• As Michigan ages and provider shortages deepen, older residents can fall through widening gaps in care
• Caregiving can fill needs, but researchers, doctors and others often focus only getting family members to help
• By including friends as caregivers, health care providers and policymakers can better support an aging state

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It never occurred to Mary and Bill Hase not to care for their friend, Ed Niemi, just as they did for his late brother, who had multiple health problems, after the brothers’ mother died.

“Maybe that’s why they call me a mother hen,” says Mary Hase, who helps the Munising resident sort medications and clean house while her husband helps with yard work and nudges Ed — who can struggle with personal care — that it’s time to take a shower or change his clothes. 

“It’s just who we are,” she said.

The words “care partner” or “caregiver” often conjure thoughts of family ties: a sandwich-generation child or an overwhelmed spouse.

But Mary Hase, 67, is one of more than 2.4 million Americans who are quietly helping friends delay the need for social services and avoid nursing homes despite having no blood or legal ties to them, according to a new study published by the Journal of the American Medical Association.

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“We’re missing the boat by just thinking about primary caregivers when there’s actually a larger network — or a lot of my caregivers prefer the word ‘team’ — involved,” said Amanda Leggett, a researcher at the Wayne State University Institute of Gerontology and lead author.

The findings are important in Michigan — a state aging faster than most others, while also struggling with transportation gaps; loneliness, uneven funding for and gaps in aging services and severe shortages in health care. 

Without support, many Michigan seniors end up in nursing homes. That can cost an average of $350 a day per Medicaid resident — about 2 ½ times as much as in-home care, according to some estimates.

Leggett’s findings were based on questions asked of 2,619 older adults with activity limitations in the National Health and Aging Trends Study conducted at Johns Hopkins University Bloomberg School of Public Health.

The data also reaffirm what another team of Michigan researchers — this time at University of Michigan — identified last year as a “significant disconnect” between the traditional view of caregiver and what’s really happening.

Leggett and her team also found differences between caregivers who are friends and those who are relatives. Compared to family caregivers, friend caregivers typically:

• Provided fewer hours of care
• Were less likely to provide intimate personal care
• Were less likely to be the sole caregiver 
• Were more likely to provide care on a variable schedule
• Were more likely to focus care on specific tasks, such as providing rides 

Why it’s important

It’s tough to know precisely how many caregivers older Michiganders rely on. According to one University of Michigan poll, 1 in 3 Michigan women 50 and older reported being a caregiver.

Nationally, the number of adults providing unpaid care rose more than 30% between 2011 and 2022, from 18 million to 24 million, according to one study. Other estimates put that number higher: 38 million people 15 years old or older provide unpaid care, the US Bureau of Labor Statistics reported last year.

The 2.4 million friend-caregivers identified in the latest research fall within a tight caregiving definition — those assisting in tasks related to health and activities of daily living. 

They are “partners in care delivery,” according to the paper.

Friends who help with grocery shopping or home chores may know a lot more about a person’s medical history and current well-being than a grown child who lives far away or whose relationship is based on an occasional phone call,  Leggett said.

“It’s easy to say ‘you’re doing a good job,’ but we need to tie value to it, and that means first recognizing the contribution,” said Tim Niyonsenga, a senior program officer focused on health aging and caregiving at the Michigan Health Endowment Fund.

For example, a doctor who asks an older patient “Do your children help you at home?” should instead ask “Who are the closest people in your life, and how do they help you?”

“Let’s really open up the system to its full capacity,” he said.

A thin line, crossed without notice

With better recognition comes better support for both caregiver and recipient, Leggett, Niyonsenga and others said. 

Federal, state and local programs can tailor help for aging residents around assistance from friends — ensuring older patients get to their doctors’ appointments or to a senior center for friends and meals, for example.

Complicating matters, some friends simply don’t recognize their role as caregiver.

“Most people would just say ‘I’m helping out a neighbor,’ or ‘I’m helping out as a friend,’” said Jenn Dubey, operations and projects manager at the Area Agencies of Aging, which last year launched a website for caregivers.

That’s because the thin line between friend and caregiver is crossed without notice.

What begins as unremarkable kindness — a friend offers to stop to pick up coffee and visit a struggling companion, becomes habitual support.

Over a cup of coffee, there is talking, laughing and a sharing of the day’s events. Soon enough, the friend grabs some groceries along with the fresh cup of to-go coffee.

For another visit, it’s a bigger list of groceries.

… which becomes routine.

And then the offer to help with dishes that have piled up.

… that becomes habitual.

And maybe helping their friend get into the shower.

“Now there’s a panic or concern — ‘If I skip my visit, will everything be okay?’” Dubey said. “You’ve become part of that life infrastructure, and if you’re not there it may collapse.”

“If your schedule and emotional energy are tethered to this person’s well being, that’s where the burden begins,” she said.

Too often, she and others said, friends don’t see themselves as caregivers, and they, too, miss out on assistance that’s available to them, support groups, resources, and even legal and financial assistance.

In some cases, they can be paid to act as caregivers through the state’ s Home Help program, which this year pays just more than $17 an hour. Last year, more than 11,000 “non-relative” caregivers were among the nearly 41,000 people who were paid caregivers in the program, according to state data.

‘It fills my heart‘

The Hases aren’t asking for money for helping Ed — he’s been a friend for years after the three worked together at Timber Products in Munising, where Mary was a janitor and Ed and Bill were forklift drivers, Mary Hase said.

During her own medical problems five years ago, Mary and Bill Hases’ friends set up a gofundme site, visited, and sent cards and emails, Mary said.

“When I had my cancer, I knew what it felt like to have people help,” Mary Hase said.

“It fills my heart, she said of Niemi, knowing he looks back at us with a thank you,” she said. “That’s all I ask.”

(Editor’s note: The Michigan Health Endowment Fund is a sponsor of Bridge Michigan’s Health Watch newsletter. It had no role in the reporting, writing or editing of this article.)

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