It deals with a hidden underclass, "orphan elders," those who have outlived their families and friends and have no one to assist them with medical and other issues. As longevity increases, more of these elders are finally beginning to surface, forcing those charged with their care to address the issue. One social service agency has taken on the challenge.
They are called "elder orphans" -- perhaps 8,000 or so older Minnesotans in fragile health who have outlived their families, close friends and even their ability to make important medical or financial decisions.
Most are women such as Alice Furman, 74, who lives alone in a Minneapolis apartment. Others are scattered across Minnesota in houses, apartments and nursing homes, some with dementia or mental illness, all growing frail.
"They're just one crisis away from a judge appointing a guardian to look after them," said Minneapolis social worker Mary Bornong, "when often what they need is a friend."
In a program believed the first of its kind, Bornong's social service agency, Volunteers of America (VOA), is seeking out people like Furman, helping them fill out health-care instructions, then working to find advocates for them.
The advocates will become the "friends'' they need, appointed by them to carry out their wishes for treatment when illness or dementia have silenced their voices. Based on their values, the advocates might weigh the risks of surgery or drug treatments -- and in the end, might make life and death decisions.
That bit about "their values" is an important one. All jurisdictions have a process in place for appointing conservators or trustees to assist those whose competency is in issue and who need help, but that process usually gets invoked late in the process, when the elder has slipped too far to be heard. What Mary Bornung and the VOA program are offering is an earlier intervention so that sympathetic people who have been advised by the elder just what he or she desires in those situations can act in accordance with the elder's wishes when the time comes.
"But elder orphans may slip through the cracks, nobody asking the important questions until too late," Bornong said. "A court-appointed guardian may be a wonderful person, but they won't know the person they're representing. That means the patient may end up being overtreated or undertreated -- depending not on the values of the patient, but the guardian." [Emphasis added]
The VOA program at this point is a tiny one, with only $200,000 in state money to carry out the mission, but it is an important one. As a pilot project, it can point the way for other and more comprehensive projects so that this group of our population is adequately served.
Good on you, Mary Bornung and Volunteers of America.
And that reminds me: it's time to update my medical directive. You might consider doing likewise, even if you have plenty of family around.