What happens when a person grows older and can no longer make health and financial decisions for themselves — but also doesn’t 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, 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’re 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 improving their quality of life.
Not much is 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’re 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 and foot care, are beyond their financial means.
Even those who can afford these basics frequently go without these items because they have no one to purchase them on their behalf or arrange for appointments.
Our study found that overworked care aides in long-term care facilities — who often make a basic wage — frequently purchase supplies out of their own pockets to help the unbefriended. One care aide reported buying dental adhesive out of her money so the residents in her care could put in their dentures. Another reported seeing unbefriended seniors in worn and threadbare clothing, so they scouted out second-hand clothes.
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 health care and living arrangements. But public guardians are not care providers or family members. They don’t spend much time with their clients who live in long-term care facilities because they’re deemed safe and housed.
Many public guardians carry large caseloads of more than 50 clients. While they’re supposed to visit their clients four times a year, they often struggle to meet this goal.
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 food and shelter, such as quality-of-life markers and social interaction. Alternatively, governments could fund organizations to work alongside public guardians to make such services systematic so that no individual is left neglected or forgotten, or relying on the charity of care aides.
But first and foremost, we need simply to 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 of us could find ourselves in this position as we age. We owe it to those who are at their most vulnerable to provide a life of basic dignity and security.
Stephanie Chamberlain is a doctoral candidate at the University of Alberta. Carole A. Estabrooks, PhD, is a professor in the Faculty of Nursing at the University of Alberta.