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Choosing a Health Care Proxy When You’re an ‘Elder Orphan’

It is more difficult without family around, but making a choice is vital


Part of the Transforming Life as We Age Special Report

When you live alone without support of loved ones nearby as an “elder orphan,” long-term care planning is not only essential, it demands complex thinking. That’s especially true for picking a surrogate or executor of a will, power of attorney for health care, and financial matters or other tasks.

In the younger years, long before retirement, we rarely tend to consider the “what ifs” of health and finances. Alarms don’t go off until we experience another’s decline. That’s when we see first-hand just how much an older person depends on others for transportation, advocacy, daily living activities and even moral support.

Changing Times

I grew up at a time when family members took care of each other. We could depend on one another with minimal fear of isolation and abandonment. But for a lot of people today, that’s not the case. Our society is fluid and individuals don’t stay in one place anymore. Plus, the culture promotes and thrives on independence and individualization.

Research confirms that the boomer-aged segment has higher divorce rates and fewer children, which creates a group of individuals aging alone and needing assistance. I am one of the so-called “elder orphans.” The boomer segment is turning 65 at a rapid rate, and by 2050, the number of people who will be 65 and older is projected to be 83.7 million — almost double that of 2012.

Solo older adults must plan for the future and begin building support. Otherwise, we are likely to be unbefriended and isolated.

Making Difficult Decisions for Elder Orphans

Early on, we — like all other adults — need to ask, “Who will decide for us in the event of a health emergency or if we should become incapacitated?”

Keep in mind that the person you select may be the one to decide whether to maintain or discontinue life-sustaining treatment.

Linda. J. Camp, of Turning Point Consulting in St. Paul, Minn., suggests: “When crafting wills, trusts, powers of attorney and advance care directives, members of this group struggle with whom to designate and talk with about ‘the last chapter’ because it isn’t easy for anyone. But for the growing subsector, it is especially difficult.”

In Camp’s research of solo elders, she found individuals prefer a health care proxy to embrace an attitude of a pit bull — to not give up or give in because the person meets resistance. Other desired characteristics would include:

  • Being ethical
  • Being able to figure things out and ask questions
  • Having excellent communication skills
  • Being an advocate
  • Being objective
  • Being knowledgeable about death with dignity
  • Not imposing one’s own personal beliefs or values on decisions

Someone to Honor Your Wishes

In the elder orphan Facebook group I founded, we confront the issue frequently because most of us don’t have a nearby loved one or even close friends to trust. Legal and government sites discuss the importance of selecting a proxy and where to specify the person in the documents. We even receive handy advice for assigning responsibilities and tasks, but what we need most of all is real guidance on how to find a trusted ally to fill the role of an advocate.

When selecting a surrogate, Kerry Peck, an attorney with the Peck Ritchey firm in Chicago, strongly encourages elder orphans to think about the people who love you and whom you trust.

“First, a person is likely to turn to surviving siblings and their offspring,” he says. “If an individual does not have a close relative, typically one will turn to close friends. But no matter whom you choose, the proxy must understand your preferences and wishes. So, sit down and discuss your values, goals, religious beliefs and your end-of-life decisions.”

Keep in mind that the person you select may be the one to decide whether to maintain or discontinue life-sustaining treatment, “so it’s critical that the surrogate loves you more than they love your money because it’s common for proxies to receive some or part of your assets,” notes Peck.

Assembling an Advocacy Team

Choosing a health care proxy is one thing, but you must also put together a “care team,” says Tracey Lawrence of Grand Family Planning in Ringwood, N.J.

“One must design a backup plan that includes the current or potential health challenges,” she says. “Develop a health care team of professionals who understand long-term care strategies and [others who] know how to position assets to strike a balance between living comfortably and preparing for a probable illness.”

Camp says one study reported that 16 percent of critically ill patients in intensive care units have no one to speak for them. At that point, planning is no longer possible because the individuals have limited capacity to make medical decisions and have no one — either legally authorized or de facto — to serve as a surrogate.

Starting Before You Need It

What’s needed, according to Camp, is finding health care support, like an advocate, who has the wherewithal to help a solo adult plan for the “middle,” not just for the end.

“It’s that period when an individual deals with chronic illnesses that they need the most guidance and help,” she says.

In the future, Lawrence predicts there will be better planning.

“I think doctors will create treatment teams and practices focused on elder care and caregiver support. Aging in place strategies, group homes where more able elders team up to help each other and become co-advocates, will be in the future,” adds Lawrence.

Experts advise all adults to create a plan and find a person to stand in for you in case you become incapacitated. Otherwise, the courts may appoint a guardian, which can result in an entire set of problems you’re better off avoiding.

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