Over 30 years ago, researchers and geriatricians identified an "elder orphan" (sometimes called a "solo ager") as a person aging alone with little support. But when my Elder Orphan Facebook group targeting this population launched over 2 1/2 years ago, little was known about them. Even then, few realized that the hardships faced by older people with no nearby family members could be any different from those of others aging at home.
Health care professionals and companies tend to lump the older population into four segments: ages 55 to 64, 65 to 74, 75 to 84, and 85 and older. It's assumed that people in these age brackets deal with, or eventually could deal with, similar concerns relating to health, housing, transportation, caregiving and safety. But those concerns are further magnified for those who do not have a support system, and that number may be higher than you imagine. For example, in Dallas, where I live, 30 percent of people 65 and older live alone.
Thankfully, through the dedicated service of social workers, gerontologists and geriatricians, the unique challenges of the solo ager have been identified. The most recent research project, headed by Rupal Parekh, a Ph.D. candidate at the University of Texas at Arlington, School of Social Work, with the Elder Orphan Group, uncovers the preliminary data that brings clarity about the issues facing this segment of the population.
The Unique Differences of Solo Agers
Since founding the Elder Orphan Facebook group, one insight I've gained is that its members with offspring feel the most isolated and alone when distance keeps them apart from family. And those who never had children have learned to build social networks of friends.
To have the support of someone when you're sick and confined to a bed is important for everyone, but our research found that 39 percent of study participants had no one to call in that situation.
Some members of the group have created a support team and text each other by a certain time of the day or call by phone. If there is no response, they have a contingency plan of action. Their strategy offers peace of mind and causes the members to feel they have someone to count on.
One individual and a set of eight friends have taken it to the extreme; they've committed to be there for one another and even to serve as legal guardians. As a group, they've consulted with an attorney who set up the necessary documents.
Legal Medical Decisions
All types of needs for assistance increase with age, but interventions for making health care decisions are the biggest concern. Traditionally, such collaboration has been provided by family members. When someone is aging alone, it is often not clear who can and will be available to support him or her, or who will be serve as the health care proxy if necessary.
Without a supportive infrastructure, those aging alone are at risk for lack of care, inadequate care or care that goes against their wishes.
Our research has taken a closer look into this issue and discovered 43 percent of our members have not identified a health care decision maker. They say they "haven't gotten around to it," but note that when they do, they plan to pull together a team of health care professionals.
Events such as loss of support system (which could occur with the death of a family member or friends; multiple chronic health issues; a fall or other physical limitations could be the causes for their inability to make health care decisions.
However, the preliminary data revealed that more than 27 percent have fallen at home in the last six months; 26 percent live with three or more chronic illnesses and 35 percent do not have family or friends to help them cope with life's challenges. It makes sense that more would have their medical decision making plans in place, but that's often not the case.
One person in the Elder Orphan group admitted, "I couldn't get motivated until I had episodes of falling. This got my attention."
Another said, "I have an advance directive and health care proxy filed with my primary care doctor. What I don't have is an executor, and I can't think of a younger person I know well or trust enough to ask."
Help Needed Thinking Through Decisions
Being an administrator of the Elder Orphan Group, it's my opinion that members who have lost husbands and the single parents live the most insulated lives, compared to single or divorced individuals without adult children.
However, both groups have trouble finding someone close to them who can provide help when it comes to thinking through vital decisions or calling for information about them. The preliminary data shows close to 33 percent have someone, but only some of the time. And 55 percent have no one with whom to discuss medical decisions.
Most in the group want to connect socially. It's a huge desire and that's proven by the high-level number of interactions on Facebook. They also want to learn new skills and to work. But when it comes to having a list of reliable contacts, the solo ager often comes up short.
The Research Tells Many Stories
Here's a little bit about the people who comprise The Elder Orphan Group:
They are well educated; preliminary data reveals that over 70 percent are college graduates, 30 percent of those earned a master’s degree and 7 percent earned a Ph.D. or a medical degree.Those who are still working make a fairly decent income.Although exercise is recognized as the best way for adults to help ward off chronic illnesses and is touted to slow the effects of aging, 29 percent of the solo agers report they don’t do any moderate exercise.Most significantly, I want to clarify that the issues described above don't solely affect those who are single and alone, but also those who have family. That's the significance of this research; to diminish the perception that people with family don't experience isolation and loneliness.
The research intends to develop a stronger understanding of older adults who are aging alone and have limited support within the U.S. We know that elders aging alone are often a hidden population, so academic studies can help bring voice and understanding of the needs and challenges.
It's my hope to pique the interest of research scientists and to encourage investment in aging. But also, by using the members' stories along with the eyebrow-raising stats, I want to give hope and solutions to those outside the group and the professionals who work with them.
While research helps raise awareness and uncovers unrealized data, even the most rigorous statistics lose impact if the analysis is not communicated to decision makers who need to know.


What We All Need to Know About Solo Aging

Carol Marak

(This article appeared previously on Kaiser Health News.)
Phyllis Krantzman knows what she should do. But like many of her peers, the 71-year-old doesn’t know how to approach a casual acquaintance to ask who will take care of her when she needs it most.
Krantzman, of Austin, is among a growing number of seniors who find themselves alone just when aging and end-of-life care becomes real.
Unmarried, with no children, she lost her younger sister by seven years in 2014. Krantzman’s social network is limited to a handful of work colleagues and a few acquaintances. “I’m very fearful of when I reach that place in my life when I really need help and maybe can’t take care of myself anymore,” she said. “I have nobody to turn to.”
The 'Elder Orphan' Universe
Krantzman represents a universe that’s come to be known among geriatric specialists as “elder orphans” — seniors with no relatives to help them deal with physical and mental health challenges.
Their rising numbers prompted the American Geriatrics Society last week to unveil guidelines for a segment of these older adults who can no longer make their own medical decisions and have no designated surrogates. The nonprofit dubbed them “unbefriended” and called for a national effort to help prevent a surge among incapacitated seniors who don’t have a decision-maker and face a health crisis.
Reasons for the Rise in ‘Orphans’
Single seniors have always existed, but demographic and social changes have slowly transformed aging America. In 1900, average life expectancy was 47. Now, the combination of increased longevity, the large and graying baby boom generation, the decline in marriage, the rise in divorce, increased childlessness and family mobility have upended the traditional caregiving support system.
Among the indicators:
A Centers for Disease Control and Prevention report this year shows the number of Americans older than 100 increased almost 44 percent between 2000 and 2014.Nearly 23 percent of people over 65 are — or risk becoming — elder orphans, according to a 2016 study by New York geriatrician Maria Torroella Carney.A U.S. Census report from 2014 projected that by 2050 the 65 and older population will be 83.7 million — almost double the 2012 estimate of 43.1 million.The nonprofit Population Reference Bureau in Washington, D.C., reported earlier this year that family provides more than 95 percent of informal care for older adults who aren’t in nursing homes.“Americans are spending less time than ever in the married state,” said Susan Brown of the National Center for Family & Marriage Research at Bowling Green State University in Ohio, which “raises questions about who’s going to care for these people as they age and experience health declines.”
“The computer is so important to me because I have so few people in my life,” said Phyllis Krantzman, 71A Potential Caregiving ‘Crisis’
Reference Bureau demographer Mark Mather said the combination of aging boomers and family dislocation is creating “a potential caregiving crisis or at least major challenges down the road.”
The oldest boomers are now 70. With more on the horizon, the impact of smaller family size will become more pronounced: Boomers had fewer children than previous generations and significant numbers are childless, said demographer Jonathan Vespa of the U.S. Census.
“As people have fewer children, there are fewer people in that next generation to help take care of that older generation,” he said.
Trying Out New Ways of Living
New 2015 U.S. Census data also reflects more elders who live alone — 42.8 percent of those 65 and older. Yet new twists have emerged, such as co-housing, in which people live independently in housing clusters with a common building for meals and socializing.
Such thinking, said gerontologist Jan Mutchler, of the University of Massachusetts Gerontology Institute in Boston, suggests a “shift [in] the way people are thinking about who can I rely on and who’s going to be there for me.”
Katie McGrail, 77, spent much of her working life in San Antonio or New York, finally retiring to Texas five years ago. McGrail and her friends daydream about “having these little houses around the spoke of a wheel and at center have a nurse and a good cook.”
Avoiding the Topic
Mary Gleason, 85, is an unmarried only child with no children. She’s lived on St. Thomas in the Virgin Islands for 51 years, where she developed a close group of “extremely supportive friends.” Most, she said, are five to 15 years younger, which proved important in January when Gleason had open-heart surgery.
“That was it,” she said, noting she never talked about future care. “Now that I’m feeling so much better, I try to keep away from discussing that kind of stuff.”
It’s a mindset Mutchler knows well.
“People in general avoid planning for unpleasant things,” she said. “A lot of people don’t have wills or think about long-term care or what they would do if they needed it.”
Without a Surrogate
Timothy Farrell, a physician and associate professor at the University of Utah School of Medicine in Salt Lake City who worked on the new American Geriatrics Society policies, said he would “regularly encounter patients with no clear surrogate decision maker.”
The guidelines include “identifying ‘non-traditional’ surrogates — such as close friends, neighbors, or others who know a person well,” "standardizing approaches to caring for the unbefriended in urgent, life-threatening situations," and being sensitive to cultural factors in considering a person's best interests.
Boosting social ties among elders is part of a national campaign launched last week by the AARP Foundation and the National Association of Area Agencies on Aging, a nonprofit. The aim is to combat loneliness.
Although Krantzman works part-time and lives in a government complex for low-income seniors, she said the computer she bought at 62 has expanded her reach to connect with others.
“The computer is so important to me because I have so few people in my life,” she said. “Having the computer thoroughly altered my entire life.”
KHN’s coverage of end-of-life and serious illness issues is supported by The Gordon and Betty Moore Foundation.


Creating A Safety Net for Isolated Older Adults

Sharon Jayson

Thriving in a place that’s safe and comfortable, surrounded by cozy memories, is a natural desire of older adults. We treasure independence and want a space to call our own, and we prefer that place to reflect the person we’ve become. We understand that aging bids compromise, and once 65 hits, the changes bring reminders that we’re no longer the same. We don’t move as quickly, we don’t multitask as well, nor do we easily adapt. Those are the simple cues. As we age, the physical and mental challenges delivered through loss, immobility and dependence are the ones that put us at higher risks.
Who Is an Elder Orphan?
However, the effects of aging land harder on an "elder orphan," because the worry and concern of “what will become of me if I can’t care for myself?” triples when no one is around. An elder orphan has no adult children, spouse or companion to rely on for company, assistance or input. About 29 percent (13.3 million) of noninstitutionalized older persons live alone. The majority of those are women (9.2 million, vs. 4.1 million men).
The stresses of living alone will likely worsen for the boomers as a group since we have fewer children, more childless marriages and more divorces compared to earlier generations.
I am an elder orphan — on my own to decide where, and how, I age.
And it’s the reason I launched the Elder Orphan Facebook group. In just a few months, it’s grown to over 1,100 members. Each person joined for different reasons, but primarily to find community, connection and support — my particular motives for starting the group. Here, we talk about what’s on our minds and state our doubts.
Common Topics for Elder Orphans
These are a few topics that come up regularly among the members:
Legal and care issues: “My husband and I are over 70, and by every measure we are and will continue to be elder orphans. We have no children and absolutely no family or living friends who can attend to our financial affairs and to care for us when we need it. We have read articles on the topics, but they end with 'find a trusted friend or family member to oversee your affairs.' We have neither. So, can anyone recommend a group or entity who could handle our predicament? We would like to get a mechanism in place so that we feel secure.”
Affordable housing: “I am 69, and dependent solely on Social Security. I am losing my home after 30 years. I have a mobile home which is my haven, but I can no longer afford it. I have tried all government agencies and found no one who handles mobile home loans. I am alone with my dog and don't know where to turn. I fear becoming homeless, and I am scared to death. Has anyone here ever been through a foreclosure? How did you handle it and what did you do, step by step? I do not want to go into a senior high-rise and was looking into co-housing. I want to go into some independent living but don't know where to start or what to do. I hope someone could help me.”
Transportation: “I truly experienced the ‘elder orphan’ dilemma during the recent surgery. I had to use a voluntary car service to get to the hospital only to find out the ride was not able to bring me home. I didn't tolerate the surgery as well as had been anticipated, so I ended up being admitted because there wasn't anyone to care for me overnight.”
I’m grateful for the group members and happy to report that concerns like these get handled quickly with useful advice and tips. However, since aging comes with sets of unique happenstances, it’s clear that we need services and supports at the local level to age successfully.
Local City Strategies
We need city leaders and policymakers across the country to develop solutions to improve older people's lives in communities. With the graying of America, entrepreneurs and business leaders could benefit by seeking opportunities prompted by this massive longevity economy. It’s the local level that holds answers for the elder orphans and the aging populace.
The Milken Institute is answering that call. They work with mayors’ offices to help build awareness of what’s needed for residents to age successfully. Read about the community programs that some cities have taken on to encourage healthy aging in Milken’s 2017 Best Cities for Successful Aging.
We all want positive results when growing older. We want it for ourselves, and we want it for our parents and grandparents. I am thrilled to see an organization dedicating efforts on issues and desires that mirror the needs of those who age alone:
To live in places that are safe, affordable and comfortableTo be healthy and happyTo have financial security and be part of a healthy economyTo have living arrangements that suit our needsTo have mobility and access to convenient transportation systemsTo receive respect for our wisdom and experienceTo be physically, intellectually and culturally enriched, and connected to families, friends and communitiesThe Milken initiative is not about the best, or least expensive, place to retire. Instead, they work with local leaders to enhance communities so the aging population can thrive — the same desires I hear daily in the group.
But there’s much more needed to instigate dialogue among thought leaders, decision-makers and stakeholders. The demand for age-friendly communities has far surpassed the current solutions.
Giving Credit to Well-Deserving Cities
The three cities that rank highest in Milken’s criteria:
Provo, UtahMadison, Wis.Durham-Chapel Hill, N.C.Provo ranked high in healthy living, a vibrant economy and safe neighborhoods, but lower on affordability and health and wellness. Madison ranked second in health care and third in community engagement, but fell behind on employment and general livability. The Durham-Chapel Hill metro ranked No. 1 in health care and No. 11 in education, but trailed at No. 54 in transportation and convenience and No. 81 in general livability.
Three small metros were also recognized for their leadership: Iowa City, Iowa; Manhattan, Kansas; and Ames, Iowa.
I encourage local leaders to become involved in programs like the “Best Cities for Successful Aging.” To date, 216 mayors, representing all 50 states, have taken the pledge to participate with the Milken Institute. And it’s critical that they do because too many older adults live in the grips of isolation, unaffordable housing, unhealthy situations and immobility.
Here’s how I know: the research from the city data across the country shows that thousands of older adults receive nominal Social Security benefits and live on average incomes. However, for those who are lucky enough to own a home, many still have mortgages. For older adults who rent, in some cities, close to half don’t own a vehicle, and fewer have jobs. The data illustrates the need for local services and more attention from policymakers and thought leaders.
Help for Aging in Place
If cities could provide the much-needed services like public transportation and even simple things like sidewalks, then people could get up and move around. Maybe then, chronic diseases would decrease and we’d have few older adults who become isolated and lonely.
I feel confident that organizations like the Milken Institute will hold city officials’ feet to the fire so older Americans can truly age successfully at home.
For those of you aging alone and in need of support, please consider joining the Elder Orphan Facebook group. It is a closed group; your privacy will be respected.


'Elder Orphans' Have a Harder Time Aging in Place

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?”
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 ethicalBeing able to figure things out and ask questionsHaving excellent communication skillsBeing an advocateBeing objectiveBeing knowledgeable about death with dignityNot imposing one’s own personal beliefs or values on decisionsSomeone 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.
Next Avenue Editors Also Recommend:
Guardianship in the U.S.: Protection or Exploitation?
Advance Care Planning for Procrastinators
Don’t Let Fear Stop You From End-of-Life Planning






 


Choosing a Health Care Proxy When You're an 'Elder Orphan'

With her recent book, Essential Retirement Planning for Solo Agers: A retirement and aging roadmap for single and childless adults, Sara Zeff Geber brought the term “solo agers” into the national vocabulary. By Geber’s definition, a solo ager (sometimes called an “elder orphan”) is a boomer without children and/or grandchildren. Geber, a 2018 Influencer in Aging based in Santa Rosa, Calif., is a retirement coach for boomers, a life planning and retirement transition expert, a professional speaker, a workshop leader and a Forbes contributor. She has a Ph.D. in organizational behavior.
Next Avenue: Your bio says: Sara has been among the first professionals in the field to recognize that the baby boom generation would re-invent the whole notion of retirement in a very exciting way. Tell me about that.
Sara Zeff Geber: In 2010, nobody was talking about this. Boomers were primarily in the workforce. I was looking at the trajectory of the boomer generation and what we’ve changed in society and the likely changes we will enact in our later years. Now, we’re starting to see them bigtime.
Why is there so much interest in solo agers now? 
For one thing, there are so many of us. Almost 20 percent of boomers don’t have kids and as I keep being told in my talks, solo aging is not limited to people who don’t have kids. Lots of people are aging alone with kids who live a long way away and a lot of them don’t want to rely on their kids.
Some people refer to older adults without children as ‘elder orphans,’ but you don’t like that term and many others don’t either. Why?
I hate that term. I find it offensive; the word ‘orphans’ has always had a negative connotation. I wanted to use words that are positive or at least neutral. I think I coined the term ‘solo ager’ eight years ago and now I’m pleased others are using it.
What are the challenges and opportunities solo agers face that are different than other people?
Opportunities? You absolutely have a lot more freedom to decide where you’re going to live. You don’t have the tug of kids or grandkids to live in a particular climate you don’t want. And you can go wherever you want.
What do people ask you about solo agers when you give talks about it?
People are very interested in the topic of where they should live. I’m not the biggest fan of aging in place; I like to see people focus on aging in community. It’s so important to build and maintain a social support network. I encourage people to think through to the end of life when we need people around us.
What do solo agers need to do first for their retirement planning?
They should use professionals like financial advisers and estate attorneys and get their paperwork in order — advance directives, wills, trusts, powers of attorney. That forces solo agers to think through: ‘Who will I name on those documents?’ And they have to talk to those people; you can’t just name them and let it go. You need to tell them your values and your vision for your future.
What happens when a solo ager asks someone to be in charge of their end-of-life wishes?
I can’t say people are always very gracious and say: ‘Yes, I’d be happy to do it.’ They’re not always comfortable at first. Help them understand you need people in your corner as a solo ager. If you tell me ‘I asked one person and she declined,’ I say: ‘Move on to the next person.’
I encourage people to start with family: a niece or nephew who lives near them.
What happens is often people go into a crisis after a fall or a medical event and there they are in the hospital and somebody needs to be there as an advocate waving paperwork saying: ‘I am power of attorney.’
What do you want your legacy to be?
I want people to remember me as a person who opened the world’s eyes to the fact that many people in the coming older generation of boomers, and possibly generations to follow, don’t have the safety net of adult children as we get older. And we need to plan in many ways what want to be, who we will be around and how we will avoid isolation and loneliness.


Sara Zeff Geber: Offering Retirement Advice for Solo Agers

Richard Eisenberg

(This article was originally published on Caring.com.)
As age-related health issues make it tougher to get around and stay independent, most older adults at some point will rely on a family member for help. Usually, one or more adult children will step in to provide or arrange for care when that day comes.
But what about those who never had children? These people  are referred to as “childless” or more recently, “childfree.” Who will care for them when they’re no longer able to care for themselves? Author and retirement planning expert, Sara Zeff Geber calls these older adults “solo agers,” and is working to raise awareness about the need for this cohort to plan for their future.
Geber says she often sees solo agers who seem to be in denial about the need to plan for their long-term living and care arrangements. “That led me to the realization that people needed some guidance for what to do for themselves when they don’t have that safety net,” says Geber.
But Geber has also noticed a growing awareness of the importance of long-term care planning among childfree older adults, especially as more of them provide care for their own aging parents. “People are spending time and resources and sometimes opening up their homes to their own aging parents, and they’re seeing the result of people living so much longer today,” Geber says.
Yet, with higher-than-ever life expectancies and a graying boomer population, an AARP study points to a growing gap between the number of older Americans who will need care and the available supply of family caregivers. According to the study, there were seven potential caregivers for every person 80 years and older in 2010, but that ratio is expected to drop to four to one by 2030, and to three to one by 2050.
Among boomers, the rate of solo agers is almost 20 percent. With more people now choosing to forgo parenthood altogether, the number of solo agers is only projected to rise, underscoring the need for a greater emphasis on planning for a future without adult children to call on.
Advantages of Being a 'Solo Ager'
Despite the prevailing wisdom, there are plenty of advantages to being childfree as an older adult. Since childfree older adults never had to shoulder the considerable costs associated with childrearing — the U.S. Department of Agriculture’s latest estimates put the average cost at about $245,000 per child from birth to age 18, not including higher education costs — they’ve had decades to save more of their income for their later years.
“That money may have been growing since their 20s or 30s rather than being spent on raising children,” Geber says.
She points out that in many cases, these older adults have had more time and space to form strong bonds with friends and to build up a network of close, non-familial relationships. At the same time, many childfree Americans have also been able to develop close relationships with nieces and nephews or other younger relatives.
Once they hit retirement age, childfree older adults typically have more freedom of choice when it comes to where they’ll live. While many parents choose to live close to adult children and grandchildren in their later years, solo agers don’t have progeny to bind them to any one place. Nonetheless, plenty of older childfree adults opt to remain in the communities near long-established networks of friends and acquaintances, Geber notes.
Drawbacks for Childfree Americans
A clear disadvantage of being a childfree older adult is the absence of a built-in safety net to care for you when you need assistance. While not everyone will care for their parents later in life, most do step in to provide some form of help in the event of a serious health issue, Geber notes.
The absence of adult children is perhaps most acutely felt when it comes to end-of-life planning and during the end of life itself. While childfree older adults aren’t necessarily alone in their last days, weeks and months, they won’t have adult children to fall back on during that time.
“In the end, when people are dying, it’s usually those grown kids at their side,” Geber says. “That’s a disadvantage for solo agers that never goes away.”
Yet, when it comes to ensuring that your end-of-life wishes are respected, good planning can make up for most, if not all, of the gap left by the absence of adult children, says Geber.
Housing Options for Childfree Older Adults
Without the prospect of adult children to take them in or help them make decisions about housing in their later years, it’s especially crucial that childfree older adults make decisions early about where they want to live later in life.
The same older adult housing options available to older adults with children are often great choices for childfree older adults, too — from Continuing Care Retirement Communities (CCRCs), which allow residents to remain in the same community even after they require assistance with daily living routines, to assisted living communities, board and care facilities or nursing homes when higher levels of care are needed.
Another housing option that’s gaining popularity is co-housing, an arrangement in which a group of older adults or multi-generational residents live in a community of homes specifically designed for aging adults’ changing needs. Community members typically organize regularly scheduled shared activities, meals and events.
Meanwhile, others are opting to age in place with the help of in-home care. Growing numbers of those who choose to remain in their home are now joining what’s known as the village movement, a membership-based network that connects neighbors and provides services such as transportation, yard work and home maintenance. The aim of these villages is to help older adults stay in their homes for as long as possible.
Planning is Crucial
Advanced planning is key to ensure that long-term care and end-of-life preferences are honored, whether someone is a parent or not. But for those without adult children, this planning is even more crucial.
Part of that planning includes going to visit different types of older adult housing (CCRCs, board and care homes, assisted living facilities, etc.) to get an idea of what might someday be the best fit for you, Geber says. For those who plan to age in place, she advises turning to services like Caring.com (where I am a content producer) to learn about in-home care options.
With a clearer idea of the older adult care arrangement you want, the next key piece of the puzzle is having conversations with loved ones (this might include nieces, nephews or other younger relatives you’re close to, or it may mean close friends). Making sure your power of attorney and advance health directive documents are in order is also critical.
“The real key," says Geber, "is to let people know what you want.”
Geber also advises childfree older adults to consider the services of a fiduciary, a financial professional you authorize to act on your behalf. “You can put in the hands of a professional fiduciary the kinds of things you would expect your adult children to do,” she notes.
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What it Means to Be a Childfree Older Adult

Laura Dixon

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.
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.”
 


Who Will Provide Care for Childless Boomers?

Denise Foley

I am euphemistically known as a "solo ager," a 66-year-old child-free widower with no plans to seek another primary intimate monogamous relationship. I must admit that the term "solo ager" is preferable to the horrible designation made by other social scientists who refer to me as an "elder orphan." That phrase reeks of an aging Oliver Twist, developmentally frozen in the pain of abandonment and fear.
I am certainly not orphaned. I am well loved by others, continue to be involved as a psychologist in meaningful professional work and live independently. I feel vital in my activities of daily living and am as busy as I want. That said, it is a truth that I am existentially and observably alone as I live into this stage of life. This alone-ness carries unique risks for those in my cohort.
It's Challenging for Men to Be Vulnerable
A good deal of consideration is currently being given to solo aging. Themes abound for connecting to others and making personal wishes, including legal and financial directives, formal and concrete. While good advice, much of it tends to go in one eye and out the other as I, and many men of my generation, view such guidelines through a traditional male lens. 
Most of us are feeling lonelier and more isolated than we care to admit. 
Men of my ilk were taught from an early age never to admit vulnerability or to ask for help. So, we don't. 
We were taught to figure out problems independently or be humiliated:
Am I sick? "If I'm not feeling better tomorrow, I'll go to urgent care."
Am I lost? "I can't be far from where I'm going. I don't need the GPS. Let me try this turn." 
Do I need help carrying my groceries to the car? "It's just a sprained ankle. I can get this."Am I lonesome?  "I'm fine. I'm fine." 
As men, we would rather stand naked in rush hour traffic than risk the exposure of not knowing, or worse, being seen as weak and culpable for perceived fragility.
This type of traditional masculine maneuvering is potentially dangerous territory, particularly on the heels of the pandemic.
Most of us are feeling lonelier and more isolated than we are willing to admit. Our support systems have been disrupted, our health challenged and any sense of a normative rhythm upended in ways unknown during our lifetimes.
Fortunately, there are social science directives, translated here in masculine frames of reference, that may be helpful to mitigate the challenges of going it alone.
3 Steps for Successful Solo Aging
1. While You Are Healthy, Make Plans.
Complete advance directives and designate a trusted health care proxy. Spell out personal wishes regarding medical treatment. Grant someone the power of attorney to handle legal and financial matters should the need arise. Inform those close to you about your designate to ensure as little misunderstanding as possible in the event of a crisis or emergency.
Talk to an elder care financial planner. A 2020 study from Northwestern Mutual reports that "Overall, single men and women are generally less satisfied with their financial circumstances than married Americans. More than four in ten single men and half of single women say they feel either a moderate or a high level of anxiety about their personal financial security." 
Rely on the professional to assist in formulating a reasonable plan for managing money and financial resources, including considerations for long-term care, however that might emerge.
2. Go Toward Others.
Social science tells us there is great benefit in being social as we age. The impact of social distancing during the pandemic will be studied for years to come. Already, there is sound determination that the loss of broad interpersonal communities has undermined our collective sense of security and anchoring to day-to-day living. 
The psychologist John Cacioppo, in his 2009 book "Loneliness: Human Nature and the Need for Social Connection," reports that loneliness may have twice the impact on early death as obesity and is as damaging as disadvantaged socioeconomic status.
We men are notorious for waiting for others to contact and recruit us into social activities. Such a stance never, never, never works.
Perhaps that statement is unclear and bears repetition: Waiting for others never, never, never works. 
When lonesome, sitting and waiting for others' invitations breeds disappointment, isolation, cynicism and contempt. Social connection requires reaching out and intentionally moving toward desirable activities and people. When activities are fun and meaningful, most in the gathered group will be equally engaged, making for easier collegiality and companionship.
Perhaps that statement is unclear and bears repetition: Waiting for others never, never, never works. 
A male solo ager is entirely responsible for his social life. Guys must be friendly to have friends.  This truth is easier for those, like me, who are extroverts. For those who are introverts, think carefully about living choices. Living alone in a family home may require an increased amount of solitary upkeep.
If there are adult children, remember they have their own urgent lives and may not be able to attend to elders with the frequency or intensity that a solo aging parent expects.
There are contemporary options for living at this stage of life, including 55-plus or retirement communities, walkable communities if driving is a challenge and village-to-village networks , which are grassroots organizations formed through a cadre of caring neighbors who want to change the paradigm of aging. Local villages connect members to a full range of practical support services to help with non-medical household tasks, services, programs, and transportation.
3. Get Busy. Stay Physically Active.
A major contributor to isolation and adverse aging is found in the loss of a schedule. Particularly for men, we rely on the identity that work provides. Typically, we are known for what we do. Our work identity provides meaning and accountability.
After retirement, there are new personal definitions to enhance our sense of self as we age. We shift into being known for who we are. This "hard right turn" from what we do to who we are is enhanced by routine rhythms of planned activities which contribute to ordinary vitality. Add regular physical activity and stay in motion. Research confirms that when physical exercise and social activities are combined, overall psychological health is amplified.
Looking ahead, allowing room for help, and seeking the companionship of others are keys to going it alone with integrity. Does it solve all the loneliness encountered as a solo ager? Certainly not, but it does keep us in in charge of what is manageable as we grow older.


How Men Adapt to Being Solo Agers

Jackson Rainer

My family is all dead, and I never married or had children. The new term for people like me is “solo ager” or "elder orphan." Aging alone highlights the dilemma of what to do when you need help managing your health, finances and the disposition of your estate because you can't. With no family or friends to name as trustee or executor, what does one do?
My lawyer said I needed to hire a private fiduciary. That is someone who will step in and take over, should I become unwilling or unable to handle my affairs. Someone to see that I get medical attention when needed. Someone to carry out my final instructions when the time comes. I didn't know anyone I thought could take on this responsibility.
My lawyer gave me two referrals to fiduciaries he knew. His parting words were "Don't procrastinate. This should be an easy decision." But it wasn't quick or easy.
Finding a fiduciary has turned out to be the most daunting, arduous and important decision I have had to make at this phase of life.
What is "easy" about turning your health, your money and ultimately, everything you own, over to a stranger? And how do you make a decision like that quickly?
Finding a fiduciary has turned out to be the most daunting, arduous and important decision I have had to make at this phase of life (I'm a boomer). Here’s my five-step plan to finding one, and how — if you're a solo ager — you can hire a fiduciary, too.
The First Step
I began my fiduciary journey with targeted research.
In Arizona, where I live, the Administrative Office of the Supreme Court licenses fiduciaries. There are 14 pages of public and private fiduciaries listed on its website, along with  all the complaints that have been filed against the fiduciaries and the outcomes.
This site — and your state may have a similar one — let me glean a lot of useful information: how fiduciaries operate, their reporting obligations and their internal policies and procedures.
On the court’s site, I verified that the two referrals my lawyer gave me were licensed. I also learned they each had complaints filed against them, albeit mostly minor in nature.
I wanted more names to consider, so I searched the internet for local fiduciaries. I also called estate planning lawyers, and asked which fiduciaries they referred their clients to try.
A few names began to pop up repeatedly. I called them for interviews and looked at their company websites. But all my research left me feeling lost and overwhelmed.
The Second Step
I took some deep breaths, and acknowledged I had fears, concerns and a lot of "what ifs." Who wouldn't? Among them:
How will I know the best fiduciary to hire?Will the people I interview still be working there when I need them?What if the fiduciary sticks me in some crummy group home and robs my estate?What about elder abuse?What if I have dementia and the fiduciary takes advantage of me?What if the fiduciary forces medications on me I don't want to take?What if the fiduciary doesn't follow my instructions?How do I trust a complete stranger?What else should I be considering?The Third Step
I interviewed seven fiduciaries over the course of six months.
I’ve listed some of my questions below. You undoubtedly will come up with others for your situation, but hopefully these will serve as a guideline.
Here are the questions I learned to ask:
How long have you been a fiduciary?What are your qualifications?What professional licenses do you hold?What local, state or national fiduciary organizations are you a member of?How many clients do you have?How many people work in your firm and what are their areas of expertise?What is your employee turnover rate?What is your succession plan?How often do you raise your rates? By what percentage?What are your current charges and fees to: open a file, keep me on "standby" status, administer services as an "active" client, mail a letter or send an email, make a phone call and to finalize my estate?How do you keep in contact with me until I need your services?How will you know if I need your help?What if I am unable to contact you?Do you have three client references I can call?Have you ever had a complaint filed against you or your firm? For what? What was the disposition?What is the average size of the estate you handle?What happens to my pets?How will you get into my house?How do you store house keys, entry codes and my personal information?What is the average cost to close an estate of my size?What happens if my estate runs out of money?The Fourth Step
My fourth and final step was making the decision, which I finally did after months of research and interviews, reviewing all my notes and sleeping on it for several days.
The fiduciary I decided to hire seemed head and shoulders above the rest. I felt OK with my decision and a sense of relief. But not really a sense of peace.
I informed my attorney and he prepared the paperwork to make it official. Then I contacted the fiduciary and asked what the next steps would be.
It is now several months later, but not much has happened. I have not completed all of the fiduciary’s paperwork, nor has the firm contacted me to ask why. They also don’t have my house keys or entry code either.
Do I still think my decision was a good one? Yes, sort of. At least someone is in place should something happen. And I can always hire another fiduciary if I find someone “better.”
The Fifth Step (Not Yet Taken)
There is still one more step I need to take: Appoint a trust protector.
That is someone who can "look over the shoulder" of the fiduciary, and has the power to fire them if necessary. A trust protector is someone who could receive my medical reports and financial statements as well as monitor the performance and fees of the fiduciary.
Ideally, that person would be much younger than me, someone willing to step in and to keep an eye out. Someone who would be available in 10 years — or tomorrow.
It’s not easy to find someone like that. It is not something you ask of an acquaintance or of a friend's child or grandchild. I am concerned about this step. But hopeful, I will eventually find someone.
Because we don’t know how we’ll age, it’s critical to get your “team” in order before you need them. Hopefully, this article will make your “journey” easier.


A Solo Ager's 5-Step Plan to Finding a Fiduciary

Jodi Weisberg

Jane Curry, of Chicago, settled into a retirement community a few years ago, where she found friends and support. It was part of her preparation to age in place in a home of her own. But the now-75-year-old widow knew that taking a fall could play havoc with her ability to stay in her second-story condo.
Jane Curry used Plan Your Lifespan to think through her contingencies in case health issues diminish her independence.“My balance is off more as I’ve gotten older,” she admitted. “That frightens me.”
At 14, Curry developed a rare form of cancer in the connective tissue of her wrist. In the 1950s, her only option was to have her left arm amputated. “I was so young when it happened that I adapted and I’ve been able to live my life without thinking about it too much,” she said. But now, Curry worries that being an amputee increases the likelihood she could take a tumble.
“I had the fear, but not the plan" for what to do about it, Curry said.
That changed about three years ago, when she volunteered to be on a panel of 70 older adults who met in focus groups with Dr. Lee Lindquist, chief of geriatrics at Northwestern University's Feinberg School of Medicine. The panel's work resulted in a website called Plan Your Lifespan, a free resource that prompts older people to plan for predictable problems like falls and to communicate in advance about their preferences on how to handle them.
Relieving the Fear of Having No Plan for Aging
Curry’s risk may be higher than others her age, but falls are a common — and often devastating — occurrence in the aging population. According to the Centers for Disease Control, falls are the leading cause of fatal and non-fatal injuries for Americans 65 and older. So Curry's perspective became an important element to weave into the Plan Your Lifespan site, which was created through a partnership of the federal government's Patient-Centered Outcomes Research Institute and Northwestern’s Feinberg School. The site went live in December 2015.
“We saw many older seniors who were living on a cliff. If one thing went wrong, their whole world would turn upside down. But they didn’t want to think about that,” Lindquist said. “At the same time, many feared being a burden to loved ones as a result of not planning.”
Lindquist and her investigators quizzed their panel about events that would disrupt even their best-laid plans for the last chapter of their lives. Based on that input, they went to work, producing an online resource that allows older adults to walk through those eventualities and think about how they would manage a hospitalization, a fall or developing dementia.
Plan Your Lifespan lets people type in the action steps they would prefer to take. They can store their responses online and print out a copy. The site also asks users to specify which people in their lives they want to help them with certain issues — for example, evaluating whether they should continue driving or managing their finances if they develop memory problems.
“We came up with a practical way for seniors to make concrete plans now that will help them in the future,” Lindquist said. “It’s all there when these situations actually arise and everything starts happening fast.”
Misconceptions About What Older Users Would Want
The site was built, and then rebuilt, with an eye to keeping the content practical, concrete and easy to use. What it lacks in cyber-flashiness it makes up for in elder friendliness.
“I had misconceptions about what the users would want,” Lindquist admitted. “We went back to our senior stakeholders and found out that they hated the layout that I thought was so pretty.”
The final version is presented in a high visibility font: black-on-white for easier reading. Users click to progress from screen to screen; Lindquist learned that many older adults lack the dexterity or skill to make the scrolling motion. Short videos on each topic are embedded for easy viewing, with real-life stories of preparing for each situation.
“We didn’t have money for actors, so we went back to the people from our focus groups for the clips on the website,” Lindquist said. “Seniors talking to seniors to explain the steps they've taken. They were very effective.”
One of the videos features Curry, who explained how she sat down with her daughter-in-law to spell out what she would want if she ever needed long-term care.
“We got into it so much as, 'If you’re in a nursing home or if you’re in a hospital room, do you want to be by a window, do you want to be higher up?'” a smiling Curry said to the camera. “I happen to like traffic. I like to see people going by on the street. I like action.”
Different Needs In a Smaller Community
Although the research team was based in Chicago, the site's creators also sought feedback from older adults more likely to live in houses than high-rises. Chris Forcucci, a nurse leader with Indiana-based Aging and In-Home Services, was recruited to talk to elder advisers from Fort Wayne and surrounding rural counties.
”Our population is more likely to need a plan for grass cutting and snow shoveling, so they can stay in their homes. They have fewer transportation options than in a city,” Forcucci pointed out. “There’s also a faith component that did not surface with older adults in Chicago. The seniors here want to plan how they can get to church if they can’t drive.”
Since beginning her work with the project three years ago, Forcucci, 59, has become the caregiver for her parents. That’s given her the chance to put the Plan Your Lifestyle site to use.
“It’s a communication starter, and these are not easy conversations to have,” she said. “We’ve printed it out page by page, then talked about it and saved it.”
So far, users in 36 states have logged on to Plan Your Lifespan. Lindquist continues to collect feedback from users and will rely on it to update the site and make it more responsive.
“I think a lot of times seniors are treated like they don't have opinions. Actually, they have a lot to say about their options,” she said. “But they need to communicate what they want to the next generation or they will all have to fly by the seat of their pants.”
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