manage the challenges of aging and whom we can engage to help us.

The remainder of this book focuses on being proactive about planning—for where we will live, how we will manage our money, who will represent us when we can no longer speak for ourselves, and where we might turn for companionship in the future. Solving those riddles will be the key to our safety, security, and well-being in the latter decades of our lives.