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Along with things that go together like love and marriage and a horse and carriage, the words “friends and family” are permanently linked together in policy documents on health and social care. Last week on twitter, the wonderful John’s Campaign were discussing issues around the importance of family in care settings with Andrea Sutcliffe from the CQC when I crashed in to make my usual point

AWOC wholeheartedly supports John’s Campaign to enable family carers of people with dementia to have access to hospital wards at all times. We support any campaign that extends the rights and recognition of family carers and we would never underplay the role that family carers. Indeed, we spend a lot of time pointing out just how much families do do to all the people who keep saying families just aren't there to help older people anymore.

The issue of how older people without children and/or any other family are supported and advocated for in care settings and more generally is definitely near the top of the many wicked problems ageing without children will bring.

There is a definite assumption that people without children create, or will create, a substitute or surrogate family of close friends who they will be able to turn to or rely on when they get old the same way older people with children often turn to them in moments of need or crisis.

To help me write this blog, I posted a question on the AWOC facebook group

“Would you want or expect friends to e.g. take on power of attorney or make sure that your care was properly provided? Do you think it would change the nature of your friendship? Do you even have friends close enough to ask? What do you think?”

Below are some of the responses

“I have a will and two LPAs in place. I have a very close friend who is the attorney for health and welfare, she is a little younger than me and I have thought about the age issue (I’m 65, she’s 58), so I also have an advanced directive lodged with and signed by my GP. My property and finance attorney is my goddaughter to whom I’m very close, she’s in her 30s. Each of these deputise for the other. It’s the best I could manage, I trust them both completely. I have no family at all, no siblings, cousins, nieces, nephews. It’s a big responsibility however for them and not something I asked lightly, it took a lot of soul searching”

“This is a huge issue for me. I do have close friends but, having their own families, lives and commitments I can’t expect them to take me on in this way so I’m kinda at a loss”

“I have nobody close enough to do it. The idea that everyone has available competent friends in this age of mobility seems to me as much of a myth as the idea that we all have family. And even people with strong social networks often comment as they get older that everyone is leaving the world and that there is nobody still here who really knows them anymore”

“The issue about friends is that they are generally in the similar age cohort as ourselves so if the time for assistance arises they may not be in great health or mobile etc themselves. So as much as we would want to help out our friends we may not be in a position to do so”

“The two friends I count as my closest friends are both my age, so no way of knowing if they’ll still be around or capable when it’s time to be my executor. (Or me doing it for them either.) Other friends aren’t really close enough friends for me to be comfortable asking them. No siblings or nieces/nephews in the UK”

 “OnIv just put in place the new POA for my mother, on advice of a trusted solicitor. I Am thinking of putting my own in place as single and no children, but no one I feel I can ask in the extended family so I have asked close friends who I trust although that may change as we all age and maybe less able so I will have to keep assessing my own situation at a cost that’s if I am able”

Of course the AWOC facebook groups isn’t representative of all people AWOC but perhaps another way to look at it is this; how many older people who have children appoint their friends to act as e.g. power of attorney or executor of their will as opposed to their children? One of the reasons why some people can find AWOC so challenging as an issue is that it asks all of us, whether we have children or whether we dont, what our own expectations are of old age and who will support and care for us if we need it.

In “Our Voices” we point out the danger of using friends and family interchangeably

“Secondly, because of the widespread use of the phrase ‘friends and family’ when discussing support and care for older people, it is important to find out how much the reality for older people without children actually is a network of ‘friends and family’ involved in or interested in their care in the way that policy assumes it is. If the reality of family involvement is in the vast majority of cases a matter of a spouse or partner, and children, then that needs to be acknowledged. Equally, as people age, the role of their friends in providing care and support will change, and for the oldest old, the number of friends will decrease as people die”

Like the other assumptions made about people ageing without children, the important thing is to establish an evidence base. Researching to what extent older people without children do have wide friendship networks but also understanding when, and if those friends are able to step in to help both in times of crisis and when there is a need for prolonged support is crucial. Just as AWOC is often told we must not assume family support will be there, equally we must not assume friendship support is there either.

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