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Alternative Living Arrangements for the Elderly

By Daniel B. Kaplan, PhD, LICSW, Assistant Professor, Adelphi University School of Social Work
Barbara J. Berkman, DSW, PhD, Helen Rehr/Ruth Fitzdale Professor Emerita, Columbia University School of Social Work

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Patient Education

Living arrangements and relationships that do not involve living with a spouse, with an adult child, or alone are fairly common among the elderly. For example, a substantial proportion of elderly people who never married, are divorced, or are widowed have long-standing and close relationships with siblings, friends, and partners. Understanding the nature of these relationships helps practitioners plan care that is in keeping with a patient’s wishes.

Consideration of the homosexual elderly

About 6 to 10% of the US population are estimated to be homosexual adults, including as many as 4 million of the elderly. Elderly people in a homosexual relationship face special challenges. The health care system may not be aware of their sexual preference, may not recognize their partner as having a role in caregiving decisions or as being part of the patient’s family, and may not provide services that are appropriate for their circumstances. For example, an unmarried partner may not have legal standing in decision making for a cognitively impaired patient and may not be able to share a room in a nursing home or other congregate living setting. Health care practitioners should ask questions about partners and marital status or living arrangements, and try to accommodate patient preferences.