Four types of aging families, who can afford geriatric care management and home care long as they have the financial resources, will call you over the holidays. Mom is unable to pull off the ritual of either Thanksgiving, Hannukah, Christmas or New Years or usually all four.You need to have excellent clinical skills to manage these families- get them through the holiday season and stabilized as the ongoing client after the first of the year.

The first two are dysfunctional aging families and take extensive psychodynamic skills. The last two are nearly normal aging families must have the crisis solved and shown tools and resources to arrange care in the future. Many times they can handle themselves after you have established care and a GPS to access the future care they need. But they may also want to remain as your clients for you to manage their care. 

Part of this is drawn from Claudia Fine and Nick Newcombe excellent chapter ” Entitlement in the Aging Family”, Care Managers Working With the Aging Family, Jones and Bartlett)

Narcissistic-Entitled Families:

Entitlement in these families usually develop from a specific kind of “not good enough parenting” in which the parents themselves have struggled with personality disorders, most typically, in this type of family, narcissistic  borderline personality  .( example President Trump)They struggled with borderline personality that went undiagnosed or was formally diagnosed and untreated. The narcissistic or borderline parent essentially does not experience the child/children as separate and discreet from themselves and, moreover, uses the child/children to serve parental needs.  This parent-child relationship is characterized by severe boundary issues in which seduction and abandonment are ever-present dynamics and where emotional unpredictability and instability are constant.  ( Fine and Newcombe- Entitlement in the Aging Family, Care Managers Working with the Aging Family)

 Rich and Famous-Entitled Families:

These families are identified by the parents’ socioeconomic, financial and political prominence.  ( example President Reagan)They are families in which all basic needs, services, resources and creature comforts are obtained via income, assets, abundant discretionary cash flow and/or come from the political position, station or power.  Once again, the entitlement of the family is passed from the parent to the child who in turn brings these behaviors and actions to the caregiving milieu and care management relationship.  In this category, the entitlement arises out of a family that is accustomed to purchasing everything.  They look to paid others to meet their needs (as opposed to families who must themselves find and orchestrate ways to meet basic and complex needs themselves or with the help of the extra-familial system).  Often these families have household staffs, i.e., nannies, butlers, drivers, private pilots, cooks, and maids.  They may have available to the business and family lawyers and accountants, as well as, teams of medical professionals and concierge physicians.  Consequently, in almost all situations they are uninvolved in processes, especially those that are difficult, stressful and time-consuming.  ( Fine and Newcombe- Entitlement in the Aging Family, Care Managers Working with the Aging Family)

Well-heeled seniors,

According to the New York Times, may be middle-class retirees who buy shoes from Payless but have a defined pension can afford care at home when they need it and private care management. They rode the post-war economy, held jobs long term and through that defined pension (no 401K) face a very healthy financial picture in aging.  They worked for city, county, state government are teachers, truck drivers, social workers or were union members in all trades. They had a career at Xerox, IBM, Campbell Soup and big Fortune 500 companies.

Professionals- Physician, Attorneys, CPAs

This group made a very healthy living during the late 20^th Century, probably had a defined pension and have very lucrative investments that allow them to afford home care and care management. They usually come from nearly normal families and have been well parented although you will find a mixture of dysfunctional aging families. Their adult children tend to be supportive of their parents, although again you will find a mixture of dysfunctional families in this category.