Putting in place an A-team of allies

Jun 1 2017

Earlier this year, 30 senior citizens convened in a living room to talk about growing older and needing more help.

Who will be my allies as I go through this process, they asked.

Many were unmarried, without children, living alone. Some had adult children living elsewhere, with demanding jobs and busy lives. Others had spouses who were ill or temperamentally unsuited to the task.

None of the seniors had talked about this issue in a public forum before the gathering here. Most weren't sure what to do.

Millions of older adults are in a similar situation, peering into an uncertain future without knowing whom they can count on to be at their side.

The Chicago get-together, organized by The Village Chicago, a community of adults 50 and older on the city's north side, offers some "I'm in the same boat" guidance.

At that meeting, Bill Gordon, 80 — single, with no children — got up and described an extensive "allies" system he's worked hard to put in place over the past several years.

The setup has four tiers. In the first are three close friends who have powers of attorney for legal, financial and health care decision-making, should Gordon not be able to handle these responsibilities.

In the second are more than 25 friends and acquaintances whom Gordon — disabled by degenerative motor neuron disease — can call on for a ride to the doctor or a trip to the grocery store.

In the third tier are Gordon's primary care doctor, lawyer and financial adviser, with whom he has close personal relationships. In the fourth are helpers he pays for services, including a driver and a handyman.

The underlying principle: "You need a team of people who you can call upon," Gordon explained recently in a conversation in his artfully decorated Chicago apartment.

He's made sure the three core members of his team — a male friend in St. Paul, Minn., a female friend and former work colleague in Chicago and another male friend in Chicago — know each other and can step in for each other should that be necessary. All have copies of essential legal documents.

As for his circle of friends and acquaintances, "I don't ask anyone for help unless I absolutely have to. You don't want to wear people out," Gordon said.

Nor do you want relationships to become defined by your needs. "You have to stay in touch with people, and not just when you need something," Gordon said.  "I remember birthdays, I send emails, I pick up the phone and call."

Also, you need to make sure that your core allies really know what you value as you grow older. When he turned 80, Gordon updated his preferences regarding health care — "no invasive tests of any kind to get at the bottom of what's wrong with me" — and discussed the changes at length with his tier 1 friends.

At the Chicago meeting, Carole Senderowitz, 74, divorced for seven years and with no children, decided she needed to expand her group of allies. So, she invited a woman she'd worked with and considered a friend to lunch. "This was someone who had never let me down," she said.

When Senderowitz asked the woman if she would be an ally, her friend said she was touched and would gladly offer whatever assistance she could.

Next, Senderowitz connected with a retired cardiologist who'd been helping his elderly parents with all kinds of issues. "He said maybe I should open a business and do this for other people, and I said I'll be your first customer," Senderowitz remembered. The doctor replied that he'd be there for her as a friend.

Now, Senderowitz is reconsidering what to do with health care decision-making.  The friend who agreed to serve as her power of attorney for health care is at the height of her career and has a tendency to cut Senderowitz off when she tries to talk about difficult issues.

"We talk in snippets instead of having a conversation where we go from start to finish, which is what I really want," Senderowitz said.

An essential ally should be someone you trust, who's willing to have these kinds of conversations and who has time to follow through, the Chicago seniors agreed during their meeting.

Ideally, you'll have younger allies as well as those around your age, so they can step in if a core member of your team becomes incapacitated.

"It's a big deal" to make this kind of commitment, said Beth Bradfish, 68, a Chicago composer who agreed to assume legal, financial and health care responsibility for a friend of 40 years, Catherine.

When Catherine, 84, fell last year during a hospitalization and suffered a brain bleed that left her in a coma, Bradfish had to decide whether to continue or withdraw life support. She chose the latter option after extensive deliberation.

Today, a year after Catherine's death, Bradfish is convinced she did the right thing. Yet still, she wishes she'd talked to her friend about her preferences in much greater depth.

"I didn't really know what I was getting myself into," Bradfish acknowledged.

Barbara Susin's relatives are scattered across the country and wouldn't have expertise in navigating Chicago's hospitals, rehabilitation facilities or nursing homes on her behalf. So, after attending a meeting about allies, she hired a private health care advocate.

"I wanted a professional who had lots of experience," said Susin, 76, who's single and lives alone. The advocate will be the leader of her team, which includes a friend in the Chicago suburbs who has her power of attorney for health care, and another member of The Village Chicago, who has her legal power of attorney.

Until recently, Susin thought she could handle any problems that came up herself.  But after an injury that was misdiagnosed and didn't heal properly, she now acknowledges: "I shouldn't be in charge of me during a crisis."

That may be the most important message the Chicago seniors took away from their discussions. Dianne Campbell, executive director of The Village Chicago, sums it up: "People are realizing they don't have to go through difficult situations alone and it's OK to ask for help."

KHN's coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

We're eager to hear from readers about questions you'd like answered, problems you've been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.