Homeward Bound: Lessons on Modern Families and Elder Care

In 2010, we began the Homeward Bound project, hoping to study the intersection of modern families and elder care because we saw, all around us, how elder care is changing. Seven years later, it is exciting to see the results of the project in the form of a published book, Homeward Bound: Modern Families, Elder Care, and Loss, and to share some of what we learned in this post.

The catalyst for the project was a conversation with a dear friend of ours, Julie, whose Baby Boomer parents are divorced; each parent then remarried and divorced again. One of Julie’s ex-stepparents—her ex-stepmother Tina—was about to undergo critical surgery, and Julie didn’t know what to do. Tina had been married to Julie’s father for 15 years, starting when Julie was a toddler. While Julie was growing up, she spent holidays with her father and Tina. After the divorce, Julie no longer visited Tina, but they remained in regular contact by phone and email over the years. Julie fondly remembers how Tina mothered her during childhood illnesses and crises, and she felt some responsibility for Tina, especially since Tina had no children of her own. However, Julie felt overwhelmed as she thought of handling all of the medical, financial, and legal caretaking that her parents, stepparents, and ex-stepparents would need from her as they aged. Julie, who also has two young children, explained that she simply was not prepared financially or emotionally to care for all the people who might need her—and she felt alone in her worries, with few resources and little support.

Of course, Julie is not alone. The Baby Boomers were the first to divorce in unprecedentedly high numbers in their young adulthood, and even now, they continue to divorce in high numbers, leading to the term “gray divorce. As we looked at the sociological data on divorced, single, and remarried Baby Boomers, we realized that the nature of caretaking is changing. There are not only more potential family members who can be involved in care, but also more possibilities for conflict between all of those new family members because of divorce and remarriage.

To figure out how caretaking is actually happening in these often complex families, we interviewed members of Julie’s generational cohort who have already cared for and now grieve a parent or stepparent to learn what worked and what didn’t in their care experience. We used our expertise in hospice care, law, and religion to analyze and tell the stories of today’s modern families who are caring for a parent.

We learned three key lessons:

1) Families shape the quality of the elder care and grieving experience of grown children. Their caretaking and mourning processes are profoundly affected by whether or not their mother and father are married, or are married to a stepparent.

The National Alliance for Caregiving reported in 2015 that the estimated prevalence of adults caring for another adult over the age of 50 is 16.6 percent, or 39.8 million Americans. Our current elder-care support systems presume a married-parent family where the healthy parent, the dying parent, and the grown children work together to provide support. When conflicts arise, which they always do, they are resolved privately, without much intervention from professionals. The death of a parent is mediated by shared norms—and a surviving spouse.

By contrast, single-parent families and stepfamilies are typically more emotionally complex, so they demand a higher level of intentional sensitivity from family members as well as professionals. A parent often serves as the cog connecting siblings, stepsiblings, and a stepparent. But when that connecting person dies, the remaining family members must cope with the loss, and, because their connecting cog is gone, they may scatter. If a blended family remained in contact a year after the death, the grown child described the care and grief experience as understandable, manageable, and personally or spiritually meaningful.

2) Formal planning helps facilitate a positive experience. All families benefit from formal planning, but, for single- and remarried-parent families, planning is even more critical because it can mediate conflicts and compensate for a lack of shared, private norms. Almost no one in our study had filled out an advance medical directive that established his or her wishes on a substitute decision-maker or on end-of-life care. Very few had bought life insurance, or written a will. We recommend including nudges related to end-of-life planning with marriage licenses and divorces. Getting married or divorced is a time to think about who is kin and who is not, and to explain what role grown children, former spouses, or a new spouse should play during a medical emergency or when an estate is settled.

3) Families rely on medical, legal, and religious professionals to begin and guide the decision-making conversation in a way that is catered to their unique structure. Medical professionals, lawyers, and clergy members can play a critical role in helping single and blended families manage elder care, loss, and wealth transfer. We recommend hospice and palliative care usage whenever possible. Most advanced planning in our research happened once a family was already enrolled in hospice. The interdisciplinary professionals in hospice or palliative care are well equipped to assess the unique family system of the dying person and cater the resources to them.

Baby Boomers are now facing end-of-life issues, and blended and single-parent families are the new normal. Our research shows how critical it is for medical, religious, and legal professionals to adapt to the heightened needs of families who do not have a shared history and common norms to resolve conflicts and clarify roles at the end of life.

Ultimately, we learned that daughters and stepdaughters, like our friend Julie, have a reason for hope, as well as the need to respond to a call to action. Many family members showed great resilience in finding ways to understand each other, to work together to each contribute something to the care process, and to decide that they would remain a family after the death of one of its members. In other families, the lack of shared norms and an absence of experienced professional support meant that caretaking and grief became a time of division, rather than unity. But, as we also learned, the time to plan is now.

Amy Ziettlow and Naomi Cahn are the authors of the new book, Homeward Bound: Modern Families, Elder Care and Loss (Oxford University Publishing, April 2017).

*All names have been changed.