Alternative Living Arrangements for Older People
Living arrangements and relationships that do not involve living with a spouse, with an adult child, or alone are fairly common among older people. For example, a substantial proportion of older people who never married, are divorced, or are widowed have long-standing and close relationships with siblings, friends, and partners. Some older people choose to live as unmarried partners for financial or other reasons.
Older people in unmarried partnerships may face special challenges. The health care system may not recognize their partner as having a role in caregiving decisions or as being part of the person's family and may not provide services that are appropriate for their circumstances. For example, a partner may not have legal standing in decision making for a cognitively impaired person and may not be able to share a room in a residential care facility or other congregate living setting. Laws regarding who is able to visit people in the hospital and make treatment decisions for people (see Surrogate Decision Making) who are unable to make them vary from state to state, so people in these circumstances may need to consult a lawyer.
In some instances, someone may be willing to move into the dwelling of an increasingly dependent older person. That someone is most often an adult child, but it may be another family member or even a friend. The person moving in may provide companionship only or may undertake some caregiving responsibilities. This type of living arrangement may extend the time older people are able to remain in their own home and may be quite satisfying to all involved. However, expectations of each person regarding the arrangement should be clearly expressed and agreed on.
About 6 to 10% of the United States population are estimated to be lesbian, gay, bisexual, or transgender (LGBT), including as many as 2.7 million people over age 50 and 1.1 million people over age 65. About 20% of LGBT older adults are people of color. One third of LGBT older adults are living at or below 200% of the federal poverty level, including 40% of LGBT adults over age 80.
In addition to high rates of poverty and often a lifetime of discrimination and oppression, older people in a homosexual relationship face special caregiving challenges. The health care system may not be aware of their sexual preference or gender identity, 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. Health care practitioners should ask questions about partners and marital status or living arrangements and try to accommodate patient preferences.