By Stephanie
Chamberlain and Carole Estabrooks November 11, 2019
What
happens when a person grows older and is no longer able to make health and
financial decisions for themselves — but also does not have family or friends
who can make those decisions on their behalf? Health and social services
use a hard-hitting term to describe this growing population: “unbefriended.”
“Unbefriended”
individuals may have experienced homelessness or mental health issues or
substance abuse; they may be estranged from their family, have outlived their
family or never had a partner or children. Although the “unbefriended” can be
of any age, they are often older adults.
“Unbefriended”
seniors are the most vulnerable of the most vulnerable — and we need to do more
to safeguard their access to basic daily needs, including companionship, and
improve their quality of life.
There’s
actually not much known about this population, which is why we undertook a study — the first
of its kind in Canada — examining the quality of care and quality of life for
the “unbefriended” across seven long-term care homes in Alberta.
Our
study found that many of these individuals are low-income, living on limited
government-provided pensions. Even though they are living in long-term care
facilities where they have food and shelter, few can afford basic personal care
items, such as clothing, lotions or denture adhesive. Similarly,
uninsured services, such as dental, hearing and eye care and foot care services
are beyond their financial means.
Even
those that can afford these basics frequently go without them because they have
no one to purchase these items on their behalf or arrange for appointments.
Our
study found that overworked care aides in long-term care facilities — who
themselves often make a basic wage — frequently purchase supplies out of their
own pocket to help the “unbefriended.” One care aide reported buying dental
adhesive out of her own money so the residents in her care could put in their
dentures. Another reported seeing “unbefriended” seniors in worn and
thread-bare clothing so scouted out second-hand clothes for them.
We also
found that “unbefriended” individuals have limited social interaction,
especially if they exhibit challenging behaviours due to mental illness or
dementia. Little social interaction contributes to a lower quality of
life. Those with more financial means could hire a companion for social
interaction, but most are unable to afford this luxury or are unable to
facilitate hiring someone.
In
Canada, “unbefriended” seniors are assigned a government-appointed public
guardian to take over decision-making responsibilities on their behalf, such as
for their healthcare and living arrangements. But public guardians are
not care providers or family members. They do not spend much time with
their clients who live in long-term care facilities because they are deemed
safe and housed. Many public guardians carry large case loads of well over 50
clients. While they are supposed to visit their clients four times a year, they
often struggle to meet this goal.
Our
study found that compared to residents with family members, “unbefriended”
residents often have different “goals of care” — the medical orders that
provide guidance to health practitioners about what level of life-saving
interventions to employ. Most public guardians wish to keep these goals at the
highest possible resuscitation levels even though this may not be consistent
with the resident’s care goals.
So what
can be done to improve the quality of life and access to basic daily living
needs for someone deemed “unbefriended”?
We
could expand the public guardian role to include basic living needs beyond just
food and shelter, such as quality of life markers and social interaction.
Alternatively, governments could fund organizations to work alongside public
guardians to systematize such services so that no individual is left neglected
or forgotten or relying on the charity of care aides.
But
first and foremost, we need to simply put the “unbefriended” on the map. We
can’t address what we don’t count and measure, and largely, they are the
forgotten population in the policy landscape.
With
the numbers of single households rising
dramatically, more and more of us could find ourselves in this
position as we age. We owe it those who are at their most vulnerable to provide
a life of basic dignity and security.
https://quoimedia.com/unbefriended-seniors-often-lack-basic-daily-needs-and-suffer-extreme-social-isolation/
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