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Who Will Provide Care for Childless Boomers?

Many will grow old without family to look after them

The last piece of real estate Pam and Bruce Boyer purchased together was more than 20 years ago: adjoining plots in the cemetery across the street from their home in historic Bethlehem, Pa.

“We chose a place we really like. We walk there – it’s like a park in London,” says Pam Boyer, 68, a retired magazine researcher whose husband is a freelance writer. “We got it taken care of early before it seemed morbid – or too homey,” she adds with a laugh.

‘Elder Orphans’

It wasn’t the only accommodation the Boyers made to the fact that they are childless, a circumstance an estimated one in five boomers find themselves in as they age.

One study predicts that about a quarter of boomers may become “elder orphans.” That’s a newly coined term for people who reach old age with no family or friends left, like the 81-year-old North Carolina man who made the news in May when he called 911 for food because he had no one else to turn to.

Fewer Caregivers

Family members provide about 70 percent of long-term care services, according to a survey by the American College of Financial Services. Not only are more boomers childless, those who do have children have fewer than the previous generation. Trendsetters from the start, the boomers have spawned a new phenomenon: caregiver shortage.

As of 2010, there were more than seven family caregivers for every person 80 and over. By 2030, estimates say, there will only be four and by 2050 there will be fewer than three.

The key thing is choosing someone who will enforce the decisions that you’ve already made.

— Bert Rahl, Benjamin Rose Institute on Aging

That raises the question: Who will take care of the childless boomers when they’re old?

Avoiding the Serious Questions

What alarms many experts is that it’s not the boomers who are asking that question.

“I’d say of every four people I meet, three have not made any decisions at all about their health care when they age,” says Bert Rahl, a licensed social worker and director of mental health services at the Benjamin Rose Institute on Aging in Cleveland, Ohio.

Understanding the Truth

The Boyers chose to be proactive. What made it easier: In light of their circumstances, they’d given it a lot of thought.

They knew when they married more than 30 years ago that they were never going to have children. Pam Boyer is an only child who cared for her grandmother and both her parents — her father had Parkinson’s disease, her mother, Alzheimer’s — in their later years.

“We’re not a healthy family,” she says ruefully.

And neither of them was squeamish about talking about death — even their own.

Take Charge of Your Life

So not only did the Boyers pre-plan their burial, they downloaded documents from the Internet that allowed them to create an advanced directive (a living will that spells out your wishes for end-of-life care) as well as durable power of attorney (POA) so a trusted friend could handle both health care and financial decisions for them when they couldn’t.

(Unlike an ordinary POA, a durable POA stays in effect if you’re incapacitated. The medical version of the POA is called a durable POA for health care.)

They also bought long-term care insurance to help cover expenses if they develop chronic illnesses that require treatment over a long period of time. Premiums for this kind of insurance are high — they can range, on average, from as low as $1,700 to more than $5,000 a year — but they offer the couple peace of mind that a catastrophic illness won’t bankrupt them.

Preventing Falls

They also did some preventive remodeling. They added grab bars to their bathtub and moved their washer and dryer from the basement to the main floor of their house to reduce their risk of falls. Falling is the No. 1 cause of hospitalization for older adults in the United States and a leading reason those 75 and older wind up in long-term care.

“Making your home fall-resistant is one of the best things you can do. Your injury potential goes way down,” says Louis Tenenbaum, a former carpenter and contractor who founded the Aging in Place Institute. The organization advocates for housing modifications to meet the needs of seniors who want to stay in their own homes as long as possible.

Every step the Boyers have taken to protect themselves in old age is a wise move even if you have children who say they’re ready and willing to be your caregivers, says Dr. Bruce Chernof, President and Chief Executive Officer of California-based SCAN Foundation, a nonprofit dedicated to improving the range of health care for seniors.

Finding Strong Supporters

Chernof, who himself is a married boomer with no children, says “family” needs to be defined broadly.

“It’s not just children. We all should be thinking about how we want to live our lives with dignity and independence and we should be building a circle of friends and family around us to help us realize that plan,” Chernof notes.

The key thing is choosing someone who will enforce the decisions you’ve already made, Rahl says. “It’s very important to communicate ahead of time what your wants and wishes are, and choose someone who will honor your wishes, not impose their own personal values,” he adds.

Draft Documents, Get Insurance

Having that “circle of support” isn’t enough without the conversation about what you want done when something happens to you. “Seventy percent of those over 65 are going to need long-term service, including help around the home, dressing, transportation and more,” Chernof says. “Not only should you be talking about what you want, it’s incumbent on you to have tools in place — like durable power of attorney and an advanced directive document and long-term care insurance if you can afford it — to support your circle of support when you hit a speed bump.”

Having those conversations isn’t easy.

Alice Alexander, 57, admits she’s one of those “typical people who have their head in the sand” about growing older.

But she took one step that she knows is in the right direction, though she did it for other reasons: She and her husband of three years recently moved into a co-housing condo community in downtown Durham, N.C. Like the Boyers, they’re childless.

Being There for Each Other

“I wanted to live in a community and with co-housing, community is there when you want it,” says Alexander, Executive Director of the Co-Housing Association. “I wanted one of those neighborhoods where you know your neighbors, where you remember each other’s birthdays and feel comfortable knocking on the door when you need help but you can always close the door. I think together as a group we’ll all find the courage to have the conversation, because we really do need to think about this.”

Alexander’s multigenerational co-housing neighbors — the Durham Central Park Co-Housing Community — haven’t set up a legal covenant spelling out how neighborly they’re going to be. But they have agreed that they want to be there for one another.

The plan was tested during the month of move-in, when one of their single neighbors broke her arm and couldn’t care for herself.

Rather than see her go to rehab, “We scheduled visiting with her, bringing her food, and some people volunteered to help her bathe,” Alexander says.

Revisit the Decisions

While setting plans in place for the potential and the inevitable are a good idea, they’ll sometimes require some tinkering. Over the last couple of years, the Boyers realized that asking a close friend to be their support was probably not the best idea.

“Unfortunately, he’s our age, which is not going to be a practical solution,” Pam says. “We’re going to ask an attorney to take over for us.”

Her advice: “Talk about it while you’re still feeling good and revisit it from time to time. It’s not once and done.”


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