Working with Seniors: Health, Financial, and Social Issues
Chapter 6: The Family and Social Support Systems
Kate Hixon, 79, rises early every morning to read the paper and drink coffee on her porch as the sun comes up over the bayou. Her neighbor and friend Sam Houston, 76, likewise gets up early and takes his dog Charlie for a walk. Neighbors for 52 years, they know each other’s daily habits and unconsciously monitor these patterns to check in with one another. If one doesn’t see the other one by mid-morning, they put in a call, followed by a visit. When Kate fell five years ago and broke her leg, it was Sam who found her and got her to the hospital in less than four hours. Likewise, last year when Sam got a bad case of the flu, Kate came by with hot soup and a caring hand to see him through. They each have children and grandchildren who regularly visit, but they do not live nearby; in the day-to-day business of living and in times of need, they have come to rely on one another.
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Goldie Steinberg, 86, knew as a young girl she wanted to be a doctor. Therefore, it came as no surprise to her family and friends the day she announced that she had made a decision to pursue a career in medicine. Although she never married, Goldie has never lived alone nor regretted her decision to be single. As a young woman, she lived with her aunt in New York City, than later another doctor that she worked with at the hospital. In midlife, Goldie bought a large home in Brooklyn with a plan of helping other young female interns by offering them inexpensive room and board. Officially retired for 20 years, she has remained active in the field volunteering at a neighborhood clinic and traveling overseas with Doctors Without Borders. She continues to have a close relationship with her sister and her children, as well as a close circle of friends that she sees regularly. “Goldie’s girls” continue to come and go as resident doctors, but never lose touch with Goldie. On her 85th birthday, 85 of her old roommates gave her a surprise party to celebrate her life and their unique family of women doctors.
Introduction
Call it a clan, call it a network, call it a tribe, call it a family. Whatever you call it, whoever you are, you need one.
—Jane Howard
By birth, adoption, marriage, or other social arrangement, nearly everyone belongs to a family. From the cradle to the grave, most of us depend on our families for love, care, support, guidance, a sense of identity, and a feeling of belonging. Often we play a variety of family roles over the course of our lifetime—child, sibling, cousin, spouse, parent, in-law, grandparent, or even great-grandparent and great-great grandparent. Family members may live separately, with a partner, or in a nuclear family, extended family, or blended family household. While what constitutes a family varies by historical time, region, and circumstance, the family group is universally the most basic of social institutions.
Families play an important role in social support systems—the family, friends, and organizations that we turn to in times of need for emotional support, financial assistance, personal care, household help, and any other assistance (Atchley & Barusch, 2004; Himes, 1993). Social support provides people with a sense of being loved and cared for, esteemed, and valued. It allows us to receive and to give to others reassurance, affirmation, and assistance, especially during difficult times.
Strong family bonds and close ties with friends helps seniors cope with the life events commonly associated with aging, such as retirement, widowhood, decreased mobility, and poor health. An increasing body of research suggests that social support is an important factor of successful aging (Rowe & Kahn, 1998). Older adults with strong social support systems are more likely than those without such support to experience better physical health (Bosworth & Schaie, 1997), better mental health (Krause, 2001), a lower risk for long-term care placement (Freedman, 1996), and longer lives (Seeman, Kaplan, Knudsen, Cohen, & Guralnik, 1987).
Over the past few decades social, demographic, and economic factors have significantly altered the structure of the American family. For example, more mothers are working outside the home, people are living longer—many with limited mobility or cognitive impairment—and families are more geographically dispersed. Not surprisingly, these changes in family structure affect family relationships and the types of support provided to older family members. In spite of these challenges, the large majority of Americans strive to continue to meet the needs of their elders (Atchley & Barusch; Bengtson, Putney, & Wakeman, 2004).
It is important to note that due to constraints of space, we have generalized much of the information about families to reflect that of the majority of Americans or the national average. Family patterns differ widely between racial and ethnic groups, as well as by income and other factors. For example, the national average of female-headed households with children is 8 percent. This, however, varies considerably by race and ethnicity. In 2002, about 5 percent of non-Hispanic white and Asian households were female-headed households with children, compared to 14 percent Hispanic households and 22 percent of African-American households (Ameristat, 2003).
The interdependence and deep emotional feelings between family members create an intricate and often delicate web that you will need to understand and navigate in order to best serve your senior clients and families. This chapter provides readers with an overview of the American family—dispelling some of the myths and affirming the realities of where we have been, where we are today, and how things are likely to change in the future. It also reviews the importance of friends in social support systems. You will learn about some of the key challenges that elders and their families face and resources that can help fill in those gaps. This knowledge on the social support systems of elders will also help you identify potential problems, locate resources, and make referrals without overstepping boundaries or getting enmeshed in family conflicts.