Showing posts with label abandonment. Show all posts
Showing posts with label abandonment. Show all posts

Monday, June 7, 2021

Family Ties? Estrangement Common; Complicates Aging in Place Planning

Aging in Place Planning demands careful attention to the personal social safety net available to a senior.  This social safety net, meaning family and friends who are willing, available, and able to help a vulnerable senior, is vital in protecting a senior from avoidable and unnecessary institutionalization.

Complicating planning is what appears to be a rising incidence of familial estrangement, and the hesitance on the part of seniors to disclose or acknowledge estrangement where it exists.  Add to these the possible callousness of some family members, whether or not estranged, and a senior has an outrageous prescription for disaster.  This blog has previously discussed familial callousness and abandonment, in  shocking and heart-breaking examples.  See, for example, "Seniors with Dementia Abandoned by Family Caregivers at Hospitals and Homeless Shelters."  This latter article  describes a not-uncommon pre-COVID-19, practice of putting demented family members on planes with one-way tickets to major metropolitan centers, hoping that they will be collected and cared for by authorities.   

The Economist, recently asked, "How many American children have cut contact with their parents?" The subtitle to the article suggests an answer: "A young field of research suggests it is surprisingly common."  A recent study conducted by Cornell University, for example, found that 27% of adult Americans are estranged from a close family member. Karl Pillemer, a professor of sociology who led the research and wrote a book about its findings called “Fault Lines”, says that because people often feel shame, the real figure is likely to be higher. The relationship most commonly severed is that between parent and adult child, and in most cases "it is the child who wields the knife."

Unfortunately, family estrangement has been a subject of research for only the past decade, and as a result, there is no data to show whether it is becoming more common. Many sociologists and psychologists think it is.  Divorce, for example, has long been understood to  heighten the risk of other family fractures. Joshua Coleman, a psychologist and the author of “Rules of Estrangement," found in a recent survey of 1,600 estranged parents that more than 70% had divorced their child’s other parent (children of divorce are more likely to dump their fathers, he notes). In recent years, though  America's divorce rate has actually fallen, other trends are making parent-child estrangements more likely. 

The Economist explains:

A rise in individualism that emphasizes personal happiness is the biggest factor. People are increasingly likely to reject relatives who obstruct feelings of well-being in some way, by holding clashing beliefs or failing to embrace those of others. Personal fulfilment has increasingly come to displace filial duty, says Dr Coleman. Whereas families have always fought and relatives fallen out, he says, the idea of cutting oneself off from a relative as a path to one’s own happiness seems to be new. In some ways it is a positive development: people find it easier to separate from parents who have been abusive. But it can also carry heavy costs.

More individualistic than most rich countries, America also has a higher divorce rate. This suggests adult-child separation is more common in America than it is in other places. “My impression is that this isn’t considered much of a problem in many European countries,” says Dr Pillemer. Geography also plays a part. Though people move from state to state less than they used to, America remains one of the most geographically mobile countries in the world. The vast distances often involved allow people who want to leave their families behind to do so.

.     .     .

Those who decide to break off contact with their parents find support in a growing body of books (often with the word “toxic” in the title), as well as online. Threads on internet forums for people who want to break ties with their parents reveal strangers labelling people they have never met as narcissistic or toxic and advising an immediate cessation of contact. This may make it easier to shelve feelings of guilt.

Therapy has played a role too, says Dr Coleman. A lot of therapy in America emphasizes the role family dysfunction plays in personal unhappiness. Though it is often a factor, it is also often not, he says. “As therapists we need to do due diligence on what our patients say. Just as I wouldn’t take at face value a parent’s depiction of their parenting as flawless, I wouldn’t assume an adult child’s claim that a parent is ‘toxic’ should be accepted without further inquiry,” he says. He is launching an online programme with a British researcher that helps therapists and others develop techniques for working with those who have become estranged from close relatives.

Raising awareness about the issue in this way is likely to be important, and not only because some broken bonds may be fixable. Parent-child estrangement has negative effects beyond the heartbreak it causes. Research suggests that the habit of cutting off relatives is likely to spread in families. But most immediately, it is likely to exacerbate loneliness in old age.

Dr. Pillemer, who is also a professor of gerontology in medicine at Weill Cornell Medicine, says the idea for the research was sparked by a one-to-one survey he did of elderly people. “I discovered that dozens had been cut off by their children,” he says. Often, they did not want to admit it. People who work with the elderly should consider the possibility, he says, that an old person is not receiving the support and solace that might be assumed about someone who has adult children. “Mrs Smith may say she has two daughters,” he says. “She is quite likely not to add that she never sees them.”

Heartbreaking. 



See: How many American children have cut contact with their parents?, The Economist, May 22, 2021 (last accessed June 3, 2021).  

Monday, November 19, 2018

Seniors with Dementia Abandoned by Family Caregivers at Hospitals and Homeless Shelters

Jeremy Jojola, investigative reporter for Denver KUSA/9NEWS, has published a heart-wrenching story uncovering a horrifying, but all-too-common, practice of family caregivers abandoning seniors suffering from dementia by abandoning, and stranding  seniors in public airports, malls, hotels, hospitals, homeless centers, and in at least one instance, a local McDonald's.  Jojola described the plight of 80-year- old Jerry Ellingsen, who suffers from Alzheimer's:
Within the bustle and organized chaos of Denver's massive airport, an 80-year-old man with Alzheimer's disease named Jerry Ellingsen was found wandering alone after traveling with his small dog from Fort Myers, Florida. 
Jerry didn’t know where he was or why he was in Denver.
A United Airlines supervisor found Jerry confused and alone, with only a small dog, near an exit door outside the ticket counter, and promptly called the police.  A police report indicated a flight attendant described Jerry as possibly suffering from Alzheimer’s.  One Denver police officer spoke with Jerry, and noted in his report:
“He was very confused about general details of his life to include where he was at, where he was coming from, who he was coming to visit and his family members’ names."
Police looked up the woman who checked him into his flight, and ended up talking to his daughter.  Police soon learned that Jerry's daughter, who was his agent under a Power of Attorney, put him on the one-way flight from Fort Myers, Florida.  She intended for Jerry to live with his estranged wife, but had texted the estranged wife only the day before with a simple notification that Jerry, and his dog "will arrive on a flight in Denver tomorrow afternoon."  The daughter made no other arrangements to transport her father, or communicate with her father's estranged wife, until sometime after he arrived, and then only texted the estranged wife, "[i]f you need to drop my dad at a homeless shelter, it’s fine. I just want him to have a roof over his head. Please." 

Jerry's family refused to rescue Jerry so police transported Jerry to University of Colorado Hospital. Laws require hospitals to admit and keep at-risk adults who’ve been abandoned until caseworkers can find safe placement for them, which can lead to extended stays for months and even years.

Jerry’s story sparked a 9Wants to Know investigation into at-risk adults who end up languishing in hospitals because they have no family to take care of them, or a facility willing to take them in due to a lack of space, finances, or appropriate scope of care.  The investigators conducted a point-in-time survey with the help of the Colorado Hospital Association because hospitals do not keep track of stays by people like Jerry.  Investigator Jojola described what the investigation discovered:
A three-month long 9Wants to Know investigation is uncovering a growing health care epidemic where hundreds of people like Jerry are abandoned every year at metro-area hospitals. The epidemic is costing hospitals and in some cases, taxpayers, millions of dollars a year.
Nineteen metro area hospitals participated in the survey, which revealed on a single day in September, 113 at-risk adults were stuck in the system, beyond medical necessity.  Of those patients, about 30 percent had mental health issues like Alzheimer's and dementia. Most of the stranded people were men over 40 years old.  The longest stay was 577 days!  

According to the article, Denver Health has a special wing called the "Oasis Unit" that houses around 30 at-risk adults on any given day. Denver Health reports it expected to spend $18 million on the Oasis Unit in 2018.  Anecdotally, Denver Health officials cited a case that resulted in a stay of eight years in the Oasis Unit.  Tax payers and consumers end up bearing the cost.  Hospitals in Colorado can cost up to $2,500 per day, per patient. 

A Knoxville television station also broadcast a report about Jerry's case.  Both reports indicated that charges were unlikely to be filed against and member of Jerry's family. The video broadcast identified the daughter's name, who, ironically worked for a health care agency specializing in providing health care for seniors.  

Instances of professional caregivers abandoning patients and residents are well-documented (see, for example, here, here, and, see here, what is hopefully an usual case in which professional caregivers abandoned a couple, who were then later abandoned by a privately paid professional caregiver who had worked for the first professional caregiver).  Family abandonment is less well understood and documented.

Given the stress and strain of caregiving, and the feelings of helplessness and abandonment that caregivers often feel, it is possible that caregivers simply surrender, leaving their vulnerable wards at risk.  Regardless, the only solution is advanced planning, including considerations of the demands and risks of caregiving, and the costs of same.  Greater education and support for caregivers from the community is also well past due.   

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