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Surrogate Families and Long Term Care

Spring is a time to turn the page on our bad habits and start new and positive behaviors.  Here’s a challenge of what self-interested baby boomers should resolve to do right now:  reach out with personal compassion and respect to younger people.  This might seem to be inverted thinking from “respect your elders.”

Over the last century, progress in transportation and technology enabled the settling of our vast country and made the intergenerational family farm all but obsolete.  Maybe your children, as mine, are now adults who have relocated outside of our geographic area to fill the labor needs of America’s expanding economy.  As 20th century labor mobility has undercut traditional family life, affordable cellphone plans appeared in response.

In 1915, a 3-minute coast-to-coast phone call cost $20.70, which was 3 percent of the $687 average annual income.  By 1940, that same call cost $3 when the average house rented for only $30 per month.  By 1970, the 70-cent cost was the same as a McDonald’s quarter-pounder.  Now the insignificant cost of a lengthy call along with Skype might deceive us into believing that our family needs are fulfilled by inexpensive communication.  They aren’t.

Today’s communication is not much more meaningful than when I, as a child, chimed in “Hello Grandma, I love you” during a 3-minute call.  Fifty years ago, Bell Telephone advertised that “long distance is the next best thing to being there.”  Maybe it is but it’s a “poor second” and an inadequate balm for the loneliness and vulnerability of older persons who are distant from their family’s younger generations.

When I was growing up, my mother “adopted” three widows who shared special times with our family.  Those surrogates helped to fill the void of absent biological grandparents whom I rarely saw.  Until she was in college, our daughter did not realize how lucky she was to grow up in the same town with two sets of grandparents who she saw often and knew well.

Especially since our children live out of state, I’m glad that my wife and I own long-term care insurance and have colleagues at Keystone Elder Law P.C.  Both will be great assets when aging causes us to become frail and we need to develop and implement a caregiving plan.  It certainly would be a healthy supplement if a surrogate, family-like relationship would develop outside of our organizational environment.

I have witnessed such an intergenerational relationship develop among members of a service club when one is missing a parent/grandparent(s) and another is missing a child/grandchild(ren).  Similarly, such relationships can originate naturally among neighbors.  Churches that seek a means to translate scripture into practice could encourage and nurture intergenerational surrogate families.

Pennsylvania rewards live-in caregivers. The state initiates an action during probate to recover Medicaid funds paid to provide care in a nursing home.  However, live-in caregivers who do not own their own home and who lived with an unrelated frail person for at least two years prior to that person relocating to a nursing home may inherit the home free of any estate recovery.

In his futuristic novel titled “2030,” Albert Brooks suggests that by that date, the national debt will have outpaced the gross national product, medical breakthroughs with cancer and other diseases will enable longer life expectancy, and older persons will be confined in worn-out and all-but-forgotten cruise ships that are anchored off the West Coast.  Young people, who work harder and receive less, will be incited to form gangs and become violent against older people who to them seem selfish.

Could surrogate families be a possible antidote for both the intergenerational separation caused by mobility and the pessimistic clash between the young and old as told in Brooks’ novel?

Over the past half century, the American melting pot has blended Catholics and Protestants, and Christians and Jews, into neighborhoods and families.  Is it too hopeful to imagine that Judeo-Christian families and neighborhoods will assimilate peaceful Muslims?  Would acts of kindness from Judeo-Christians to vulnerable younger Americans not only lead to surrogate families but also make our younger generation less vulnerable for recruitment by radicals who promote terrorism?

As my wife and I visited our children and grandchildren in south Florida over Thanksgiving, I observed a significant number of interracial families. This contrasted with my recent, sad experiences with a couple of families in which a parent had alienated their child decades ago because of an interracial relationship.  Could it be that racial intolerance within families is waning as rapidly as the relevance of the cost of a long-distance call?

The legislature and courts have forced a legal settlement of most of the controversial sexual preference issues.  Is Brooks correct that the emerging issue for the 21st century will be the young versus the old?  According to a Pew Foundation study, the declining percentage of Americans who are younger than age 15 will cross over the growing percentage of Americans who are over age 65, at the number of 20 percent just before the year 2030.

How will the legislature and courts manage public resources and entitlements when fewer younger people are available to support the larger number of older people who live longer?  Will life-prolonging drugs be provided to the poor?  Will Medicare have maximum lifetime benefit?  Will the cost of long-term care for seniors deplete Medicaid funding for young families and children?  Will the ethics of assisted suicide and euthanasia be considered seriously?

Politicians have kicked the can of painfully real solutions into the future.  Our children will be taxed excessively not only to repay escalating public debt created by our generation, but also to pay for entitlement programs to take care of aging baby boomers. Be proactive about this dilemma.

If not out of sheer kindness, then in recognition of your probable future long-term care needs, create a surrogate family.  Find younger people in your neighborhood, service club or church to befriend graciously now.  Maybe they will respond in kind to manage and advocate for your care in the future.

Dave Nesbit is the principal attorney certified in Long Term Care insurance at Keystone Elder Law P.C. in Upper Allen Township. They can be reached at or 697-3223. The Elder Care column appears Fridays in The Sentinel.