"As traditional family structures shift and individuals age alone, the bonds of friendship are increasingly stepping in to fill crucial eldercare gaps, redefining what it means to care for one another in later life."
The notion of eldercare has long been rooted in familial duty, a responsibility passed down through generations. However, a significant demographic evolution is reshaping this landscape. With increasing numbers of individuals remaining unmarried, divorced, or choosing to forgo having children, the traditional reliance on spouses and offspring for care in old age is becoming less assured. This societal shift is creating a growing need for alternative support systems, with friends and neighbors emerging as vital, yet often overlooked, caregivers. This article explores the burgeoning role of platonic relationships in providing essential support to aging individuals, examining the motivations, challenges, and profound impact of these evolving caregiving dynamics.
In Sausalito, California, the story of Nicole Straight and Patricia Wood beautifully illustrates this evolving paradigm. For years, their relationship was one of amiable neighborliness, marked by polite greetings and occasional coffee. This changed dramatically last October when Wood, 93, suffered a fall that resulted in a broken neck, necessitating a three-month rehabilitation. Upon her return home, which she shares with her niece, Wood found herself unable to walk without assistance, admitting, "I still don’t dare go up and down stairs unless someone is with me."
This life-altering event transformed their neighborly acquaintance into a deep, supportive bond. Straight, 53, a retired chef, now dedicates her week to visiting Wood, bringing not only lattes and cookies but also delicious leftovers from her culinary endeavors. Beyond these thoughtful gestures, Straight’s husband has actively contributed to Wood’s safety and comfort, installing a grab bar in the bathroom, erecting shelves, and diligently changing light bulbs and smoke detector batteries. The communication between them is constant, with texts flying back and forth. Straight frequently texts, "I’m going to the grocery store. Do you need anything?" to which Wood, who no longer drives, readily provides her shopping list.
Wood, a retired insurance executive, expresses profound gratitude for Straight’s unwavering support, calling her "a gift from heaven." Their conversations are lengthy and heartfelt, sometimes punctuated by shared tears, but more often filled with laughter. "I never thought I’d have a new best friend at this time of my life," Wood shares, highlighting the unexpected joy and companionship this relationship has brought.
This personal narrative reflects a broader societal trend. Sociologist Deborah Carr of Boston University, who has extensively researched these demographic shifts, explains, "The number of older adults who have never married or are divorced has been increasing, so we have more people aging alone." Furthermore, Carr notes the growing proportion of individuals who are childless, whether by choice or circumstance, and the declining number of children per family compared to previous generations. These factors, combined with the increasing geographic distances between family members or instances of family estrangement, create a fertile ground for friends and neighbors to step into essential caregiving roles.
The extent to which friends are stepping into these caregiving gaps is beginning to be quantified by research. A recent study published in JAMA Network Open, spearheaded by researchers at the University of Michigan, investigated the role of friends and neighbors as caregivers, primarily in supplementary capacities. Utilizing data from the National Health and Aging Trends Study, which surveyed over 2,600 older adults with health limitations (average age of 79), researchers identified individuals who received assistance from friends and family members. While family members remained the most common caregivers, approximately 14% of participants identified friends, including neighbors, as providing crucial help. This translates to an estimated 2.4 million caregiving friends nationwide.
Complementing these findings, a national survey conducted last year by AARP and the National Alliance for Caregiving reported that 11% of caregivers support individuals who are not related to them. Karen Fingerman, a gerontologist at the University of Texas-Austin and co-author of a commentary accompanying the JAMA Network Open study, emphasizes that "Friends are among the auxiliary caregivers who have not been acknowledged. We neglect the sacrifices they make."
The University of Michigan study, considered the first nationwide examination of caregiving friends, revealed distinct differences in how they function compared to relatives. It’s uncommon for caregiving friends to live with the person they are assisting, and they rarely serve as the sole caregiver. Yee To Ng, a gerontologist and lead author of the study, noted that friends typically provide fewer care hours, averaging 18 hours of help per month, in stark contrast to the approximately 67 hours provided by family caregivers.
The nature of assistance offered by friends also tends to differ. "Friends are more likely to provide transportation," Ng states. The top five tasks most frequently performed by caregiving friends include driving their friends, shopping, assisting with outdoor activities, meal preparation, and accompanying individuals to medical appointments.
In some instances, friends offer more comprehensive support. Czes Ferrino, 82, a widow living alone in Westerly, Rhode Island, found herself in need of assistance when her car broke down. Her next-door neighbor accompanied her to multiple dealerships to help her find a replacement vehicle. Ferrino described his involvement as deeply supportive, remarking, "He walked me through it like a son would for a mother or grandmother."
However, Ng also points out that "there are some tasks friends might not be well equipped to provide or be comfortable with." Intimate personal care, such as bathing and dressing, largely remains within the purview of family members. This distinction is rooted in the inherent nature of these tasks. "Those can infringe on people’s self-esteem," Ng explains. "With family, we accept that when you’re really ill, they step up with intimate activities. It’s embarrassing to have your friends help you use the toilet."
The study also identified demographic characteristics among those receiving care from friends. Respondents who named friends as caregivers tended to be younger than those who relied solely on relatives and were more likely to hold college degrees. Fingerman suggests that individuals with higher education levels often possess broader social networks, which can translate into more readily available friends for support. Unsurprisingly, those assisted by friends were also less likely to be married and more inclined to live alone.
Ann Greenwater, 84, residing in a mobile home park in rural Humboldt County, California, exemplifies this profile. She managed independently until a few years ago when severe back pain left her bedridden for nearly three months. While she has since regained mobility and can handle most daily tasks, she admits, "I’ve never really fully recovered." Greenwater is single, with no close family beyond a distant nephew, and has stopped driving. Fortunately, a supportive network of friends from a nearby Zen Buddhist center has stepped in to assist her.
Milli Quam, 86, launders Greenwater’s clothes and delivers them, often picking up prescriptions along the way. Another friend, aged 73, has helped Greenwater navigate her computer, and several others regularly accompany her on grocery shopping trips or shop on her behalf. Additionally, members of a local volunteer organization provide transportation to her medical appointments. "I love Ann, and I’m happy there’s something concrete I can do," Quam shares, expressing a sentiment of purpose and fulfillment. "I hope I can keep doing it for a long time."
The advantages of friends as caregivers are notable. Carr suggests that "Our friends are our own age and understand what we’re going through. They may have more empathy and sometimes real knowledge they’ve acquired." When family caregivers are already providing support, the contributions of friends can significantly alleviate their burden.
However, the stability of support from non-relatives can be a concern. Neighbors may move away, and friendships can face strain if the care recipient becomes overly demanding or experiences guilt over accepting help, potentially challenging the egalitarian expectations inherent in friendships. Such strains can exacerbate depression in individuals with physical limitations, as indicated by research led by Carr.
Furthermore, policy support for these non-traditional caregiving relationships is limited. Laura Lawless, a labor and employment lawyer, notes that the federal Family and Medical Leave Act, with very few exceptions, does not provide job-protected leave for caring for a friend with a serious health condition.
Carr observes that while the expectation for family is often "through thick and thin," the societal perception of friendships can be different. "There’s huge stigma to being estranged from your family, but it’s kind of normal for some friendships to just fall away."
Back in Sausalito, Wood jokingly, but with underlying sincerity, tells Straight, "she’s not allowed to move until I die." Greenwater’s friends in Humboldt County have also remained steadfast, but like Greenwater, they are also aging. At 86, Quam acknowledges that she too may eventually be unable to drive. "I’m wondering what will happen when these friends aren’t able to come to me," Greenwater muses. "I guess we’ll deal with it when it comes." This sentiment reflects the ongoing uncertainty and the proactive, yet often unresolved, planning that accompanies the reliance on a shifting support system in later life.
