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Tips for Long-Distance Caregivers

This is part 2 of a series about caregiving from a distance. Read part 1 here.

Fern, 92, called her daughter in a panic. She couldn’t turn off her television because she couldn’t find the remote. Due to Fern’s hearing loss, the volume was very high. Fern was afraid the blaring TV would keep her and her neighbors up all night.

Her daughter, Monica, couldn’t help. She was in Michigan; Fern lives alone in Sarasota, FL. 

Fern’s situation wasn’t life threatening. But it’s an example of how even a minor issue can become a crisis when an older loved one lives far away. For the millions of Americans in that situation, it’s a major source of stress. In fact, research suggests that long-distance caregiving is even more stressful than face-to-face caregiving. 

Unlike those caring for an older adult nearby, long-distance caregivers often face situations that can’t just be handled as they arise, whether it’s a missing TV remote or a serious medical crisis like a stroke or an injury due to a fall. There are no easy fixes. But experts advise that thinking ahead, and assembling a support team, can help families navigate long-distance caregiving more effectively. Here are some tips. 

Divide and Conquer 

Start by gathering family members for a conference, virtually or in-person, advises Maria Hood, a social worker and director of admissions at United Hebrew, a senior care community in the New York metropolitan area.  

“Develop a strategy to divide and conquer,” Hood says. Make a plan to rotate visits and regular phone calls. Clarify roles so no one person feels overburdened. Those who can’t visit in person might tackle other tasks: a family member who is an accountant can help manage financial issues; another who’s a medical professional can establish lines of communication with the older adult’s physician. 

As much as possible, involve the older adult in the conversation, and initiate it before a medical crisis or other “point of vulnerability” occurs, adds Barry Wu, MD, professor of medicine (geriatrics) at Yale School of Medicine.  

“Understand what your [older adult] family member’s wishes are,” Wu says. “If they don’t want aggressive treatment in the event of a medical emergency, the family should know that. If their heart stops, or they stop breathing, do they want to be hospitalized? Do they want a feeding tube? You need to know what their wishes are.” 

Other questions to ask might include:  

  • What kind of support would be helpful now? That might include transportation to doctor visits or outings, help with meals, errands or housekeeping. 
  • Could alterations in the home make life easier and safer? For example, switching from an upstairs bedroom to a downstairs bedroom or installing a ramp leading down from the front porch could prevent future accidents or make daily life easier.
  • What about anticipated future needs? If an illness or loss in mobility makes it difficult or impossible to live alone, what would the older adult want to do? Move into assisted living? Move in with a family member? Stay at home, with in-home support, as long as possible? 

Remember to keep the older adult’s wishes paramount, says Teri Dreher, an RN and patient advocate who assists older adults and their families. 

“A sense of dignity, autonomy and agency over one’s own life is even more important as we age,” she says. “Nobody likes their children to talk to them like they’re children.” 

Dreher says older adults can become stubborn or unwilling to share honestly about their struggles. Some may resist discussing the issue or insist, “Don’t ever put me in a home.” In that case, a visit to an assisted living community might help reassure them. 

“I worked with a couple in their late 70s that stayed in their house, even though they couldn’t take care of it, until the house was finally condemned,” Dreher says. “Once they moved into a senior living community, they saw how great the food was and changed their minds immediately.”

Start the money conversation as part of these family talks. How is a loved one paying for daily expenses now? How might they pay for additional care if it’s needed? These questions are important for any caregiver, but especially when family members aren’t close enough to quickly access financial records. Needs can change suddenly; an older adult could become incapacitated temporarily or permanently. 

Explore Resources 

Many agencies and local governments offer services to assist older adults—these can be lifesavers when family members can’t be present. However, it’s not always easy to find out about these services. For example, some local charities, city governments or agencies offer wellness checks—regularly scheduled phone calls to check in with an older adult, with follow-up calls and/or visits if they don’t respond. To determine if such a service is available in the older adult’s community, try searching online using the zip code or town (such as, “older adult welfare check 75024”). Or check the search tool of Shepherd’s Centers of America, which provides welfare checks through more than 50 affiliates around the United States. 

Hood suggests contacting a hospital in the older adult’s area and speaking with staff in the social work department. Similarly, the marketing staff at a senior living community near the older adult’s home will likely know what’s available locally.

Create a directory with contact information, including the older adult’s physicians, local fire, police and EMTs, and non-emergency numbers, like those of the apartment security staff or community director where the older adult lives, and names and numbers of neighbors, friends and family members. Add a list of medications and a list of locations of key documents, such as insurance policies and the person’s will. Share copies with family members and post a copy on the older adult’s refrigerator or another prominent spot. 

Enlist Technology

A big source of stress for many long-distance caregivers: worry over the older adult’s safety. Unfortunately, it’s not uncommon for older adults, especially those 90 and older, to fall and end up on the floor for hours before someone comes to help. If the older adult is amenable, consider a medical alert pendant and/or installing an in-home monitoring system. Most require some type of subscription or monthly connection fee that is not covered by insurance or Medicare.  

These systems are typically either “active,” where the user presses a button on a home unit, wearable device or wall to call for help, or “passive,” transmitting data from the user to a trusted care partner without requiring any action on the older adult’s part should they fall or become unresponsive. For example, the Apple Watch offers a passive fall detection function that can be set up to call 911 automatically if the wearer falls. (However, this technology isn’t yet 100 percent reliable and automatic updates to the watch’s software may disable the function without alerting the user.) 

Make the Most of Visits 

Many older adult living communities see an uptick in inquiries right after the holidays, when family members visit and notice signs that their loved one isn’t coping well. Visits are a good time to observe. Look for piles of dirty dishes or unwashed laundry; unopened mail, overdue notices or other signs that paperwork isn’t getting handled; rotten food in the fridge—or no fresh food at all; scorch marks on pans or countertops, possibly signs of inattention to cooking tasks. 

Visits also present opportunities to set up local lines of communication. Accompany the older adult on a doctor visit and ask to be added to the list of emergency contacts. Inquire about joining future telehealth visits, with the older-adult patient’s permission, as a way of tracking health conditions.

Keep in mind, after the visit, that an older person’s health, mobility or cognitive status can change quickly. Be ready to pivot. 

Finally, use a visit to enlist “boots on the ground.” Go to home care agencies, visiting nurse associations, transportation services and other local support services to learn what they offer. Exchange contact information with the older adult’s friends and neighbors and encourage them to call if anything raises concerns, like unusual behavior or if something seems out of place (a door left open or lights on overnight).

The key to long-distance caregiving: find local people who can provide help when your loved one needs it.

If finances allow, consider a consultation with a geriatric care manager in the older adult’s area. Also called “aging life care managers,” these professionals are usually licensed nurses or social workers experienced in the care of older people. They can provide a neutral assessment of the older adult’s situation and advise on options available locally. Generally, they serve clients and families whose incomes are too high to qualify for publicly financed services like Medicaid. Care managers can also offer references to reputable home-care agencies or professional caregivers in the area. Find a care manager in the older adult’s community by using the Aging Life Care Association’s expert search tool or the Eldercare Locator, a public service of the US Administration on Aging.

If the older adult has complex medical issues, consider hiring a local patient advocate who can step in should an emergency arise. Once a relationship is established, the patient advocate can accompany the older adult to the ER and serve as a point of contact until an out-of-town family member arrives. 

Unfortunately, these services are not inexpensive. Labor costs have increased considerably in recent years. In-home care now averages about $26 an hour for homemaker services (cleaning, cooking, etc.) and $27 an hour for a home health aide, according to Genworth’s Cost of Care Survey. Some companies’ employee assistance programs (EAP) assist employees in caring for older family members, with help finding caregiving services and even help covering the costs. 

Some Medicare Advantage plans also provide coverage for personal care assistance, non-medical transportation and in-home meal delivery through a private provider or services like Papa.com. Papa is a platform that connects older adults with Papa Pals, vetted local people available to provide companionship or to assist with cooking, cleaning, transportation and laundry. 

A Papa Pal came to the rescue when Fern couldn’t find her remote. Connor Carroll has been visiting 92-year-old Fern regularly, helping her with light housekeeping, running errands and assisting with other daily needs. After each visit, he calls Fern’s daughter, Monica, to fill her in on how Fern is doing. 

“We’ve built a rapport,” Carroll says. “It’s a comfortable relationship. Fern calls me ‘the son she never had.’ Monica tells me it’s nice to have me as her eyes and ears in the area.”

Hood says that’s a key to long-distance caregiving: connecting with professionals and others in the local area who can step in to help when needed. 

“When it comes to caring for an older adult,” she says, “it really does take a village.” 

Caring from Afar

This is part 1 of a series about caregiving from a distance. Read part 2 here.

A few years before he passed away, Maria Hood noticed that her father wasn’t shaving or showering regularly, which was unusual, because the retired military man had always been impeccably groomed. 

“He wasn’t getting into the shower because he was afraid of falling,” she said. “And his home, normally spotless, was getting messier. The dust bunnies were starting to have babies.” 

It was clear he needed help. But her father lived in Florida, and Hood was in New York.

Hood’s dilemma is a reality for millions of Americans: providing eldercare from afar. According to a 2012 Journal of Gerontological Social Work report, nearly one-third of informal caregiving occurs from a distance. 

Studies estimate that four to seven million people in the United States are long-distance caregivers, and those numbers are expected to rise as longevity increases and birth rates decline. Mobility factors in too. Adult children move away from their parents to pursue careers; parents migrate to warmer climates when they retire. When the older adult begins to experience medical issues, or mobility or cognitive decline, relocating isn’t always possible for either party. 

While the physical and emotional toll of caregiving is well documented, less has been documented about how distance plays a role. What is clear: “Geographic separation can exacerbate care-related stressors,” according to the 2012 report. 

“When you live far away, you don’t know what’s going on,” said Hood, a social worker and director of admissions at United Hebrew, a senior care community in the New York metropolitan area. “You are not the person with eyes on the ground.” 

Long-distance caregivers don’t handle round-the-clock physical care, but many experience significant emotional and psychological distress. They may feel even more distressed than local caregivers, as researchers Joan Monin, PhD, and Richard Schulz, PhD, were surprised to find in a 2009 study.

Distance can make problems seem worse than they actually are. 

“Caregivers who lived farther away, who were the siblings of the primary caregivers, often were more distressed than the caregivers providing the daily support,” said Monin, associate professor at Yale School of Public Health. 

Similarly, a 2004 study found that long-distance caregivers were more likely to report emotional distress than caregivers either residing with their care recipients or less than one hour away.

Stress often stems from the perception that a loved one is suffering, whether it’s physical pain, loneliness and isolation, or confusion due to dementia. Distance tends to amplify that perception. 

“When you’re not nearby, you may be thinking the situation is bad all the time,” Monin said. “There’s no way to know if things are actually fine if you’re not there. The psychological distress is the ruminating, the feeling that you need to stay vigilant.” 

In working with older adults with dementia and their children, Teri Dreher often hears concerns about safety—and feelings of helplessness.  

“I call it the fear of unknowing,” said Dreher, a registered nurse and patient advocate who assists older adults and their families. “It’s not understanding what’s going on and being so far away, you can’t do anything except worry.” 

Diana Cannon, a companion caregiver for older adults in the Dallas area, serves as “another set of eyes” for families who live out of town. Clients hire her to visit their loved ones in senior living communities, sometimes even in high-end facilities that purport to provide round-the-clock care. 

If you hire a caregiver locally, she can report in regularly and even send smartphone videos to reassure you. 

“That’s a big source of stress—making sure family members are getting adequate care,” she said. Communities may boast posh facilities and lavish amenities, she said, but don’t always offer consistent care, which usually boils down to the staff person on duty, who’s typically working for low pay. 

“You don’t know what’s going on, especially if the person has dementia,” Cannon said. “I’m there to make sure they’re not lonely, that they get turned over regularly [if bedridden], that someone answers when they hit the call button, that they’re being listened to and their medications are being dispensed correctly.”

One of her clients called Cannon an “extra daughter.” The client lives in Houston; her mother lived in a senior living community in Dallas until her death at age 96 in 2018. Because her mother had severe hearing loss, talking over the phone was almost impossible. 

“I’d have to scream the whole time,” the daughter said. She hired Cannon to visit and call afterward with updates. Sometimes Cannon even sent short iPhone videos showing how her mom was doing. 

Even with the means to pay for extra help, the client said, caregiving from a distance was stressful for her and her sister, who also lives hours away. 

“When you’re there with your loved one, you wish you were doing what needed to be done at home,” she said. “When you’re at home, you wish you could be there. Diane was our ‘boots on the ground.’ She helped reassure us that Mom was getting good care.” 

Strained Relationships 

Family dynamics often complicate the long-distance caregiving situation.

“Distance can invoke a lot of feelings of sadness, guilt and shame,” said Vanessa Sommer, lead family therapist for signature programming at Caron Treatment Centers in Pennsylvania. “The adult child feels guilt for not being able to be an immediate support source. The caregiver who lives far away may feel a sense of rejection if they offer something as support or help, and it’s refused. The parent may feel abandoned. Or they don’t want to be a burden to their kids or to be seen as less than capable.”

The family’s relationship history plays a role too. “Caregiving crises can bring up a lot of old resentments,” Sommer said. 

When one adult child lives close to the older adult—and the other lives far away—that can lead to conflicting perceptions of how the older adult is faring. 

“The adult child who is closer may have more daily engagement and involvement with the older adult, and they see the changes over a period of time,” Sommer said. “Whereas the distanced child who has only intermittent contact may not necessarily see the physical changes, and that can lead to disagreements.” 

It’s not uncommon for siblings to argue over caregiving decisions, especially when medical crises arise, according to Marilyn Gugliucci, professor and director of geriatrics research at the University of New England. 

“Just as there are helicopter parents, there are helicopter kids—adult children who are too controlling because they fear losing the parent,” she said. “The older adult may have said, ‘I don’t want to go through heroic measures, I’ve had my life, let me go when the time comes.’ But one of the adult children might feel the need to control their lives to ensure they live longer.” As much as possible, the older adult’s wishes should dictate how to proceed. 

It can be difficult to find out from a distance about local resources available for caregivers. 

The stress of caregiving often has ripple effects on the relationships with the caregiver’s spouse and children. Sommer, who works with families of older adults with substance abuse disorder, says a stressful caregiving situation usually affects the entire family. 

Cognitive loss or personality changes due to dementia can make communication even more problematic. Plus, older adults are often reluctant to admit that they’re having difficulty. 

That’s been a challenge for Hood, who is also caring for her in-laws, who live in Tucson. 

“So much depends on the prior relationship between the adult child and elderly parent,” said Hood. “My mother-in-law is the most amazing, sweet woman. But is she at her best dealing with a husband in poor health? Not always.” 

Family members may get frustrated when an older adult is less than forthcoming, or even dishonest, about their situation. Monin encourages empathy. 

“Imagine someone doubting your ability to care for yourself,” she said. “That can be super threatening, even when the parents and children have a good relationship.” 

“All you can do is give each other a lot of grace,” said Hood. “Try to put yourself in the person’s shoes. Most older people are fiercely independent. They don’t want to burden their children. They may dread moving into a senior living community or having someone coming into their household. It’s easier to think, ‘I’m OK.’” 

Searching for Solutions

Tracking down assistance in another city can also pose challenges. Some communities offer services like daily telephone calls or other welfare checks for older adults. Finding out about those services, however, isn’t easy for those who live far away. Monin thinks policy makers need to assist long-distance caregivers in finding and connecting with resources from afar. She’d like to see a searchable, technology platform that would allow caregivers to find reputable resources in the care recipient’s local area, such as senior community centers, long-term-care centers, hospitals, physicians and other networks of supportive communities.  

In the meantime, to keep stress as manageable as possible, experts advise thinking ahead. Anticipate problems, know the older adult’s wishes in the event of an emergency and have a plan. 

“It’s all about prevention,” said Barry Wu, MD, professor of medicine (geriatrics) at Yale School of Medicine. “If your loved one falls, for example, you don’t want to be scrambling at the last minute.” 

Wu is in Connecticut; his 90-year-old mother lives in Pittsburgh. He relies on technology to help bridge the distance. 

“Her mobility has steadily declined over the last few years, so I set up cameras in her room, with her permission,” he said. He can look in on his mother any time from his smartphone. In addition, he calls her once a day, at a specific time, to make sure she’s OK. He assembled a list of local contacts—his mother’s physicians, the security person in her apartment building, neighbors and friends—which he posted on her refrigerator and saved in his phone. When problems crop up, he can call on his brother, who lives in the Pittsburgh area, to step in. 

Maria Hood began to travel to Florida more often once her father’s housekeeping and hygiene started to lapse. She hired a housekeeper to tackle some of the household chores, which allowed her father to stay in his home a little longer. Eventually, he moved into an independent living senior community, and then, after an injury, into skilled nursing, where he spent the rest of his days. 

In response to her experiences with her father and her in-laws, Hood and her husband sat down with their son and daughter and expressed their wishes for how they’d like to be cared for when the time comes. She draws on her own experience for her job at United Hebrew as she advises families navigating caregiving from a distance.

“The first thing I tell them is, ‘You are not alone,’” she said. “There are a lot of people in the same boat.” 

What AI Can Do for Older Adults

When Alyssa Weakley’s 82-year-old grandmother was diagnosed with Alzheimer’s in 2019, the family scrambled to respond. Her grandmother lived in southern California; Weakley and other family members were in northern California and Washington State. As problems arose, they took turns flying down to see the older woman. Often, that meant leaving a job or making child-care arrangements on short notice. 

Weakley, who is an assistant professor in the Department of Neurology at University of California Davis Health, tried to find a way to use technology to help. Despite her expertise in both Alzheimer’s and assistive technologies, she had no luck. 

“There was nothing that allowed us to help her or to get feedback to know what was really going on with her,” said Weakley. 

Now, she’s part of a research team working on what she hopes will be a solution: Interactive Care, or I-Care, a platform that will use unobtrusive sensors to help caregivers stay connected to older adults living with mild cognitive impairment or early-stage dementia. 

Unlike most existing platforms to monitor older adults, I-Care will harness the power of artificial intelligence (AI) 

“Advances in AI technology offer many ways of improving people’s lives,” said Björn Herrmann, PhD, a Scientist and Canada Research Chair in Auditory Aging at the Rotman Research Institute at Baycrest Academy in Toronto. “I believe these will ultimately enable older adults to be more independent and live longer in their own homes.”

Wide Range of Benefits

“Artificial intelligence” broadly refers to machines that can understand, synthesize and generate knowledge [in] much the way that humans do, although the precise definition is still a matter of debate. AI is already embedded in many aspects of our daily lives; if you rely on a virtual personal-assistant app like Siri or Alexa, or drive a car with a navigational system or parking assist, you’re using AI.  

The public release last year of ChatGPT—a type of AI that can respond to questions and generate novel content in natural language—has raised awareness of AI’s rapidly expanding capabilities. It also highlighted concerns about its potential for proliferating misinformation and threatening individual privacy and security. 

“It’s a huge, tectonic change in the whole landscape of technology that has opened up a new era of possibilities,” said Vol Berezhniy, founder of OBS Group, an AI tech startup in Plano, TX. 

An AI system would “think” and make judgments the way a doctor does. 

AI’s potential for assisting older adults spans a wide spectrum that includes robots, exoskeleton devices, intelligent homes, AI-enabled wearables, voice-activated devices and self-driving automobiles. AI-powered devices might serve as rehabilitation therapists, emotional supporters, social companions, personal organizers and cognitive assistants. 

Many experts are especially optimistic about AI’s potential to provide more personalized medical care to older adults. Daniel Chow, MD, co-director of the Center for Artificial Intelligence in Diagnostic Medicine at the University of California, Irvine, is studying ways AI might facilitate precision medical care, which “delivers the right therapy for the right patient at the right time.”

For example, Chow said, researchers are discovering that there are many types of Alzheimer’s or dementia. A patient’s genetic makeup may point to one type or another. Each type may respond better to some medications or treatments than others. Imaging studies, like brain MRIs, provide vast amounts of additional data, including changes in the brain over time. Patients’ speech patterns might also provide clues about the type and stage of disease. Even patients’ social, economic or environmental situations may also need to factor into treatment plans.   

“That’s a lot of information, so how do we put it all together?” asked Chow, who is also neuroradiology chief in the Department of Radiological Sciences at the UCI School of Medicine. “AI allows us the computational method to include and incorporate all this information and tailor treatment accordingly.” An AI system would “think” and make judgments in the same way that a doctor does, but with the ability to quickly factor in vast quantities of data from imaging, genetics, patient history and more—and even “learn” from information collected on each patient’s response to treatment.  

Robots as Companions

Frank’s story started with a common problem: he was having trouble taking care of himself. The older man, who had mild dementia, wasn’t eating regularly or remembering to take his medications. 

Worried, his son bought him a companion robot. At first, Frank was resistant. “That thing is going to murder me in my sleep!” he groused. But soon Frank warmed to the robot, which prepared his meals, cleaned his home, helped with his medications and became a constant companion. 

Frank’s story is fiction—it’s the plot of the 2012 film Robot & Frank. But AI is turning fantasy into reality on some levels. Humanlike robots that can perform all the tasks of a butler or home health aide—and converse naturally with a human being—are still a long way off, but advances in AI are making robots more and more useful for specialized tasks, said Wendy Rogers, PhD, professor of kinesiology and community health at the University of Illinois and director of the Human Factors and Aging Laboratory. 

Several tech startups are experimenting with social robots, which provide companionship and conversation. Rogers has studied Moxie, a robot designed for children with autism, for its potential for providing social engagement for older adults with mild cognitive impairment. Unlike Alexa or Siri, users don’t need to remember to use the robot’s name to engage. 

“Moxie is very socially interactive,” she said. “One of our older adults was just talking with it and having a whole conversation.” 

Another social robot on the market is ElliQ, a small device resembling Pixar’s playful desk lamp and accompanied by a tablet. As part of a pilot project, the New York State Office for the Aging is providing ElliQ to older adult clients like Judy Washington, 74. ElliQ greets Washington every morning when she wakes up (cued when she turns on the room light), reminds her to exercise and take her medication, keeps track of her comings and goings and occasionally tells corny jokes. Washington laughs when she shares how ElliQ even gave her a nickname: “Nugget.”  

“I know it’s a machine, but it helps a great deal,” said Washington, who lives alone and has limited mobility due to a stroke. “It keeps you company.”  

For older adults who live alone, a companion robot can provide reassurance, mental stimulation and even a connection to other people. 

ElliQ typically interacts with a user 20 times a day; the device is programmed to be proactive and emotionally intelligent. Initial studies show that ElliQ reduces loneliness by 80 percent and spurred some 82 percent of users to be more physically active. 

“For older people living alone, a robotic companion can provide a sense of having someone in the house, some reassurance and safety, keep them connected to the world and other people and provide cognitive stimulation,” said Elizabeth Broadbent, PhD, professor of psychological medicine at the University of Auckland in New Zealand. “The robots can also send health data and medical alerts to medical professionals and family members to provide assistance when required.”

Broadbent has also studied Paro, a therapeutic baby harp seal robot developed in Japan. When tested in a residential care facility for older adults in New Zealand, Paro proved reliable, easy to use and comforting and calming for residents.

But there are still hurdles to widespread adoption. Robots are expensive and must be recharged periodically. Most require a connection with a monthly service fee.  

“It’s still very challenging to build a reliable robot for a price that people are willing to pay for it,” said Broadbent.

Experts note that robots and other AI-powered devices will also benefit older adults in many significant ways they may not see. Rogers expects that “back of house” robots will handle more and more time-consuming, repetitive tasks in senior living communities and hospitals. If robots deliver medications or meals in a senior community, for example, staff members are freed up to spend more time engaging directly with residents. 

Herrmann expects AI will also accelerate research in many areas that will benefit older adults. In his own work in hearing and aging, he uses brief audio stories to assess subjects’ hearing. Before, creating the stories meant enlisting writers and voice actors; now they can be generated in minutes using ChatGPT.  

Potential Downsides

The spotlight on AI and ChatGPT has raised concerns about protecting users’ privacy and security. How those issues will be addressed remains unclear, but it’s likely that government regulation, academic research and market forces will combine to design safe systems. Currently, the European Union is negotiating an AI Act to regulate how the technology is developed and deployed. In the United States, the Federal Trade Commission has issued statements with guidelines for AI companies. Academic and research institutions are also shaping the conversation.  

Some researchers worry about the potential for AI to perpetuate ageism, similar to the way social media spreads misinformation. A 2022 World Health Organization policy brief proposed measures to counter that, such as including older people in the design of AI-based technologies and on data science teams; collecting data in an age-inclusive manner; investing in ways to boost digital literacy among older adults and protecting the rights of older users to give their consent and to contest issues.

AI technologies could also empower fraudsters to reach more older adult victims, more quickly and inexpensively, with even more convincing scams. Herrmann led a study that revealed that older adults appear less able to distinguish between AI-generated speech and human speech, compared to younger counterparts.

“These findings suggest that older adults may be at higher risk of being taken advantage of,” he said.  

AI can also generate speech that mimics a specific person’s voice, which offers great promise for older adults who have lost speech capabilities. For example, AI can enable ALS patients to speak with a natural voice much like their own, in contrast to the robotic voice that became Stephen Hawking’s trademark. In the wrong hands, however, the same capability could make it easier for older adults to fall for the so-called “Granny Scam,” in which a caller posing as a grandchild claims to be in trouble and convinces an older relative to send money. 

Living Independently 

In the I-Care project’s current stage, Weakley and her team are tracking human subjects as they move about and perform activities of daily living in an apartment-like lab. Sensors installed in each room track vibrations created by the subject’s movements.

AI interprets these vibrations in precise ways. The sound of a human falling is different from a box or other object falling; information collected by the researchers will “train” the AI to detect the difference. Similarly, the system will track whether the subject spent much of the day in bed or on the couch, took their medication on time or made an unusual number of trips to the bathroom. Ultimately, the data will transmit to a family member or caregiver who can step in if needed. 

The system is unobtrusive (there are no cameras) and passive (the older person need not input any information or wear a device).

Laurie Miller, founder of AgeTechNow.com, predicts systems like I-Care won’t replace human caregivers but will act as caregivers’ eyes and ears when they are not present. 

“That might help reduce instances of ’crisis-based care’ that force families to scramble,” she said. For example, if the system notes the resident using the bathroom frequently at night—something that even a live-in caretaker might otherwise miss—that might suggest a urinary tract infection. The caregiver may be prompted to seek medical help before the problem becomes an emergency. 

If an individual can live the life they want, longer, with less assistance … that’s going to have positive emotional effects for the caregiver as well as the care receiver.

Alyssa Weakley, PhD

Miller, who also owns Apple Care and Companion, a home care agency in Plano, adds that even with current technology—like wearable pendants or the Apple Watch fall-detection app—instances where an older person falls and can’t get up for many hours still occur with alarming frequency. Older users may forget to wear their devices or refuse to call 911 out of embarrassment. Passive AI-based systems would help alleviate these problems. 

“With just a little of this kind of oversight, many older people can live safely at home longer,” she said. 

Weakley hopes the system she’s working on will eventually make life easier for the four million Americans who care for a loved one in another city or state. Had her family had access to I-Care back in 2019, she believes their story would have unfolded differently. 

Today, Weakley’s grandmother is in an assisted living community near her home. Although she resisted the move initially, she’s now happy and well-adjusted. 

“My grandmother would’ve had the potential to stay home longer,” Weakley said. “There would’ve been less crisis care; we would not have had to drop everything as often as we did. And it would’ve made the decision to transition her (to assisted living) easier.” 

Weakley thinks AI-powered innovations will ultimately boost older adults’ sense of self-efficacy and connection. 

“If an individual can live the life they want longer, with less assistance or (with) the kind of assistance they want, in an environment that is as normal as possible, that’s going to have positive emotional effects for the caregiver as well as the care receiver,” she said. 

 

Innovators Find Creative Ways to Connect the Generations

As the pandemic receded, Lenox Hill Neighborhood House, a community center in New York City’s Upper East Side, came back to life. The halls buzzed with people of all ages, from young children in the preschool to older adults who came for activities and communal meals. 

But few were connecting beyond their age-segregated groups. 

“We’ve always had kids and older adults in the same building, but there were a lot of things that were preventing them from coming together, including safety concerns on both sides,” said Jessica Leylavergne, director of visual and performing arts at Lenox Hill.  

To help change that, Leylavergne piloted an intergenerational theater program for children, ages 7 to 11, and a small group of older adults. The weekly meetings started with icebreakers, such as fun debates over questions like “Outer space vs. ocean?” and “Sleeping or reading?” 

“The kids were a little nervous at first,” she said. “They didn’t know how to act around the older people.” 

Next, group members collaborated to create scripts for two modern versions of classic tales: “The Influencer’s New Clothes” (a variation of “The Emperor’s New Clothes,” featuring a social media star, an idea contributed by a young participant) and “The Gingerbread Kid Takes Manhattan” (a takeoff on “The Gingerbread Man,” with the Kid blowing up Twitter, a twist proposed by an older participant).

Soon, the age barriers began to fall away. The group became a working theater troupe. 

In “The Influencer’s New Clothes,” Ric Suarez, 76, played the Assistant Baker, with the role of the Baker played by a young person. He laughs when recounting how his younger counterpart “told off” his character for doing things wrong. 

“At first, the kids treated us like their parents or grandparents,” he said. “They were cautious because we were the adults. But soon they learned they didn’t need to treat us with reverence. They just accepted us for who we are.” 

The pandemic revealed the harmful effects of loneliness, isolation and disconnection, which tend to affect younger and older people most acutely.

Giulia Manfe, 9, played the Designer in the same play. 

“Working with the older people was fun,” she said. “We have good relationships with the older adults.” 

Lenox Hill’s theater is one example of a wave of new initiatives cropping up across the United States. In recent years, community leaders, social innovators and even business entrepreneurs have begun devising creative ways to forge intergenerational connections.

“I think the pandemic was a turning point,” said Donna Butts, executive director of Generations United, Inc., a nonprofit focused on intergenerational collaboration. “People are realizing how critically important it is to have opportunities for young and old people to connect.”

The pandemic shined a light on the harmful effects of loneliness, isolation and disconnection, which tend to affect younger and older people most acutely. The problem has become so widespread that the US Surgeon General issued an advisory in April. The pandemic also led to learning loss among school children, a rise in mental health issues, especially among teens and young adults, and a worrisome increase in divisiveness and polarization. 

In addition, the pandemic highlighted the vulnerability of many older adults, Butts said. 

“Intergenerational solutions can really help to combat all that,” she said. “They help build bridges, not just between ages but also between a growing older population that’s white and a growing population of younger people of color. Intergenerational programs help connect those two very different-looking groups so that they care about each other.”

Tech innovators are building digital platforms that connect older adults virtually with children, teens and young adults. Activists are finding ways to attract multigenerational volunteers and leverage their complementary strengths. Entrepreneurs are devising for-profit businesses to match people of different generations for mentoring.  

“I think we’re at an inflection point in our society right now that’s making [intergenerational efforts] rise in urgency and importance,” said Eunice Lin Nichols, co-CEO of CoGenerate, a nonprofit working to bridge generational divides. “There’s a lot of frenetic energy, in a good way, around finding new ways to bring older and younger people together to be part of the solution to problems we’re facing.”

Tech-Driven Innovation

A fateful cab ride 12 years ago was the first spark of Eldera.ai, a digital platform that brings together older adult mentors with children and teens for weekly, virtual conversations. After a dinner party, Dana Griffin agreed to share a taxi with an older woman named Linda Storch. The two women quickly became best friends, even though Storch was more than 30 years Griffin’s senior. Not only did they just enjoy spending time together, Storch, a chief financial officer at a high-fashion shoe company, encouraged Griffin in her career in advertising and coached her on relationships.

“We had so much fun together,” said Griffin. “She had my back when nobody else had my back.”

Griffin was devastated when Storch passed away in 2017 at age 64. Hoping to help others make friendships across generations, she founded Eldera.ai. The platform uses artificial intelligence (AI) to match older adult mentors with young mentees and to monitor the conversations to ensure children and older adults stay safe. 

“Older adults experience increased purpose, community and health span,” Griffin said. “Kids gain resilience and social/emotional skills. You can’t learn those from TikTok. You can really only learn them from another person.” 

Parents of young mentees have reported they’ve seen a difference in their children at the dinner table. “They tell me their kids are more open, more curious, more interested in human connection with their own families,” Griffin said. 

The mentors benefit just as much. Patty Early, a retired teacher, mentors Margot, a 16-year-old girl with Down’s syndrome, through Eldera. 

“Margot helped me to reconnect with kids and brought me out of isolation,” Early said in a blog post. “She makes me feel loved. She makes me laugh. She accepts me exactly as I am. That’s what friends are for.” 

Connecting Generations to Create Change

Traditionally, intergenerational programs have brought together people of different ages as a way of providing a service, such as the Foster Grandparent Program, which deploys older adult volunteers in daycare centers and tutoring programs, or elder visitation programs like Dorot, which enlist volunteers—typically middle-aged or younger—to visit or call older adults who may be isolated. 

Now, some are taking a new tack—connecting older and younger people to tackle issues of common concern, such as climate change or racial injustice. 

For example, longtime climate activist Bill McKibben started Third Act, which he leads co-generationally with a younger person, Vanessa Arcara. The group mobilizes people 60 and older, as allies to young people, to work together to protect the climate and safeguard democracy. When he’s called on to write op-eds for media outlets, McKibben often collaborates and shares a byline with a high school or college-aged person, to highlight the shared effort. 

Business Models

While nonprofits have traditionally operated intergenerational programs, some entrepreneurs are testing for-profit business models. 

Griffin chose to start Eldera as a business rather than a non-profit because she believes that will enable the company to offer the platform at a large scale more sustainably than a donation-supported program. To generate income, she is negotiating with Medicare and hospital networks for contracts allowing clinicians to prescribe Eldera to patients who feel isolated or who need a sense of a purpose. 

Another for-profit digital start-up, called Hey Auntie!, connects Black women virtually across ages and life stages for networking, coaching and encouragement. It’s still in early stages, but founder Nicole Kenney ultimately hopes to attract large corporations to pay for Hey Auntie! as a perk for employees, as part of their Employee Assistance Programs (EAPs). 

“Aunties” are typically older women, not necessarily blood relations, who mentor younger people. Kenney said the term is a tradition in Black communities in the United States that can be traced back to West Africa. She was inspired to start Hey Auntie! when one of her own aunties guided her through stress-related health issues.

Hey Auntie! is an example of another type of innovation: multigenerational programs that operate within a specific community with an eye toward preserving and strengthening the community’s cultural traditions. 

“I come from a broad network of aunties who have not had biological ties but who supported and mentored me,” she said. For the platform, an “Auntie” can be any Black woman with experience who would like to mentor others; those who join the platform in hopes of receiving mentorship are dubbed “Auntees.” 

Three tribal nations have created joint projects for young and old that involve activities like storytelling or gardening. 

On a similar front, the Northland Foundation’s Age to Age program has provided small grants to three tribal nations in rural northeastern Minnesota: the Bois Forte Band of Chippewa, the Fond du Lac Band of Lake Superior Chippewa and the Grand Portage Band of Lake Superior Chippewa. 

Projects vary by community. Many include storytelling or community gardening. At Fond du Lac, older adults shared traditional practices with younger participants, such as ricing (harvesting wild rice) and sugarbushing (tapping trees for maple syrup).  

“It’s about sharing those cultural traditions while bringing people of different generations together,” said Zane Bail, chief operating officer of Northland Foundation. “This has given the older adults a renewed sense of purpose. They’re less isolated, they feel better emotionally and they’re excited to contribute to helping youth thrive.” 

Back for More

At Lenox Hill, after 10 weeks of writing and rehearsing, the Intergenerational Theater Project culminated with a performance of the group’s two plays.  

“There has been a great exchange of ideas and many friendships have developed across the generations,” Leylavergne told the audience. “And we all had a lot of fun.”

Giulia Manfe, the 9-year-old actor, enjoyed the project so much that she came back in June for Lenox Hill’s production of “The Music Man Sr.,” a version of the classic musical licensed for older adult community groups. She pitched in with props and performed in the marching band for the show’s finale. Suarez, who played the Mayor, was thrilled to share the stage with Manfe and a few other young acquaintances he’d made at the earlier program. 

Suarez sees benefits for both age groups. Working together made the older participants feel young and, he believes, made younger participants feel more mature. 

“I hope people in other areas of the country will do the same thing,” he said. “It’s a great way for kids and older adults to learn about each other.” 

Making the Most of the ‘Extra 30’

When Bob Evans lost his job in 2009, he began to consider what was next. He’d spent more than 30 years in the horticulture industry, mostly in sales and customer service positions in landscaping and lawn care. 

His wife reminded him that, in his 20s, Evans had wanted to become a nurse but set the dream aside to support the family. 

“It’s too late now,” he replied.

“I don’t think so,” she said. 

So Evans went back to school—in his mid-50s, the oldest person in his class. He earned a nursing degree and got a job as a registered nurse in a hospital. Just as he’d imagined in his 20s, he loved the work. 

People can expect later-in-life pivots, like Evans’ new career, to become more and more common as we live longer, according to the Stanford Center on Longevity. Human life expectancies doubled between 1900 and 2000. Living to age 100 will become commonplace by the middle of the 21st century. 

As more people live to 100, they may alternate time spent on work and career with periods devoted to family or caregiving.

“The 100-year life is here,” according to the Center’s report, The New Map of Life. “We’re not ready.”

Most people still expect life and career to follow the timeline shaped by a 60- or 70-year lifespan, according to the report, viewing the “extra” 20 or 30 years afforded by increased longevity as an extension of retirement and older age. In this model, college and graduate school, childrearing and prime earning years are crammed into the 20s, 30s and 40s. 

That needs to change, according to the report. This unparalleled demographic shift “calls for equally momentous and creative changes in the ways we lead these longer lives.” 

As more people live to 100, the report predicts, life trajectories will become more fluid and more flexible, and multiple transitions over the course of life will be viewed as “a feature, not a bug.” People will shift gears routinely, to new phases of work and career, possibly alternating with periods devoted to lifelong learning or family and caregiving responsibilities. 

Adapting to Change

“As people live longer, they’re realizing that retirement is not a destination, it’s a transition and a time of new beginnings,” said Dorian Mintzer, a retirement coach and coauthor of The Couple’s Retirement Puzzle: 10 Must-Have Conversations for Creating an Amazing New Life Together (2014). “It can be a time to rewire, rejuvenate and revolutionize.” 

Longer lives may lead more people to follow unconventional paths, like that of Jim and Lynda McDevitt of Plano, TX. Now in their early 70s, they’ve pivoted twice in the last two decades. After retiring in the early 2000s from long careers with the Internal Revenue Service, the couple opened a neighborhood wine shop called Corner Wines—and loved it. 

“We liked to say, ‘We’re like Cheers,’ because the shop was a place where everybody knew your name,” Lynda McDevitt said. “Most of the friends we have now, we made at our store.” 

Eventually, the shop’s six-days-a-week schedule began to take a physical toll, and the couple wanted to spend more time with their granddaughter. They sold Corner Wines in 2020. Now they call themselves “officially retired” but continue to stay engaged, providing occasional consulting services and leading “wine-themed” group tours to places like Tuscany and Napa Valley. 

Self-confidence is the key to success when you start a new career or any other new endeavor.

“We had such a passion for wine, we couldn’t let it go,” Lynda McDevitt said. 

Several factors made the McDevitts’ later-in-life transition possible. Both enjoy good health. Pensions from their IRS careers provided a financial base. Wine was their passion, but they’d honed practical skills while at the IRS: the basics of accounting, managing and marketing a business. Both had work experiences that gave them the confidence to start something new: Jim had presented proposals to top officials at the IRS; Lynda had fielded media interviews as an IRS spokesperson. 

That type of confidence is key in embarking on any new career or endeavor, Evans said. Even though he had worked in a very different field before he became a nurse, basic skills—like computer proficiency—buoyed his confidence to tackle the next phase. 

“Computer literacy was a big part of being able to jump back into college in my late 50s, to be able to function and graduate,” he said. “You can’t really stay in the game if you can’t work at a computer at least at a minimum level.” Former co-workers in his previous career who didn’t embrace the computer and internet have had more difficulty adapting, he added.

Along with confidence, a new start takes humility. 

“Assuming the role of novice required … swallowing my pride,” Evans said. That was humbling but necessary to learn the skills to serve patients.

Finding Purpose

In filming her 2022 documentary Lives Well Lived: Celebrating the Secrets, Wit & Wisdom of Age, which aired on PBS, filmmaker Sky Bergman chose interviewees, ages 75 and up, who were resilient, active and engaged—and discovered that all shared a common trait. 

“Everyone had a sense of purpose,” said Bergman, who is professor emeritus of photography and video at Cal Poly State University in San Luis Obispo, CA. “That purpose could change over time, and often did change over time, but that was the common thread.”

A health scare in 2003 helped Mellanie True Hills, 71, of Greenwood, TX, identify her next purpose. She developed a heart blockage, followed by atrial fibrillation (“afib”), which caused her heart to race. Surgery corrected the problem, but at the time, patients had little access to reliable information about afib. After Hills retired from her corporate job, she created a website, StopAfib.org, and began organizing annual patient conferences featuring experts. 

Skills developed over her long career in IT, web development and accounting all came to her aid. But Hills also credits her thirst for knowledge and her lifelong learning habit. 

When you start something new, don’t be afraid to change or to take a risk.

“When I was young, I had a boss who said, ‘Mellanie finds a vacuum and fills it,’” she said. “That is the mindset you need to have to start something new. You see a need and you fill it. It’s also a matter of not being afraid to change. That is hard for some older adults. Not being afraid to take a risk. Risk is the price you pay for opportunity.” 

Jan Gero pushes himself to keep taking risks artistically at the age of 90. After five previous careers—architect, modern dancer, fashion designer, documentary filmmaker and artist—he has reinvented himself as a monologist. Recently, he performed a one-man show, Naked at 90: An Evening with Jan Gero

His daily life is solitary, which he prefers, but he shares a video journal online and hosts The Compulsive New Yorker, a public access cable show from his apartment in New York. 

“I’m basically just saying what’s on my mind,” he said. “A lot of what I’m doing is trying to come to terms with death, because it’s a finality, a biological reality. Every day, I’m kind of asking myself the question, ‘Am I on the path to going down with a smile, rather than a sneer?’” 

Envisioning the Extra Years

Jerry Cahn, an executive coach in New York, recently launched a workshop titled, “Age Brilliantly: Maximize Your Ability to Lead a Fulfilling 100+ Year Life.” It’s not just for executives approaching retirement, however. 

The 30 “extra” years that many will enjoy shouldn’t be viewed as tacked on at the end of life, he said. Those years might be devoted to sabbaticals at any age, to provide breathing space for creative growth. Cahn cited a young professional who left one high-pressure job but postponed the start of his next job to devote four months to travel, including visits to Mount Everest, Nepal and the Camino de Santiago in Spain. 

Cahn added that many executives meticulously plan their finances for retirement and later life but head into their post-career years with vague plans, such as, “I’d like to travel.” 

“That might mean traveling six or seven weeks out of the year,” he said. “But what about the other 45 weeks? They don’t tend to think about that.” 

Mary “Molly” Camp, MD, assistant professor in the department of psychiatry at UT Southwestern Medical Center in Dallas, said more and more of her patients want to talk about how they’ll handle retirement and the second half of life. 

Young people might seek help for transitions—a guidance counselor when choosing a college or a therapist for premarital counseling. But there’s little to guide middle-aged or older people to prepare for the later transitions in life. Camp hopes that’s beginning to change.

“We’re evolving in our knowledge of human development, where we don’t think of adulthood as something you reach and then it plateaus and stays the same,” she said. “Instead, we’re understanding that life changes through lots of different phases, lots of different transitions, including career changes and retirement. It’s not that we turn 55 and everything becomes static.” 

Yet Another Chapter 

The COVID-19 pandemic forced Bob Evans to pivot again in 2020. His age and health issues made it too risky for him to work around COVID patients. He left nursing with plans to eventually return—then discovered that he enjoyed retirement. His wife, an IT recruiter, still works from their home in the Cleveland area, so Evans, 68, handles the household duties, including maintaining their large, landscaped yard, and volunteers with the Cleveland Hiking Club, helping to build a new pavilion at a local park. He looks in often on his father, who’s 93 and lives nearby. He’s developed an interest in family history. 

Just in case, he also keeps his nursing license up-to-date. 

“I’m not sure what the next chapter is going to be,” he said, “But that’s the fun part.” 

How to Preplan Your Own Funeral

This is part 2 in our series on funerals. Read part 1 here. 

When Amy Martin’s mother-in-law died last year at the age of 96, the funeral arrangements were easy. Her mother-in-law had discussed her wishes with her two adult children. Everything was specified in writing: the burial plot, the chapel for the funeral service, the hymns to be sung, the scripture to be read, even the brightly colored pantsuit and shoes she wanted to be buried in. 

“She really gave it some care and some thought,” said Martin. “It was done out of love. She didn’t want any of her kids to have anything to worry about.” 

Having seen how smoothly things unfolded, Martin, 66, is glad that she and her husband also have plans in place for their own funerals—with people designated to handle them—especially, given that they don’t have children.  

But the Martins are in the minority. While most people agree that preplanning a funeral is a good idea, only about 15 percent of those over age 40 have prepared plans, according to a 2015 Harris Poll survey for the Funeral and Memorial Information Council.

Why do so few of us make funeral plans? 

“We live in a death-denying culture,” said Joe Reardon, vice president of marketing at Keohane Funeral Home in the Boston area. “We don’t talk about death. We can kill dozens of people in seconds on a video game, but otherwise, death is removed from our presence and our conversation. People die in hospitals, not homes. They’re cremated in a crematorium, with no family members present. It’s as if, ‘If you don’t talk about it, it’s not real.’”

Also, death has no place in a youth-oriented culture that’s averse to emotions like grief, sadness and loss, according to Alan Wolfelt of the Center for Loss and Life Transition. Some families now opt for direct burial or direct cremation, with no viewing, no service and no memorial gathering. Others bypass traditional funerals for festive “celebrations of life.” Wolfelt has even heard some dismiss somber memorial services as “barbaric.” 

“We lack an understanding that there are times in life when it’s appropriate to be sad,” he said. “We want to go around our grief instead of through it. Funerals are critical rites of passage. Rituals help us when words are inadequate. That’s why we’ve had these ceremonies since the time of the Neanderthals.” 

Studies show that a family moves faster through the grief process when a funeral is held.

—Randy Anderson

Procrastination is another factor. If you’re healthy and busy, planning your funeral never rises to the top of your to-do  list. Others avoid planning because, subconsciously, they fear it’ll hasten death. Gail Rubin, blogger and author of A Good Goodbye: Funeral Planning for Those Who Don’t Plan to Die (2010), addresses that fear with a joke: “Talking about sex won’t make you pregnant; talking about funerals won’t make you dead.”  

Reardon says many people neglect planning because they “don’t want to make a fuss,” spurred by a sense of self-deprecation that’s well-intentioned.  

“George Washington wanted a simple burial, with no fanfare, no oration, no state funeral,” he said. “He ended up having over 300 funerals. That’s not what he wanted, but that’s what people needed. America was a fledgling nation. He was a war hero.” 

Funerals are for the living, adds Randy Anderson, a funeral director who teaches funeral psychology at Jefferson State Community College in Birmingham, AL. 

“Psychologically, a funeral gives family and friends a chance to talk about the person,” he said. “Studies show that a family moves faster through the grief process when a funeral is held. We’re not made to grieve alone.” 

Anderson cherishes stories he heard at his own father’s funeral. 

“My father had always kept a $100 bill in his pocket,” he said. “It was his way of being prepared to help people in trouble. At his funeral, I heard so many stories I’d never heard before from people who said my dad had given them $100 after a house burned down or after a death in the family.” 

While many efforts have emerged in recent decades—such as The Conversation Project and Death Over Dinner—to reduce that fear and stigma, and to encourage people to talk openly about death and end-of-life wishes, it seems we have a ways to go before the process is an easier one.

A Big Buy

For many of us, a funeral will be the third-largest purchase we’ll ever make, exceeded only by buying a home or car. In 2021, the national median cost of a funeral with a viewing and burial was approximately $7,848 (or $6,971 for a funeral with cremation), according to a study by the National Funeral Directors Association (NFDA.) 

While homes and cars are typically purchased after comparison shopping and much planning, most funerals are arranged within days after a death, while the planner is in the fog of grief. Within hours of a death, the family must choose a funeral home or otherwise specify a place to send the remains. 

Funerals pose a significant financial burden on many families. When arrangements are made “at need,” the burden is likely to be worse. Studies show that families who’ve discussed final arrangements prior to death incurred much lower costs than families that did not. Without time pressures, and without the presence of raw grief, consumers can ask for less expensive options, compare prices and clearly understand what is required versus what would be nice to have.

“When a person dies, there are about 125 decisions that have to be made almost immediately,” said Anderson, who is also a former president of the NFDA. “Will the deceased be buried or cremated? Where and when will the service take place? Who will speak? What music will be played?” 

Most people making funeral decisions have no experience and no clear grasp of what’s involved. 

All of this happens while the family is grieving and possibly grappling with trauma, family conflict or feelings of guilt, according to Rubin.

“People don’t shop around ahead of need,” she said. “So when somebody drops dead, it’s like, ‘Oh my God, I need a burial plot,’ and ‘Oh my God, I need a funeral.’ And that is not the time to be shopping around if you want to compare prices and to be an informed consumer.”

Most people make these decisions with no experience. Many don’t even have a clear grasp of the basic components involved in funeral arrangements. 

“We’ve had [older adult] clients who assumed they’d prepaid the bulk of the cost of a funeral, because they’d already purchased a cemetery plot,” said Carl Burlbaw, director of the Elder Financial Safety Center at the Senior Source, a nonprofit in Dallas. “They didn’t understand that there’s also the cost of a casket, a vault, opening and closing the grave, not to mention the cost of embalming and a funeral service.   

Preplanning also ensures your wishes are followed and your spiritual or religious beliefs are honored. That helps a family avoid conflicts, according to Richard Paskin, managing partner at Funeralwise.com, a funeral planning website. If a parent dies without having expressed their wishes, he said, “One adult child wants to bury the deceased, another wants to cremate. One wants a no-frills funeral, the other wants a fancy one. With preplanning, you’ve at least taken some of the pressure off the family.”

Preplanning can help family members avoid last-minute scrambling by assembling information, such as details for the obituary or the names of chosen pallbearers. Pre-need planning is also key for solo agers—elders without children or surviving family members, who may not have an obvious heir to step in to handle arrangements.  

Steps in Preplanning

Planning a funeral starts with two basic decisions: First, what do you want to do with your body? Today, families have a wide range of options: a traditional burial, cremation, green burial or burial at sea. 

Secondly, what do you want the funeral service to entail? People may work with a funeral home or turn to online resources, such as Funeralwise.com, to explore their options. The NFDA offers RememberingALife.com, with a list of questions to consider for the funeral service, such as: “What music would you like played? Are there any special readings of poetry, scripture, etc. that you would like to have included? How might the location be decorated to reflect your life? What is the one thing you would want attendees to walk away knowing about you and who you are? Are there any special objects or photos you would want on display?”

Those who are religiously unaffiliated need to think creatively when there’s no church or clergyperson to provide a template for the funeral service, Martin notes. She’s been called on to organize and officiate at funerals for many unaffiliated friends. 

“We gather at houses and bars, yoga studios and dance halls, and parks if the weather permits,” she said. “We bring food to share, cover memory tables with mementoes of our lost loved ones and spread out paper to write our grief. Folks share some songs, some poems, a prayer or two  and multitudes of stories about the deceased.” 

You can prepay a funeral home or buy funeral insurance.

The next step is to estimate the cost and plan how it will be paid. 

Some expenses, such as the cemetery space, may be purchased in advance. Some people choose to prepay for a funeral, which involves making all or most of the decisions about it in consultation with a funeral director, then setting up prepayment, typically in monthly installments made directly to the funeral home. Depending on the plan, prepayment can lock in the price of some of the services or purchases involved in the funeral. 

But buyers beware. Prepaid funeral plans aren’t well-regulated. While the Funeral Consumers Alliance advocates preplanning, it advises extreme caution in prepaying. If considering that option, ask what happens if the funeral home goes out of business, and whether the dollar value of the prepaid plan is transferable to another funeral home should you move before you die. Also, you’ll lose the price guarantee if your funeral ends up at another funeral home. Read the fine print.

Another option to prepare financially is funeral insurance—essentially, a life insurance policy that pays money upon your death to cover funeral, burial and other end-of-life expenses. 

Without prepayment or insurance, the cost of a funeral is typically paid out of the proceeds of the deceased’s estate. 

Informing Your Loved Ones

The final step of funeral preplanning: share your wishes, preferably in writing, with the family member or trusted friend who will be responsible for arrangements. Update them as needed. You can also file your wishes with the funeral home you’ve chosen. 

It is possible to name a specific person to handle your funeral arrangements in your will. However, keep in mind that funeral plans are often made before the will is located. It’s important to let the people in your life know who you chose. It’s also possible to legally designate a funeral agent, a person who will handle your funeral arrangements, according to your wishes. This requires written documentation; laws vary by state. Ask an attorney or a local funeral home director for specific guidance. 

Reardon cautions against expressing wishes “in a vacuum,” without realistic guidance on costs, logistics and applicable laws. He assisted the family of a Boston area man who served at a naval base near the Gulf of Mexico. The man wanted his ashes scattered on a beach there, thinking that would be an easy option for the family. 

“But how hard is it to fly everyone to Texas, get the permits to carry the remains and then scatter them on the beach?” Reardon said. “What if not everyone could afford it?”  The man’s simple wishes proved to be a headache. 

Finally, in addition to mapping out your own plans, it’s important to encourage family members to express their wishes. That’s not an easy discussion, but Remembering A Life offers a page on how to start the conversation. 

One Last Howl

Having seen how helpful planning is, Amy Martin has made detailed plans for her own funeral. But hers won’t look anything like her Methodist mother-in-law’s funeral. 

She and her husband made plans to be cremated, with some of their ashes to be scattered at their Unitarian church’s memorial garden. A prepaid, permanent brass plaque there will memorialize them. Because nature has always been central to her spirituality, Martin designed an outdoor ritual to distribute her remaining ashes, with instructions to ensure it’s done in an environmentally responsible way. She has chosen the music and readings. Also, she wants attendees to howl when they scatter her ashes —something she’s had mourners do at friends’ funerals where she’s served as the officiant. 

“Howling is a way to let out pent up emotional energy,” she said. 

Planning also assures Martin that her earth-based spirituality will be honored at her funeral.

“To me, it’s a matter of caring for the people who will be left behind,” she said. 

Green Burials and Other Nontradional Ways to Honor the End of a Life

This is part 1 in a our series on funerals. Read part 2 here.

Near the end of her mother’s life, Barrie Page Hill began thinking about the funeral and the best way to honor her mother.  

“My mom was a wildlife artist and very into nature,” Hill said. “She was happiest when she was sitting by a babbling brook or looking out at a mountain.” 

From conversations, Hill knew her mother wanted a simple funeral but did not want to be cremated. When Hill learned about green burial—with a biodegradable shroud or casket, no embalming and no concrete vault—that seemed like a good fit. But when she tried to make plans, she said, “it was problematic.” 

No cemeteries in the Dallas area, where she lives, allowed green burial. The nearest green cemetery was in Houston. When she inquired at a funeral home, the director tried to “upsell” her toward a more elaborate casket and grave. Hill gave up on going green. 

Overwhelming Choices

Those contemplating funeral arrangements for themselves or a family member now have many choices. In addition to traditional burial or cremation, families may choose options like green burial, composting, burial at sea or donating the body to medical science. 

With more choices, families can plan funerals that better reflect a deceased person’s values or passions. However, more choices can also make the decision process more complicated, even overwhelming. And, as Hill discovered, those who want nontraditional options may face roadblocks. 

That’s because there’s a disconnect between what many consumers want and what the funeral industry offers, according to Darren Crouch, CEO of Passages International, which supplies sustainable items like willow caskets and biodegradable urns to funeral homes. 

“The funeral industry is a relatively traditional industry that has done things a certain way for generations,” he said. “When a death occurs, people are not in a good state. They’re not asking the right questions. Because funerals have time constraints, decisions get made quickly. Without advanced planning, the deceased person—who might have driven a hybrid vehicle, worn organic clothing and eaten organic produce all their life—could easily end up pumped with embalming fluids and buried in a metal casket in a concrete vault.” 

Eco-Friendlier Options 

When someone dies, surviving loved ones must make two basic decisions: what to do with the body (funeral directors call it the “disposition”) and the particulars of the viewing, funeral and/or memorial service. 

The death-care traditions of some religious groups are inherently eco-friendly. For example, for traditional Jewish and Islamic funerals, bodies aren’t embalmed; instead, they are placed in simple wood caskets and buried within one or two days.  

For many others, green burial is appealing because it offers a less expensive option with less impact on the environment, compared to traditional burial. Bodies are buried in biodegradable shrouds or in caskets made of willow, plain wood or cardboard. Green burial grounds generally do not accept embalmed bodies, although some make exceptions for newer, more eco-friendly embalming fluids. To preserve the natural landscape, most don’t allow headstones, but some do permit ground-level stone markers. 

Prices for green burials vary widely by region and the type of green burial site, according to the Funeral Consumers Alliance. A grave site and interment in a green burial ground typically ranges from $1,000 to $4,000. The biggest cost advantage of going green: instead of an expensive metal casket, embalming and a vault, the only cost is a biodegradable casket or shroud. Some burial grounds don’t even require any sort of container. 

A lot of families express interest in green burial, but few end up choosing that route, according to Joseph Reardon, vice president for community development and advance planning for Keohane Funeral Home in the Boston area. Keohane was the first funeral home in Massachusetts certified by the Green Burial Council but it faces a big obstacle: the nearest green burial ground is in Maine. The Green Burial Council estimates that there were 340 certified green burial cemeteries in the United States in 2021. 

Many traditional cemeteries are beginning to set aside space for those who want greener options. However, outdated local and state laws are hindering the growth of dedicated green burial grounds. No state laws explicitly prohibit green burial, but existing laws are tailored to the traditional burial model. For instance, some states require a large endowment fund to establish a new cemetery; that’s cost prohibitive and unnecessary for a cemetery that will be kept in its natural state and won’t need mowing or upkeep.  

Some people donate their body to a medical school because they’re disenchanted with the traditional death industry. 

Green burial isn’t the only eco-friendly option. Emerging alternatives include natural organic reduction, which composts a body into soil, and alkaline hydrolysis (also called aquamation or liquid cremation). In organic reduction, which costs about $5,000, the body is placed in a receptacle along with wood chips, straw or other organic material, and will turn into soil after about four weeks. (Farmers use a similar process to compost livestock.) Alkaline hydrolysis, which costs about $3,500, involves placing the body in a stainless-steel receptacle and adding a pressurized solution to rapidly decompose it into water. These options aren’t legal in all states. Both methods avoid the emissions and energy use associated with conventional cremation, which costs about $1,500. 

One low-cost and altruistic option is donation of the body to science. Cadavers are essential for teaching medical students or for testing new surgical techniques. Body donation usually does not involve any cost to the family. (If the body is donated to a specific medical school that’s not nearby, there may be a transportation cost.) 

A body may be donated directly to a teaching medical school or through a body donation operation such as ScienceCare. About 20,000 people (or their families) donate their bodies to scientific research and education each year, either “because they want to make their deaths meaningful, or because they’re disenchanted with the traditional death industry,” according to the MIT Technology Review

For people who felt a connection to the water in life, burials at sea can be very meaningful for their loved ones. 

Captain Brad White of New England Burials at Sea assists families who wish to scatter ashes or bury a loved one’s body at sea. Per EPA regulations, a body must be taken out to a depth of 600 feet—about 40 miles off the coast of Massachusetts. The body is wrapped in a biodegradable shroud and weighted with cannonballs. 

“Fewer families are seriously religious these days,” White said. “For some, the ocean is their church.” 

Burial at sea avoids the cost of cremation or embalming, as well as a casket, cemetery plot and vault. However, a burial from a boat large enough to accommodate many mourners can run thousands of dollars, largely due to the high cost of fuel. Full body burials at sea are not new, but they are relatively rare. In 2020, 2,544 Americans were buried at sea, according to data collected by the EPA.

Rise in Cremation

When Reardon started in the funeral business 35 years ago, virtually every local funeral followed the traditional Catholic pattern: the deceased was embalmed and placed in a metal casket for the viewing and funeral, usually presided over by a priest, then buried in a cemetery plot with a concrete vault. 

Today, about half of all funerals at Keohane involve cremation. Nationally, the average is about 57 percent. Many choose cremation because it is less expensive—but it’s not cheap. Funerals with cremation averaged $6,971 in 2021, while those with a viewing and burial cost around $7,848, according to the National Funeral Directors Association (NFDA).  

About three-quarters of Keohane’s clientele still desire some sort of permanent marker to remember loved ones, according to Reardon. Many churches and cemeteries are adding columbaria—above-ground vaults for storing the cremains of the departed—as well as spaces for in-ground burial of cremated remains. 

Scattering cremains in a meaningful spot can be problematic. Some cemeteries offer designated scatter gardens, but in other areas a permit may be required. In bodies of water, the highly alkaline cremains can foster algae blooms. That’s why the EPA requires that cremated remains be scattered so far from land, and it forbids scattering at beaches or in wading pools by the sea. 

Some families find creative ways to handle ashes. Reardon knows a family that used a small amount of a loved one’s ashes to make ink for a memorial tattoo. Cremains can be turned into synthetic memorial diamonds. Parting Stone solidifies cremated remains into smooth stones, usually about 50 to 80 stones for an average-sized person. Families share the stones with loved ones or scatter them. 

“Families are spread out these days,” said Justin Crowe, CEO of Parting Stone. “Previously, you lived and died in the same community and were buried in the local cemetery. That physical location doesn’t carry the same importance anymore.” Crowe noted that he has visited his maternal grandfather’s grave in Ohio only once, but keeps his paternal grandfather’s remains with him at his home in Santa Fe. 

Funeral: the Final Goodbye

Once the burial or cremation is arranged, the next decision is the timing, venue and format of a funeral or memorial service. Once limited to places of worship, funeral homes or chapels, memorial gatherings are moving outdoors and to nonsacred places that were meaningful to the deceased.

With a bit of creativity, a funeral can be meaningful and reflect the person’s life without necessarily being costly. NFDA past president Randy Anderson recalled a funeral at his funeral home in Alexander City, AL. The woman loved to cook, so her signature recipe for teacakes was published in a pamphlet, and teacakes were offered after the service. 

Because more and more Americans identify as “nones”—having no religious affiliation—some funeral homes provide certified celebrants to assist families with no religious affiliation in crafting a meaningful ceremony. The NFDA also offers RememberingALife.com, an extensive website with ideas for funeral planning. 

Just as hospice has moved dying from the hospital to the home, a small but growing movement is encouraging families to move the funeral to the home. Family members or death-care guides (also called death doulas) wash the body, wrap it in a shroud and lay it out on a platform. The family sits vigil for a day or two before the body is cremated or buried.  

Funerals held at home must comply with laws that vary from state to state.

Proponents say that a home funeral provides a more intimate, comfortable setting for family and friends. Mourners may be surrounded with photos, clothing, possibly even the deceased’s favorite chair. There are no hours at home funerals; people can easily sit up all night with the deceased, with more time for reminiscing or meditating on the person’s life. Like green burials, home funerals require advance planning. Laws related to home funerals vary by state. New York state law, for example, requires a licensed funeral director to handle many aspects of final arrangements, including the final disposition of the body. That means the family must pay for a funeral director’s services even for a home funeral. In states without that requirement, families choosing at-home funerals must understand the paperwork requirements normally handled by a funeral director, such as how to file the Certificate of Death. 

Many families skipped or postponed funerals during the pandemic. Some now opt for direct cremation or burial, without holding a viewing or memorial service. However, psychologist Alan Wolfelt of the Center for Loss and Life Transition advises against skipping a memorial service entirely. Sitting with the dead body of a loved one helps survivors confront the reality of their loss. Mourning with friends and family helps gather support. When people fail to grieve properly, he adds, it’s easy to end up “living in the shadow of the ghosts of grief.” 

“There’s a reason why humans of every culture have had funeral rituals for thousands of years,” he said. “They are critical rites of passage.” 

As Green as Possible

By the time her mother died at age 83 in 2018, Barrie Page Hill had finally settled on a plan that felt right. She found a small cemetery in a rural area of Oklahoma, near where her mother grew up. The cemetery overlooks a peaceful valley; her plot is under a tree. Her mother’s parents and grandparents are buried there.

Because her mother’s body had to be transported across state lines from Texas to Oklahoma, by law the body had to be embalmed. A funeral home handled the embalming and transported the body to Oklahoma. Hill, her daughter and husband traveled to the cemetery for a private burial. The body was placed in a simple pine casket and buried in the ground, without a vault. 

Hill is at peace.

“It was as green as I could get it, under the circumstances,” Hill said. “And she’s buried in a very peaceful place. It’s lovely.” 

Living with Disabilities

Until a few years ago, doctors told Deanna Mann, 85, she was “healthy as a horse.” She lived independently in an apartment and enjoyed playing bridge with friends twice a week. Then one leg suddenly swelled up. The other followed soon after. Mann was diagnosed with lymphedema, a treatable but incurable condition that made it difficult to walk. 

She started to fall. After hitting her head in a fall, she moved to an assisted living community and used a walker to get around. But Mann still hoped she could get back on her feet and eventually go home. Then her daughter pointed out that wasn’t likely. 

“That did me in,” she said. Mann struggled with depression. On bad days, she cried. She felt totally alone. She grieved over the loss of her old life. “You’ve got to give up the life you have before,” she said. It wasn’t easy. 

Many older adults will eventually deal with a temporary or permanent, age-related disability, whether it’s vision loss, hearing loss or reduced mobility, or issues such as fatigue or constant pain due to chronic illness. 

“It can be traumatic,” said Kimberly Knight, director of the caregiver support program at the Senior Source, a nonprofit social services agency in Dallas. “It can mean giving up a level of independence that the person has been accustomed to for some time.” 

A New View 

By some estimates, as many as 60 million Americans of all ages are living with a disability. About 36 percent of people aged 65 and older report having at least one disability, according to the US Census. Rates of disability increase greatly in very old age; the majority of those 85 or older are unable to perform all activities of daily living without help.

Many resources offer practical tips for older adults trying to adapt their home environments and daily routines to compensate for disabilities. But newly disabled older adults must also learn how to cope emotionally and psychologically, according to Asma Jafri, MD, chair of the department of family medicine at the University of California, Riverside (UCR) and part of UCR’s Aging Initiative, a group of researchers focused on aging-related issues. 

“If you adjust emotionally, you are more likely to thrive and to succeed in maintaining function,” Jafri said. “If a person doesn’t adjust well, that may trigger a negative cycle.” Feelings of depression or discouragement can lead to withdrawal from social connections and a less active lifestyle, which in turn leads to even more loss of function. 

To cope, older adults facing disability must adopt a new view of themselves and the world. 

“Living in a world not built for us can be an occasion for resourcefulness and a source of frustration,” wrote Rosemarie Garland-Thomson, PhD, a professor of English and bioethics at Emory University. “Living with a disability can be hard work … the burden of stigma can be heavy; managing psycho-emotional changes can be wearing; traversing the breach between us and the nondisabled can attenuate our energy and resources.” 

Building Resilience

One key factor in coping is resilience—the ability to persist, bounce back and flourish when faced with stressors, according to Arielle Silverman, PhD, research director at the American Foundation for the Blind. In her previous position at the University of Washington Medical Center, Silverman was lead researcher for a study of resilience in people with multiple sclerosis. When participants were asked about what resilience was, and what made them resilient, their answers seemed paradoxical. 

“People would talk about having a fighting spirit, not giving up and continuing to fight,” she said. “At the same time, those same people talked about acceptance and how important that was. It does seem like you need both—the drive to keep participating in life, but at the same time, accepting the fact that you do have a disability and some things are going to change.” 

That study identified facilitators of resilience, such as coping skills (like humor, flexibility and optimism), social connections, a sense of meaning and purpose, proactive planning for practical needs, and overall physical wellness.

The study also named barriers to resilience: burnout, negative thoughts and feelings, social challenges (friends’ lack of understanding, for example), stigma and physical fatigue. Study participants talked about thriving, not just surviving. “It’s not dwelling on what you can’t do, it’s relishing what you can do,” as one 56-year-old male participant shared.

Becoming disabled “doesn’t necessarily mean that the quality of your life will diminish, but it does mean that you have to take active steps to accommodate the disability,” said Silverman. 

Staying Engaged

Eve Bostic admired the resilience of her mother, Mary, 91, as health problems gradually took away her ability to walk. Even as her disabilities progressed, Bostic said, her mother outperformed doctors’ predictions time and again. 

“My mother is a very determined woman,” Bostic said. “She compensated by doing other things that her body still could do.”

When she could no longer bend over or kneel, Mary found a way to keep gardening. She read gardening magazines, ordered plants and seeds and directed family and friends who stepped in to help, pointing out what to plant where. 

Bostic credits her mother’s resilience to her life experiences. Mary contracted polio in her teens; doctors predicted she would never walk again. She worked hard at rehabilitation and proved them wrong. By the 1980s, Mary began experiencing post-polio-syndrome symptoms that led her to use a cane, then a four-prong cane, then a walker, then a rollator and finally a wheelchair and scooter. Mary fought each step of the way, maintaining what function she could, until a stroke in 2022 left her bedridden. 

Taking a cue from her mother, Bostic, 63, pushes herself to stay active. After falling and breaking her leg a year ago, Bostic is back to carrying water down long flights of stairs to the chickens and goats she keeps in her yard on a mountainside in West Virginia. Bostic could give up the livestock—she doesn’t rely on them for income—but she’s determined to stay at it as long as she can. She’s more careful too. 

“I don’t trip lightly down those steps anymore,” she said. “But I think it’s important to keep doing this. Use it or lose it.” 

Leon Miller, 89, likes to joke that he went “from the outhouse to the penthouse” over the course of his life—growing up in a poor family, getting an education and establishing a successful career as an architect. That determination, honed over a lifetime, keeps him going even after two dozen surgeries on his knees and legs, including two knee replacements. He can’t climb stairs or walk around the block; he uses a walker to get around at home. 

“My heart, lungs and kidneys are all fine, but my bones and joints are shot,” he said.

Finding ways to help others can contribute to a feeling of empowerment for someone with disabilities 

He misses golfing, but he’s outlived most of his golf buddies anyway. He’s retired but continues to manage his real estate investment in a shopping center. He taught himself to trade stocks online. 

“I’ve learned to focus on the future, as opposed to what I’ve lost and what’s in the past,” he said. 

Miller does grouse a bit about his adult children, who urge him to move into an assisted living community due to safety concerns. That’s a common situation, but a 2019 article in the Innovations in Aging journal, “Meeting Challenges of Late Life Disability Proactively,” encourages care providers and family members to give “greater attention to the adaptive potential of older adults.” 

“Disability and aging … have both been stigmatized, yet also have the potential to reveal human strengths and resiliency,” the authors wrote. Proactive adaptations—such as finding ways to help others or looking for solace and meaning in spirituality—can contribute to an older adult’s sense of empowerment and psychological well-being. 

Those two strategies have helped Nancy Becher, 65, live with a long list of disabilities, some due to a car accident nine years ago and some related to chronic diseases including Crohn’s, glaucoma and diabetes. 

After struggling with depression for more than a year—“I just wanted to die,” she said—she found hope in a support group and in her faith. She learned to focus on what she can still do. She can’t hike any more, but she can sit outside her camper along the Tennessee River and enjoy nature. She also found purpose through a nonprofit she founded called Invisible Warriors, which supports people with “invisible” disabilities, such as chronic pain or fatigue due to autoimmune disorders, which can severely restrict the lives of people who may otherwise look perfectly healthy. 

“I realized that my disabilities were life-changing but not life-ending,” Becher said. 

Becher’s experience reflects psychology’s concept of “secondary gains,” according to Pamela Garber, a therapist in private practice in New York. 

“Something that’s negative, that’s a struggle, can have a benefit also,” she said. Finding and appreciating those secondary gains can help older adults adjust to a new normal. 

The Importance of Being Independent

Research suggests that an older adult’s emotional adjustment to disability also relates closely to the person’s perceptions of dependence and independence. For many people, losing independence represents their biggest fears. They might accept limits on their activities but fight any change that makes them feel dependent. 

If older adults can maintain control over how much assistance they need, they’re likely to feel less helpless and more able to cope, according to a 2000 study. Caretakers and family members can support an older adult by understanding and respecting the person’s need for independence, however they may define that, even if it involves a measure of risk. 

That’s how Deanna Mann is beginning to adjust—by finding ways to maintain her sense of independence and feel more at home in her assisted living community. She decorated her apartment to her liking, without help. 

She negotiated a compromise when staff members wanted to assist her with showering: the aide waits outside her bathroom door, at the ready if needed, while she showers in private. She helps other residents with more severe disabilities when she can. She’s working with a home care assistant who provides a treatment that’s reducing the swelling in her legs, preventing further loss of function. She sounds upbeat as she talks about making new friends. 

“I think each person in his own way has got to find their own way … where you’re not in depression, and where you’re looking at your situation as not necessarily all bad,” she said. “I have my down days and my good days. I’m still not fully adjusted, but I’m as adjusted as I think I’m going to get.” 

Friendships Are Good for Your Health

As a human resources executive, Carole Leskin traveled around the world and worked with a diverse group of interesting people. She never married and never had children, but life was full. Then a recession ended her career at age 65. Leskin floundered. 

“I was out of work, without purpose, bored and desperately lonely,” she said. “Sometimes my only human interaction was with someone in line at the supermarket.”

To meet people, Leskin took a class at the Jewish Community Center near her home in Moorestown, NJ. Initial attempts to connect failed; she introduced herself but got nowhere. Finally, she met four women who welcomed her into their group. For years, the group shared countless hours of conversation, lunches and road trips. 

Then, one by one, all the other women in the group died. Leskin developed health problems that left her homebound. Once again, she was lonely and desperate for connection. 

Leskin’s struggle is not only common, it has massive societal implications. A growing body of research points to the importance of social connections for the health and well-being of older adults. 

“Isolation can be as deadly as obesity and smoking,” said Kasley Killam, MPH, a social scientist and the executive director of Social Health Labs, a nonprofit working to address loneliness and social connection. “In fact, its health consequences cost Medicare an estimated $6.7 billion each year. We need to take better care of older adults’ social well-being.”

Social connections were the key predictor of a long, healthy and happy life in the Harvard Study of Adult Development, which began in 1938 and closely followed hundreds of men over the course of their lives. Those in the study who were more socially connected to family, friends and community were happier, physically healthier and lived longer than those who were less connected. Other research links loneliness with greater sensitivity to pain, suppression of the immune system, diminished brain function and less effective sleep. The evidence is so compelling that one expert called loneliness a public health emergency. 

Since the pandemic, American men are in the middle of a “friendship recession.”

“Loneliness kills,” said Robert Waldinger, MD, the Harvard study’s director. “And the sad fact is that at any given time, more than one in five Americans will report that they’re lonely.”

Lane McCullough, 61, was one of those lonely people. After his divorce last year, he found himself spending his evenings alone at home, bingeing Netflix or staring at the walls. He tried going to a few bars; that proved expensive and fruitless. He tried a singles group; people in the group didn’t seem friendly. 

Tips for Making Friends 

Get involved. Volunteer. Sign up for classes. Join a book club. Pick activities that meet regularly, so it’s easier to get to know people. 

Choose activities that coincide with genuine interests. If you don’t find an organization or group that interests you, start something new.

Expand your interests. Try an activity you’ve never tried before. 

Be brave. Smile. Start a conversation. If you sense a connection, extend an invitation to meet again. 

Expect some trial and error. Don’t take it personally if your efforts are rebuffed. Give it a second or even a third try. 

Be patient. Making friends takes time. Fitting a new friend into your life takes time. It’s worth the effort. 

“It’s difficult to get and keep friends,” he said. “Where do you go? What do you do? There’s no guide for this.”

While that’s not strictly the case—books and resources on friendship abound—it’s true that loneliness affects men more than women, according to Killam. One study of over 46,000 people in more than 200 countries found that loneliness was more common among men. Post-pandemic, American men are in the middle of a friendship recession.” Men’s social circles have shrunk since 1990, and the percentage of men without any close friends has risen.      

Friendships are especially critical for older adults who don’t have adult children or close family members. Wendl Kornfeld, 74, and her husband have no children. Having cared for their aging mothers, she saw how vulnerable people can become later in life. That inspired her to start Community as Family, an education model for older adults who don’t have children or family, at her synagogue in New York. As participants met weekly to learn to navigate their older years, they naturally formed supportive relationships. After eight years as a group, the members sit shiva together, hold house keys for each other or pick each other up from the hospital. Now Kornfeld advises other nonprofits as they adopt the approach. 

Making the first move may be daunting or awkward. That’s inevitable. “If you really want friends, you have to be motivated,” said Kornfeld. “You’re going to have to get outside your comfort zone. It won’t come naturally. Friends need to be replenished, because life takes them away from you.”

Challenging at Any Age

Making friends is hard for adults of any age. As a young mother in the 1990s, Marla Paul remembers filling out an emergency card for her daughter’s school shortly after a move to a Chicago suburb. There were spaces for three neighborhood contacts; she didn’t have a single name to write. That inspired Paul to write an essay for the Chicago Tribune, which sparked a flurry of letters from readers who shared her struggle, and ultimately led Paul to write a book, The Friendship Crisis: Finding, Making, and Keeping Friends When You’re Not a Kid Anymore (2005). 

Almost 30 years later, Paul says it’s still challenging to make friends but in different ways. Her daughter is grown; social connections through her daughter’s school or activities have long disappeared.

Sometimes the best way to make friends is to get involved in local groups that are doing things that interest you.

“When you’re older, you have to be more proactive,” she said. “If you’re retired, you are not organically seeing people every day on a job. You have to work harder to find people. Virtually every new life chapter has the potential to disrupt friendships: moving, leaving an office to stay home, divorce, the death of a spouse, retirement, illness.”  

That was the case for Mina Gupta, 82, a retired microbiologist. She had no trouble making friends until she and her husband moved from the Dallas area to a suburb of Seattle in 2013. The new home was closer to grandchildren, but their social network was thousands of miles away in Texas. 

“It was horrible,” she said. “I knew almost everyone in the Indian community in the Dallas area. Here, I just couldn’t seem to connect with people.”

For Gupta, the solution was getting involved. She began volunteering at a hospital nursery, snuggling the babies of mothers with substance addictions, which led to friendships with the staff and fellow volunteers. Later, to meet fellow gardeners, she put an invitation on NextDoor (a neighborhood-based social media platform) and started a garden club. 

Getting involved also helped Donna Bearden, 75, after she and her husband relocated to Loveland, CO, 10 years ago. She found friends by joining and teaching classes in photography, art and writing. It wasn’t hard to meet people, given that those in the classes shared her passions. Bearden adds that she also learned to advocate for herself in group situations to make sure she was connecting. She wears a hearing aid; if she can’t hear well, she’ll ask people at her book club to speak up. 

“Hearing loss can make you feel so isolated and left out,” she said. “It didn’t come easy, but I’ve learned to be a little bit assertive.” 

Fishing for Friends

Showing up—whether for a singles group, a volunteer job or a community college class —is a first step but doesn’t automatically lead to friendships. Converting acquaintances into friends requires intentional effort.

“Friend-finding is like fishing,” writes Hope Kelaher, LCSW, in Here to Make Friends: How to Make Friends as an Adult (2020). “Casting out the line and, several reels and hooks in, waiting for a bite. And some days … you don’t catch anything at all.” 

“Fishing” for friends is more effective when approached with intentionality and positivity. Research shows that people who think friendships happen organically—based on luck—are lonelier, according to Marisa Franco, author of Platonic: How Understanding Your Attachment Style Can Help You Make and Keep Friends (2022). She advises friend-seekers to beware the “liking gap.” Research shows that, when strangers interact, they’re often more liked by the other person than they assume. By contrast, thinking positively becomes a self-fulfilling prophecy. 

“When people do assume others will like them, they tend to become warmer, friendlier and more open,” Franco writes. 

Developing friendships takes time and effort. One study estimates it takes 50 hours of interaction just to make a casual friend, and 200 hours of time together to create a close friendship. 

Persistence, along with trial and error, finally paid off for Lane McCullough. He found another singles group, Phase 2 Singles 50+, aimed at fostering friendships, not dating. The group boasts a busy calendar of outings and several subgroups based on different interests. Now McCullough goes out at least twice a week, one night playing pickleball and the other socializing. 

“It’s a great group,” he said. “We just clicked.” 

If you’re open to friendships with people who aren’t your age, you’ll have more potential friends to connect with.  

Social scientist Killam urges older adults to cultivate habits that strengthen “social muscles.” Studies show that people feel happier when they spend at least 10 minutes on the phone a few times a week or connect with people five times a day, whether in person, with a text or an email. 

Kelaher also advises older adults to look beyond their peers for their pool of possible new friends. She cites an acquaintance in her 70s who chatted with younger neighbors and occasionally babysat; now there’s a steady stream of visitors of all ages in her home. 

When people are open to friendships of any age, “it really expands the universe of potential friends,” adds Irene Levine, a former clinical psychologist and the author of Best Friends Forever (2009). Intergenerational friendships also offer extra benefits; younger friends may have different perspectives and may appreciate the wisdom and experience of an older person. 

In addition, be open to places to find connections: join an exercise class, alumni group, group travel, volunteer project, or local fan groups for sports teams. If possible, select activities that meet several times or on a regular basis, advises Franco. Faces will grow familiar, increasing the chances of connection.

Online Lifelines

Happily, the Internet opened options for connecting, virtually and in person. During the COVID-19 pandemic, many older adults learned to use new technology platforms, like Zoom and FaceTime. Apps like Meetup, Friender and BarkHappy (for dog lovers) help connect people with common interests. Neighborhood platforms also offer a place to start. 

A word of caution: take care when venturing online to meet people, says Thomas Preininger, LCSW, a counselor at the Ecumenical Center, a mental health agency in San Antonio, TX. Online scammers target lonely older adults: he knows several who lost tens of thousands of dollars to fraudsters who posed as empathetic friends, gained their trust and then asked for money. 

“If someone asks you for money, cut them off right away,” he advises.

For Carole Leskin, now 77, virtual connections became her lifeline after her friends died. She’s housebound due to a stroke and heart failure but has new friends all over the world. She connects via Facebook and through her blog posts on sites like Jewish Sacred Aging. Virtual acquaintances gradually evolved into close friends; she keeps in touch regularly via Zoom, texts and email. Recently, Leskin talked for hours on the phone with a friend in Melbourne, Australia. They’ve never met in person but share common interests in nature and in wetlands, in particular. 

“There is something about this kind of communication that allows for greater sharing,” she said. “It is more thoughtful, uninterrupted and open. In a way, I am closer to these people than I was to my now deceased friends.” 

What Happens When Someone Dies without a Will?

Years later, the story still haunts attorney Jennifer Cona. 

A man—in his 70s and in good health—retained her to draw up a will. He wanted to bequeath his sizable estate to his grandson and to a few charities. He did not want to leave anything to his two grown children, who lived out of state and never called or visited. 

“The grandson was very close and did everything for him,” said Cona, an elder attorney in Melville, NY. “While we were going back and forth over some of the details, [the client] died suddenly of a massive stroke.”

The will was not yet signed. The two grown children didn’t attend his funeral, but they inherited the entire estate. The grandson got nothing. 

As Cona’s story shows, without a valid will, a deceased person’s wishes mean nothing. The laws of the state where the person lived dictate who inherits—and often, not in ways that many assume. 

Lorie Burch, an attorney in Dallas, puts it this way for her clients, “If you don’t have a will, the state of Texas has one for you.” 

Why No Will? 

Most people know they need a will. Yet two out of three Americans don’t have one, according to the 2022 Wills and Estate Planning Study by Caring.com. 

Why not? Of those without a will, the study reported, one of three think they don’t have enough assets to leave behind. 

For many others, it is simply a matter of procrastination. Chris Krupa Downs, an attorney in Plano, TX, calls it the “Scarlett O’Hara philosophy.” 

“When it comes to making the decisions involved in creating a will, many people would prefer ‘to think about that tomorrow,’” she said. 

Some assume that, because family members get along, their heirs will do the right thing. Or they believe their family situation is uncomplicated and the assets will transfer easily.

Others don’t want to think about death. 

“There’s this weird human element that clouds people’s judgment,” said Cona. “It’s almost like they’re superstitious. They think that, as soon as they sign their will, they’ll go out and get hit by a bus.” 

Unpleasantly Surprised

Most people don’t appreciate how difficult the probate process can be for surviving family members when there’s no will in place—or the many unexpected ways things can go wrong. When a person dies without a will, everything that the deceased person owned falls into intestate succession: the state takes control of the estate and doles it out to the heir or heirs, according to the state’s laws of intestacy.

With blended families, succession becomes more complicated. And state law doesn’t take into account whether family members are estranged or whether an heir might have a drug addiction or a gambling problem.

“A lot of people are shocked to learn that without a will, all the decisions are made according to state law,” said Burch. 

Before the estate is distributed, there’s a probate process to identify the dead person’s heirs. Sometimes, secrets are exposed. Burch is following a case where a man, a member of the LGBTQ community, died without a will. Unbeknownst to his husband, the deceased man had fathered a child—now grown—in a one-time sexual encounter he’d had decades earlier. After his death, the daughter came forward and DNA testing proved paternity. With a will, the man likely would’ve left his entire estate to his husband. But without a will, by Texas law, biological children may have a claim on a parent’s estate. 

And now the whole story is a matter of public record.

“When there’s no will, family secrets come out, and the process is super invasive,” said Burch. 

When the deceased has adult children from a previous marriage or gave up a baby for adoption long ago, and there’s no will, things can get complicated. 

Blended families often create surprises, too, depending on the state’s laws. 

“If you have children from a different marriage, it complicates things,” said Catherine Forte, an attorney in Plano. “With blended families, the estate often doesn’t go where you think it’s going to go.” 

In Texas, for example, in situations where there is no will, it’s not uncommon for adult children from a previous marriage to take an interest in the home occupied by the surviving spouse. The widow or widower is legally entitled to stay in the home, but if the stepkids want to cash in, they may pressure that person to sell. 

Downs adds that when people die without a will, often their life history dies with them. 

“I’ve had cases where someone died, and there’s no one who knows what relationships they had in life,” she said. “There’s no one who knows the facts and the history of the person’s life.”

Duncan Webb, an attorney in Plano, shared the story of a middle-aged woman who died without a will. While she had many friends and professional associates, the woman never married and had no children. She had been tight-lipped about her family situation. When she died, her body lingered at the morgue for weeks because no family member claimed the body. Neighbors stepped forward to help; a court-appointed attorney ultimately located an uncle, who made the funeral arrangements. Her estate was divided between the uncle and a nephew she’d never met. 

Similarly, Burch knows of a woman who died without a will, and who had had a baby decades earlier and given the baby up for adoption. Her spouse was aware of the child’s existence but had no idea when or where the child was born or the child’s gender. The court insisted that the child be tracked down to give his or her consent before the assets could be distributed. 

“Now, how do you find that child?” Burch said. 

Where’s the Money?

When there’s no will, finding the deceased’s heirs is one issue. Finding the assets is another. That was the problem facing Kashif Ahmed when his father died in Pakistan in 2001. More than 20 years later, he’s still tying up loose ends of the estate. 

“As wise and as organized as he was, my father just never got around to creating a will or documenting his assets and where they were,” Ahmed said. “And to make matters worse, he had multiple assets in multiple countries and continents.” 

Ahmed knows how to handle money—he is a wealth manager in Bedford, MA, and a lecturer in estate planning at Suffolk University and Bentley University. But the process was still a nightmare. Some of his father’s assets were in nations where, even with a judge’s order, bureaucrats demanded bribes before they’d handle the paperwork to transfer the assets to Ahmed’s name. He spent countless hours combing through his father’s papers and trying to track down other assets. 

An ATM receipt, found in his father’s trouser pocket, led Ahmed to look for a bank account in Switzerland. After sending certified letters to virtually every bank in Switzerland, he eventually learned that his father had only withdrawn cash from an ATM machine while passing through the Zurich airport. There was no Swiss bank account. 

Your Brain, on Grief 

Even with a valid will in place, grieving family members often find the probate process frustrating and emotionally exhausting. Without a will, it can be overwhelming. 

Sophia Dembling struggled with this after her husband, Tom Battles, died suddenly at age 59 in 2020 without a will. The situation seemed straightforward—the couple had been married for almost 30 years and had no children.

But her effort to access a few thousand dollars in a bank account, along with some uncashed checks, both in his name, has been a nightmare. Dallas County, TX, where she lives, required her to complete a small estate affidavit to prove she’s the rightful heir. That meant compiling a list of all his possessions and obtaining notarized documents from her elderly in-laws, who lived in Chicago and didn’t want to venture out during the pandemic.

The instructions on the county’s website were confusing. She made mistakes; each time she refiled the affidavit, she got something else wrong. Dembling could use the money but still can’t get access. Hiring an attorney would likely cost more than the total amount. 

“It was so overwhelming and heart-wrenching,” she said. “Just listing his possessions— the process was loaded with sentiment and sadness and love and regret.”

Normally, she thinks the process might be manageable, but having to tackle it while grieving was too much. 

One minor error can invalidate an online will or one that’s handwritten.

“There is something called ‘grief brain,’” said Dembling, who blogs about coping as a widow at Psychology Today.  “In early grief, your thinking is really fuzzy. There’s a lot of neurological energy going into just dealing with the loss.” 

Another area where a will is essential: providing for minor children. Without a will, the state will decide who cares for the children. It’s possible for children to end up in foster care. Estate planning—usually a will as well as a trust—is also critical for parents of adult children with special needs.  

“If you don’t do your planning, the child can lose government benefits, like Medicaid or disability payments,” Downs said. “In some cases, the wait lists to get the benefits are years long.”

Attorneys warn that there are also situations where a will may exist, but it’s not valid, or it doesn’t apply. Wills must be updated whenever a family situation changes due to birth, death, divorce or marriage, or when moving to another state. And some designations can override a will. For example, the beneficiary named in a life insurance policy will get the money regardless of what the will says. Ditto for bank or stock accounts where the owner has named a payable-upon-death (POD) beneficiary, which overrides what’s in the will.

Webb and Burch also advise caution with do-it-yourself options, like online wills or holographic wills. (Holographic wills are handwritten wills created by the testator and are legal in about two dozen states, with varying requirements.) Webb has handled cases where one seemingly minor error or omission—an insufficient number of witnesses to the will, for example—rendered a holographic will invalid. 

Family Fighting

Webb often hears from clients who assume they don’t need a will because their families get along. They trust their spouse or children to divide the estate fairly and peacefully. He’s witnessed plenty of horror stories that contradict that. He cited a case of a man who died with a large estate. He had two daughters and no will. 

“The daughters seemed to get along OK when he was alive, but after he died, they fought like cats and dogs and ended up spending $150,000 in legal fees,” he said. “When you and your spouse are still alive, the relationship between children is often muted. The jealousies and envy stay below the surface. Once the parents are gone, all these things come to the forefront.”

Even when succession laws clearly state who gets what, Webb added, fights can arise. For example, if there’s no will, all the heirs must agree on who will serve as executor, and that alone can start a war. 

Cona adds that a will not only helps ward off conflicts, it can also help keep families together after a death. 

“The best thing you can do for the next generation is to take care of estate planning,” she said. “It’s the best gift you can give your loved ones.”

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