Minnesota elders need more advocates

They are called "elder orphans" -- perhaps 8,000 or so older Minnesotans in fragile health who have outlived their families, close friends and even their ability to make important medical or financial decisions.

Most are women such as Alice Furman, 74, who lives alone in a Minneapolis apartment. Others are scattered across Minnesota in houses, apartments and nursing homes, some with dementia or mental illness, all growing frail.

"They're just one crisis away from a judge appointing a guardian to look after them," said Minneapolis social worker Mary Bornong, "when often what they need is a friend."

In a program believed the first of its kind, Bornong's social service agency, Volunteers of America (VOA), is seeking out people like Furman, helping them fill out health-care instructions, then working to find advocates for them.

The advocates will become the "friends'' they need, appointed by them to carry out their wishes for treatment when illness or dementia have silenced their voices. Based on their values, the advocates might weigh the risks of surgery or drug treatments -- and in the end, might make life and death decisions.

Since last fall, Bornong has completed work with just 15 of 27 people referred to her in Hennepin and Anoka counties. But organizers hope the tiny program will spread throughout Minnesota and beyond.

With a $100,000, two-year state grant, the Unbefriended Elders Project also is training a growing web of professionals to spot elder orphans wherever they live, and to find friends, neighbors and even estranged relatives to serve as their advocates.

Furman became an elder orphan two years ago when her brother died. Her only relatives are his widow and his children on the East Coast.

"There's nobody. I've kind of been on my own forever -- church and housekeeping, that's what I did," Furman said. "I've been kind of lucky. I've been sick, but not too sick. If the sickness gets bad, well, that's where I don't know how to make things work. I've got nobody really close."

Slipping through the cracks

Most older people are able to plan ahead and discuss with family or friends the care they would like should they become gravely ill.

"But elder orphans may slip through the cracks, nobody asking the important questions until too late," Bornong said. "A court-appointed guardian may be a wonderful person, but they won't know the person they're representing. That means the patient may end up being overtreated or undertreated -- depending not on the values of the patient, but the guardian."

The issue comes up regularly in nursing homes when a resident with no family hits a medical crisis, said Liz Sether, a nurse consultant and policy analyst at the nursing home trade group Aging Services of Minnesota.

"Our homes will scramble to find somebody, and if they can't they'll ask the county adult protection office to get a court-appointed person to step in," she said.

"But usually that's somebody who doesn't know the resident or her values, a poor second choice," she said. "What VOA is doing is taking action while a frail person is still competent" to sign an advance directive and choose a health-care advocate.

At Augustana Health Care Center in Minneapolis, "we try to watch out, to be proactive," said administrator Jean Cole. "But every year we end up in court to get somebody appointed to help make medical decisions."

That also happens at Emmanuel Nursing Home in Detroit Lakes, Minn., said administrator Janet Green, although the county tries to use volunteers such as retired bankers to act on behalf of residents -- still likely a stranger, but cheaper than a guardian.

Matching care to values

The idea for the program was born in the frustration of social workers Mary McGurran and Anita Raymond at VOA Protective Services in Minneapolis.

"We were getting more and more calls from nursing homes and other places to get a guardian or conservator appointed for a resident," Raymond said. "Sometimes that was the only choice left, if the person no longer could participate in decisions.

"But we realized that sometimes -- if only somebody had time to help -- you could still intervene. You could help set up support so a guardian would not be necessary," she said.

They developed the program, sought the state grant and found community partners to make client referrals and support the program: Anoka and Hennepin counties, EverCare Health Systems, Little Brothers Friends of the Elderly, the University of Minnesota Future Doctors Program and Wilder Research.

A supporting research project by the William Mitchell Law School Center for Elder Justice and Policy estimated that about 1,000 of the state's 35,000 nursing home residents might be elder orphans, with others living elsewhere.

'Nobody really close'

Because of Furman's fragile health, an EverCare nurse referred her to the Unbefriended Elders Project.

Bornong helped Furman write a health-care directive detailing the care she wants if she cannot speak for herself, then met with Furman and her doctor to go over the document.

While she had no one close, Furman remembered three Roman Catholic nuns -- Marguerite Corcoran, Rita McDonald and her sister Kate McDonald -- women whom the Pentecostal Protestant used to meet occasionally for coffee. They did not live far from Furman, and she got back in touch with them.

All in their 80s, the three women are older than Furman but in better health. As members of the Sisters of St. Joseph, they are in a tightly knit community of support.

"Of course we agreed to be Alice's health-care advocate -- and advocate for anything else we can help with," Corcoran said.

As they talked, Furman explained how the nuns should make decisions about her care: "Reasonable stuff is OK, stuff that will get me good enough that I'm still me. But if I can't be me -- if I can't think or talk or be with people -- then don't bother."

Warren Wolfe • 612-673-7253