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Elderly Americans will depend more on friends, extended family as country ages
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No Caption - photo by Lois M Collins
Family members already form an "invisible workforce" that cares for America's frail elderly. But changes in policy and family structure from elderly divorce to smaller families suggest that friends and extended family will play even more important roles as caregivers in coming years.

Eighteen million Americans already care regularly for a fragile older relative, most often a spouse or a parent, and the number is expected to at least double by 2050.

Meanwhile, aging baby boomers have relatively fewer children than previous generations, creating what Richard Schulz, director of the University Center for Social and Urban Research and associate director of the Aging Institute at the University of Pittsburgh, calls a "looming gap between what's needed and its availability." Those most in need of help are individuals with dementia or who have difficulties taking care of their own basic needs, from dressing and bathing to preparing their own food and managing their medications and finances, among other daily tasks.

That gap will likely widen further because fewer Americans are marrying, couples who don't marry are less apt to see themselves in caregiving roles for each other, and divorce among older couples has been on the rise. So caregiving networks increasingly include what some gerontology experts call "chosen kin" and "collateral kin," an umbrella that includes friends, neighbors and more distant relatives, like nieces and nephews or in-laws.

That shifting landscape of caregiving was a major topic during the 2016 annual meeting of the Gerontological Society of America, held in New Orleans in mid-November. Experts say not only are family and friends tapped to provide a large portion of the care frail old people need, but they're also tasked to provide more complicated care.

The impact on caregivers can include more stress, financial pressure and health-related problems of their own.

Non-professional help

Rita Choula's caregiving story from Charleston, South Carolina, is fairly typical. The senior adviser to the AARP Public Policy Institute described watching her mom care for her own parents: "It's what we do. We don't put our folks into homes."

Then it was Choula's turn to juggle caregiving and career and marriage and family. She remembers shopping trips with baby supplies on one side of the cart and adult diapers on the other. Eventually, her mom's needs were beyond her capacity and she had to put her into long-term care. "I think I was more upset than she was," Choula said.

About half of family caregivers are in the workforce, as Choula was, juggling sometimes competing responsibilities. They have little training despite the fact they often undertake tasks once solely the realm of skilled professionals like doctors and nurses, according to Schulz.

Because family caregivers typically fall into the role without learning a right or wrong way to provide care, "they have little confidence in their own know-how to get the job done," said Jennifer L. Wolff, a gerontologist, researcher and associate professor of health policy and management at the Johns Hopkins University Bloomberg School of Public Health. Such caregivers are "at greater risk for burnout, depression and not being able to care for themselves."

To further complicate things, because of health privacy and security rules, those caregivers are among the "least likely (to be) able to get the information they need to coordinate and manage care" for their frail or ailing relatives or friends, she said.

Several experts at the conference emphasized the need for individuals while healthy to make sure they've completed paperwork to name trusted people to speak for them medically and just as importantly, to receive information about their care should need arise.

Caregivers need support, including training, and must be incorporated into the formal care team usually made up of professionals, including doctors and home health providers, among others "as a critical and active member," said Rani Snyder, program director of The John A. Hartford Foundation, which focuses on improving care for older adults.

"Caregivers are the linchpin of long-term care," she said, "the person who holds together critical elements of another person's life."

As people live longer, more live alone. They are also more likely to develop disabling conditions that require more everyday care. "It's a major question who will provide that care," said Jacquelyn Benson of the University of Missouri, who noted "divorce and remarriage may weaken adult children's sense of obligation." Nor is it clear who will care for the growing number of single men and women.

About 65 percent of people age 85 to 89 need help. Of those 90 and older, only 25 percent do not need assistance, said Rosemary Blieszner, associate dean of Virginia Tech's graduate school.

"Chosen kin"

If one expands the number of caregivers to include the so-called "chosen kin" or "collateral kin" who provide different types of help to older Americans, caregiver numbers jump to 34 million-plus. Chosen kin include friends and neighbors, while collateral kin are relatives like siblings and nieces and nephews. Most of those helpers don't provide the same level of assistance as spouses and children, who Jyoti "Tina" Savla, assistant professor of human development at Virginia Tech's Center for Gerontology, called the "first safety net" for frail elderly.

Friend caregivers are typically younger than the person they assist, are most apt to be female (also true of family caregivers), and often are highly educated, single and without minor children. Often, the individual they assist does have children, said Tracey LaPierre, a University of Kansas sociologist.

Pals are more likely to take an old friend grocery shopping or to the doctor than to provide personal care, though that may change alongside demographic shifts. Their help consists largely of providing transportation, assistance with household tasks and companionship. Blieszner notes that "chosen kin are often preferred over family" by the individual receiving care. Adult children and aging parents don't always get along.

Friends typically are unpaid and, unlike family caregivers, seldom live with the person they assist. Nearly one in five chosen kin provide some care for more than 10 years.

Friends play a significant role for LGBT adults who need care, she said.

In a survey, LaPierre said care recipients rated higher their relationship quality with friends who help than that of others. The friends agreed: "80 percent reported no financial, emotional or physical difficulties from caregiving," she said.
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How to avoid 'sharenting' and other paparazzi parenting habits
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A recent study revealed parents often spend up to two hours staging a single photo of his or her child to post online. - photo by Amy Iverson
Before having kids, some people just dont appreciate their friends baby posts. But after having a child of their own, three fourths of new parents jump right on the parental social media bandwagon. If you have become a member of this group, there are some rules to follow for posting responsibly.

Much of a parents worry is how to teach their children to use social media responsibly. We talk with our kids about privacy, oversharing, and setting restrictions on their devices to keep them safe. But parents themselves need to look in the digital mirror once in a while. Before having children, it doesnt take as much effort to think about what to post online. Its up to us to decide what we share about our own lives. But once you become a parent, there are many questions to think about regarding what is appropriate to post about your kids on social media.

In a recent survey, kids clothing subscription company Mac and Mia surveyed 2000 new parents to find out how they are documenting their kids lives on social media, and what concerns they may have.

First of all, people without children seem to feel a bit differently about the onslaught of baby pictures online than those who are parents. 18 percent of people say before they had kids, they were annoyed by their friends baby posts. But after having children of their own, 73 percent admit they post progress pictures of their little ones every single month.

Not only are new parents letting the world know each time their baby is a month older, but they are posting about their kids every few days or so. Men and women report they post 6-7 times per month about their baby.

And while 70 percent of new parents say the benefit of using social media is how easy it is to help family and friends feel involved, there are some downsides. Here are a few tips to avoid the pitfall of becoming paparazzi parents.

Dont miss the moment

In the Mac and Mia survey, some parents admitted to spending up to two hours to get the perfect shot of their baby. That seems a little extreme. New and old parents alike should be careful about spending so much time taking pictures and videos that they dont enjoy the moment. Years ago, I decided to never live an experience through my phone. A study by Linda Henkel, a psychology professor at Fairfield University in Connecticut, found that when people took pictures of objects in an art museum, they didnt remember the objects as well as if they simply observed them.

This photo-taking impairment effect can happen to parents as well. If we are so consumed by getting the perfect photo, we can miss out on the moment all together, and our memory of it will suffer.

Dont forget about privacy

60 percent of couples say they have discussed rules and boundaries for posting their babys photos, according to the Mac and Mia survey. Even so, men are 34 percent more likely to publish baby posts on public accounts. If parents are concerned about their childrens privacy, keeping photos off of public accounts is a given.

In the Washington Post, Stacey Steinberg, a legal skills professor at the University of Florida, and Bahareh Keith, a Portland pediatrician, wrote that sharing too much information about kids online puts them at risk. They write that all that sharenting can make it easier for data thieves to target out kids for identity theft. Check that your privacy settings are where they should be and never share identifying information like full names and birth dates.

Dont be paparazzi parents

36 percent of parents say they take issue when their childs photo is posted online by someone else. Responsible social media users will always ask permission before posting a photo of another child. But parents should also think about whether their own children will take issue with their own posted photos a few years down the road.

When parents are constantly snapping pictures and throwing them on social media, it can be easy to forget to pause and make sure the post is appropriate. I always use the billboard example with my kids. I ask them to picture whatever they are posting going up on a billboard in our neighborhood. If they are okay with that, then their post is probably fine. Parents should ask themselves this same question when posting about their children. But they should also ask themselves if their child would be OK with this post on a billboard in 15 years. If it would cause embarrassment or humiliation, it might be best to keep it private.

Once children reach an appropriate age, parents should include them in the process of deciding what pictures are OK to post. Researchers at the University of Michigan surveyed 10- to 17-year-olds and found children believe their parents should ask permission more than parents think they should. The kids in the survey said sharing happy family moments, or accomplishments in sports, school and hobbies is fine. But when the post is negative (like when a child is disciplined) or embarrassing (think naked baby pictures or messy hair), kids say to keep it off social media.
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