What If Caregiving Was About Partnership, Not Dependence?

As Barb Buettner approached retirement, she was haunted by the question of how she would live in her later years. While looking after her parents, she had gotten a glimpse of the type of difficulties she might face. Her dad was lonely in his nursing home; Parkinson’s had worn down his body, but his mind was still sharp. His wife had Alzheimer’s, and he had few peers at the nursing home who could offer stimulating company. At least he had a daughter who could visit and care for him. But Buettner didn’t have any other close family members. She couldn’t help but wonder: What’s going to happen to me?

The question Buettner asked herself is growing more pressing for many Americans, who now live longer, frequently experience chronic illnesses that require years of caregiving, and are less likely to have kin to turn to in their old age. Lots of older adults are left with no one to rely on. In the face of such challenges, some have pieced together their own support system by relying on friends. Though this setup has limits, especially if friends need care at the same time, it can save money, prevent loneliness, and, crucially, offer a way around a common caregiving dynamic, where the person being cared for feels like a burden (a benefit that disability activists have also emphasized). It opens up a different, less hierarchical model of caregiving based on not a relationship of dependence but one of equality.

This was the solution that Buettner and her close friend Inez Conrad slowly arrived at. The two had been fixtures in each other’s lives for more than two decades. They had taken long vacations together, jointly celebrated holidays, and supported each other through loved ones’ deaths. After picking a different part of the country to move to together, the friends initially planned to buy separate houses in the same neighborhood. But they soon discovered that they couldn’t each afford a home on their own. That left the option of buying one together. “We thought, Well, we never killed each other on a trip,” Buettner told me. “Maybe this could work out.” In 1998, they settled in a one-story brick house they call the Hermitage, to mean a place of refuge. There, the women became much more to each other than roommates who share silverware and rotate chores. Their long history as friends made their relationship a true partnership, in which they each came to serve as the other’s confidante, companion, and—eventually—caregiver.

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At first, they were reluctant to adopt the last role. Buettner had once thought that she and Conrad couldn’t be each other’s primary caregiver because they were too close in age; they would likely have health issues around the same time. But after Conrad had a minor medical scare while they were living together, Buettner changed her mind. “Our determination then was that we would take care of each other as long as we could,” Buettner said. Though Conrad’s son Rick would seem to be a more obvious candidate to serve as their caregiver, Conrad and Buettner feared that making him fully responsible for them would weigh him down; he lives in another state and has children of his own. With each other, they knew they wouldn’t have to worry about that. So Buettner and Conrad became more deeply interdependent, eventually getting the same primary-care doctor and granting medical and legal power-of-attorney rights to the other. Conrad even put a bell by her bed—the same one her mother had once used to summon the family to dinner—to alert her friend if she were in distress at night.

Arrangements like Buettner and Conrad’s could be the “wave of the future,” Deborah Carr, a sociology professor at Boston University who researches aging, told me. This is partly out of necessity. A growing proportion of Americans won’t have a spouse or children to take care of them. Marriage rates have declined with each new generation, and the divorce rate for those over age 50 nearly doubled from 1990 to 2019. Even among those who stay together, there’s always the risk of outliving one’s partner. The Population Reference Bureau projects that the number of 75-year-olds without a living spouse could more than double, from about 875,000 in 2010 to 1.8 million in 2030. Meanwhile, people are having fewer kids, if they have children at all. But being a parent doesn’t guarantee a caregiver for life’s later years. Adult children might not live close to their parents, or they might not have the capacity to help. Many people with aging parents are raising children of their own at the same time. And with more women in the workforce, daughters aren’t the default caregivers they once were.

Now we’re facing a future with a growing number of older adults with no close family ties—a group of people whom sociologists call “elder orphans,” “solo agers,” or “kinless.” Researchers estimate that one in five older adults is an elder orphan or at risk of becoming one, and that figure is likely to grow. Hiring professional help is one option for those in this situation. But that isn’t always so simple, given the country’s persistent paid-caregiver shortage, which is driven in large part by low wages and poor working conditions. And even if more help were available, many older adults might not be able to afford it.

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Friends are by no means a complete solution to this shortage, but they are starting to fill the gap. A 2020 AARP survey found that 10 percent of caregivers for adults were friends or neighbors. Many older adults who have close relatives still turn to friends for help. One study found that one-third of chronically ill people being cared for by a friend had children who didn’t step into that role. Caregiving among friends is especially common in queer circles. According to a study from 2010, LGBTQ Baby Boomers were more likely than the general population to have cared for a friend in the past six months, twice as likely to have involved friends in discussions about their end-of-life preferences, and four times as likely to have a friend as their caregiver. The social scientists Anna Muraco and Karen Fredriksen-Goldsen interviewed lesbian, gay, and bisexual caregivers who reported that they often viewed providing care as a natural extension of their friendship, not as an extraordinary act.

Of course, caregiving among friends doesn’t resolve the deeper structural problems that older adults tend to face toward the end of their life, including the exorbitant costs of long-term care as well as ageism that can leave them feeling invisible. And much like spouses who are each other’s caregivers, one older friend may not have the physical strength to help the other get around, or the friends could need help at the same time. Conrad and Buettner recognize this; they know their mutual support cannot last forever. But in their quarter century of living together, during which Conrad was diagnosed with a heart condition and the two weathered a pandemic together, they’ve gotten accustomed to relying on each other. Conrad had long been the one to take out the trash; now Buettner will check whether her friend is okay doing it herself or wants help. Buettner reminds Conrad to turn off the hose when she forgets, and Conrad reminds Buettner to take her medication. Yet they’re careful not to let support tip over into dependence. Buettner has told Conrad, “Help me with this, but don’t help me too much, because what if the day comes you’re not here and I need to be responsible for myself too?” But until then, they plan to continue enjoying a life together in their hermitage.

This article was adapted from Rhaina Cohen’s forthcoming book, The Other Significant Others: Reimagining Life With Friendship at the Center.