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.