The American Association of Retired Persons (AARP) projects that by 2030, approximately 16% of women will be between 80 and 84 years old and childless (Donald Redfoot, Lynn Feinberg, and Ari Houser, “The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers,” Insight on the Issues, AARP Public Policy Institute, August 2013, http://bit.ly/2rZDYS8). What are elderly persons who are without children or other family to serve as caregivers supposed to do? This article outlines some practical issues to consider, along with legal and financial matters for those who are fortunate enough to reach their 80s and beyond.
What Problems Face Seniors without a Family?
Many people have diminished capacity and are less able to care for themselves as they age. They may no longer be able to easily walk or drive, and can experience difficulty with basic activities (e.g., shopping, cooking, cleaning). They may also have difficulty arranging and attending important doctor’s appointments.
Age also brings more health concerns; chronic diseases, such as Parkinson’s disease, may degrade a person’s physical abilities and undermine the quality of life. Mental capacities may also be adversely affected; according to the Alzheimer’s Association (https://www.alz.org/facts/), 1 in 10 people age 65 and older have Alzheimer’s disease, and two-thirds of these are women. In addition, there are other forms of dementia that plague the elderly.
Historically, it is the children of the elderly who typically serve as primary caregivers in these situations; they monitor their parents’ health, oversee their financial decisions, and serve as watchdogs for their lives. Persons without children, or who no longer have a relationship with adult children, will need to make alternate arrangements, as detailed below.
Where Will the Person Live?
Most seniors prefer to remain in their homes amid familiar surroundings. This may be a viable option if certain matters are addressed.
- Make the home elderly-friendly. This may entail installing grab bars in strategic locations in bathrooms, moving kitchen items to reachable locations, or installing ramps. Obtaining a medical alert system to enable a person to call for help in case of a fall or other medical emergency is critical.
- Create a support system. This may be as simple as setting up automatic daily call-ins; they can often be arranged through friends or local police departments. The callers have the information for emergency contacts (e.g., doctors, relatives living remotely). In some cases, house keys in secured boxes are provided so emergency responders can gain easy access when needed. Apps such as EyeOn (http://eyeonapp.com/) enable an elderly person to easily call for help through a push notification to designated individuals, as well as to set up scheduled check-ins. There are various personal emergency response systems that work in a similar way but may offer special features such as fall detection. Support may also come from in-home visits by people who provide services ranging from companionship and help with cooking and cleaning to medical care; home care agencies that provide these aides should be contacted and interviewed.
Some tools for living alone are free; others may have a monthly cost that should be factored into the elderly person’s budget. Consumer Reports has a comparison of home alert systems (Catherine Roberts, “How to Choose a Medical Alert System,” Apr. 23, 2018, http://bit.ly/2kaPmai).
Those who can or want to move to a more senior-friendly environment can seek out a variety of living arrangements designed for the elderly. These communities provide support systems (e.g., social activities, medical access, assistance with activities of daily living). These options include:
- Assisted-living facilities. These provide some level of in-home support services.
- Continuing care retirement communities. These offer housing and a range of services that adapt to a person’s needs, starting with independent living and eventually transitioning to a nursing home when the individual requires a higher level of care.
To determine the living arrangement most suitable to the elderly person’s needs, it may be advisable to consult a geriatric care manager (GCM). This professional can assess the medical, psychological, and personal needs of the elderly person and connect with needed resources. A GCM can be found through the Aging Life Care Association (http://www.aginglifecare.org/), formerly the National Association of Professional Geriatric Care Managers; the National Association of Social Workers (https://www.socialworkers.org/); and the National Academy of Certified Care Managers (http://www.naccm.net/). Individuals may also want to contact their elder care attorney for a referral to a tested and reputable GCM. Geriatric care managers usually charge by the hour; rates vary with their experience and location. A GCM is especially useful for those seniors without family nearby.
In deciding on a living arrangement, cost and the elderly person’s resources come into play. For example, a continuing care retirement community may have a sizable entry fee in the hundreds of thousands of dollars and monthly fees in the thousands. A financial advisor should be consulted in order to ensure that the individual can afford the choice of the living arrangement now and in the future.
Who Will Help with Healthcare Matters?
An important area of concern for elderly persons who live alone is healthcare matters. Technology can be of assistance. For example, an app called Pillboxie (https://apple.co/2rW6eF8) reminds a person to take medications, another app called Blood Pressure Monitor (https://apple.co/2IAsN9p) tracks blood pressure and weight, and Red Panic Button (http://redpanicbutton.com/) will summon help in a medical emergency.
Having a healthcare advocate to evaluate medical advice is highly advisable for everyone. This person should be familiar with the medical conditions and medications of the elderly person so that, when accompanying the person to medical appointments, she can express the patient’s concerns, ask questions about medical advice, and keep notes. For elderly individuals who live alone, finding someone to be a healthcare advocate can be challenging. A trusted friend, good neighbor, or fellow congregationalist can be a good option. A trusted geriatric care manager can also serve as an advocate.
In deciding on a living arrangement, cost and the elderly person’s resources come into play.
Beyond being accompanied to appointments, an elderly person must have legal documents related to healthcare in place. These include:
- Healthcare proxy. This document designates a person to act as the patient’s agent in making medical decisions if the patient is unable to do so. Of course, for an elderly person living alone, it can be difficult to find the right agent for this purpose. A close friend living nearby who is in sync with the elderly person’s wishes may be preferable to a relative living far away.
- Living will. This document spells out the kind of treatment that a person wants or does not want (e.g., artificial nutrition) when unable to express consent.
- Do-not-resuscitate order (DNR). This is a written instruction to medical personnel not to perform cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS).
When an elderly person resides in more than one state, it is important to have documents drawn up in each location to meet state legal requirements.
Who Will Manage the Senior’s Finances?
As with personal care, people may become unable to manage their own finances as they age. Depending on the degree to which assistance is needed, there are several options.
Help from professionals.
CPAs and financial advisors can provide money management services to the elderly. This can include paying bills, reconciling bank statements, and reminding about required minimum distributions from IRAs. Some professionals offer this as a service to longtime individual clients who have reached this stage in life.
Banks may permit an account owner to add the name of another person who has only signatory authority to the account; this person can sign checks but is not the account’s owner. For an elderly person with an adult child living far away, this can still be a good option for money management; a child can pay the parent’s bills through this authority. Of course, the senior must trust the person completely.
To simplify the financial responsibilities of an elderly person, someone can assist this person in arranging for automated payments of recurring expenses (e.g., utility bills, rent, Medigap insurance).
Representative payee for Social Security benefits.
Social Security benefits are typically deposited automatically in a person’s bank account; however, one can also designate a representative payee to receive the funds (https://www.ssa.gov/payee/). This person, typically a family member or friend, must file reports with the Social Security Administration showing how the funds have been used.
Daily money management programs.
There are companies that can handle bill paying and other routine financial matters for elderly individuals; they may also be able to deal with health care insurance forms. Professionals offering these programs can be found through the American Association of Daily Money Managers (http://bit.ly/2LiHakD).
Aging alone can be a challenging experience, but it doesn’t have to be a bad one.
An elderly person can add another person’s name to a bank or brokerage account; this person can use the accounts to handle the elderly person’s finances (e.g., pay bills, make investment decisions) in the same way as someone with an authorized signature. Again, the person added to the account need not be local, so if an elderly person has a child living in another state, this may be a good solution for day-to-day financial management. Recognize, however, that the person added to the account has unfettered access and must be unquestionably reliable (i.e., not have her own financial problems or creditors). There are many potential downsides to such an arrangement, so it should only be employed once the individual has consulted with his attorney and advisors.
Durable power of attorney.
This is perhaps the single most important planning tool for seniors and most others. This legal document designates an agent to act on behalf of the elderly person in financial matters. It can define the scope of the agent’s authority (e.g., whether and to what extent the agent can make gifts on behalf of the elderly person) and remains effective even when the elderly person becomes incapacitated. Of course, the document can only be signed when the principal has the requisite capacity.
These arrangements hold legal title to an elderly person’s assets (e.g., bank account, brokerage account, home), which are managed by a trustee for the benefit of the elderly person (i.e., the trust beneficiary). There are several trusts that can be used; for example, the person can set up a living trust while still capable of managing assets and continue to act as trustee, retaining the right to revoke the trust and regain title to assets. When the person becomes incapacitated, another person named as the successor or co-trustee takes over, assuming the trust has not been revoked. This person can be a relative or trusted professional (e.g., CPA who receives compensation). The trustee can also be a bank trust department, which can be expensive but is a good option for an elderly person with substantial resources but no individual to serve as the trustee. Instead of a living trust, the elderly person may choose to set up an irrevocable lifetime trust for Medicaid and long-term care planning purposes wherein someone else is designated as trustee from the beginning. Trusts are not do-it-yourself documents, however; they require professional assistance to make sure that the terms reflect the elderly person’s wishes and needs.
___ Am I familiar with resources to help me remain in my home?
___ Have I considered what future living arrangements I may need?
___ Do I have a living will?
___ Have I designated a healthcare proxy (healthcare surrogate or power of attorney)?
___ Do I have a durable power of attorney?
___ Am I familiar with resources that can help me assess my needs?
An Ounce of Preparation
Aging alone can be a challenging experience, but it doesn’t have to be a bad one. With the right team for support and good financial advice, this time of life can be rewarding, enjoyable, and safe.