Preparing Solo Agers to Receive Long-term Care

Abstract:

Unrealistic expectations on the part of parents and Solo Agers that presume adult children, family members, and friends will step up as caregivers is a recipe for disaster. While much is advised about retirement, approaching the subject of long-term care is often met with resistance and denial. Care is not a welcome topic in most conversations—personally or professionally. To be helpful to those who depend upon you for expert advice is to better understand the myriad mindsets associated with caregiving, and influence clients and patients to realistically plan ahead for caregiving alternatives.

Key Words:

caregiving, adult children, eldercare, LGBTQ+ aging, planning, age-in-place, long-term care, longevity

As a business advisor and keynote speaker who helps professionals prepare their clients and patients for aging solo, I often hear, “Who will take care of me when I’m old?”—an unsettling question that is on the minds of millions of people who are and will be aging alone (Alden Network, 2021). If you have not already heard your clients and patients voice this concern, it may well be because they are afraid of the answer.

An only child, Chuck was the son every parent dreamed of. He was dependable and kind and known as “everyone’s son” in the neighborhood where he and his mother Kathryn lived. When Chuck died unexpectedly of a brain aneurysm at age 51, Kathryn was unprepared. She never thought to make alternate care plans and now faces the rest of her life alone.

Having collaborated over the past three decades with adult children and their elders, older adults, and industry professionals, I have witnessed firsthand the vulnerabilities of longevity and solo living. Understanding how to be of assistance and engage in open, honest conversations concerning people’s deepest fears about aging when they have no known family member or surrogate to act on their behalf is now at the forefront of my work.

To fully prepare Solo Agers to receive long-term care, one must first address concerns specific to the never-married, separated, widowed, divorced, and “child-free” population: Have the financial realities of living longer and aging solo sunk in yet? Will technology be embraced as a care substitute? Will healthcare systems keep up with the unique needs of solo-ager patients who live alone?

At its core, people will look to you, the professional, for the answer to who will take care of them when they’re old. Are you ready?

Different Attitudes and Mindsets

People are divided into separate and distinct mindsets about preparing for long-term care: Some understand the immediacy of planning for the day they hope will never come; some conclude that having their legal and financial affairs in order is enough of a plan; and others insist that planning for a care event that may never materialize makes no sense whatsoever.

Family caregiving also plays a role in planning. The experience of caring for parents and other elders tends to shift people’s thinking about long-term care. Inevitably, attendees of my workshops never fail to inform me that managing the care of family members opened their eyes to myriad crises they encountered (such as parents running out of money and being forced to move out of the family home) that could have been avoided had eldercare-related conversations taken place years earlier. Family members are determined never to let the same misfortunes happen to them or their own caregivers.

Not surprisingly, Millennials (who outnumber Baby Boomers at 83.1 million to Boomers’ 75.4 million; Corley, 2015) now make up almost a third of my audiences.

As Forbes reported, “More than half of young American Millennials between 18 and 34 years old do not have a significant other. Likewise, Canadians between ages 20 and 34 years old, living without a partner, has risen to a 20-year high. Six in 10 young Canadians have not found their other half” (Coughlin, 2020).

Denial also helps explain being unprepared for future care needs. According to the Administration for Community Living (2020), someone turning age 65 in 2020 had a 70% chance of needing long-term care in their remaining years. Despite those odds, the topic of getting sick someday is close to the top of the list of taboo conversations within family circles.

For instance, one of my clients, Carol, always thought that she had a trusting bond with her father. “It never occurred to me that bringing up the subject of paying for long-term care would cause a rift between us,” she said. “He became hostile and accused me of trying to put him in the grave.” She went on to say that such conversations went no further. “As long as we didn’t talk about it, the belief is it would never happen.”

Some people who think they will never be alone are in a different kind of denial, couples included. According to an Age Wave/Merrill Lynch Wealth Management study, three-quarters of couples surveyed say they would not be financially prepared for retirement if their spouse passed away (Dychtwald, 2018). Spouses, significant others, and friends die. Children, nieces, nephews, and other family members move away. We all need backup long-term care plans.

Reliance on Family and Friends as Caregivers

The following scenario describes a typical eldercare family arrangement: A parent expresses a desire never to be put in a nursing home and the child immediately vows to keep that promise. And just like that they return to their daily lives, never realizing that without proper preparation, the care agreement between them is built on a foundation of sand, and the quality of life for everyone involved is sure to be seriously compromised.

The updated definition of the Solo Ager includes some parents. A common assumption with this designation is that an adult child will step up and take on the role of caregiver. Non-parent Solo Agers may forge relationships with nieces and nephews with similar caregiving expectations. However, bearing offspring is no guarantee of being cared for by those children in later years. While many adult children feel it is their obligation to take care of their parents regardless of the impact it has on their own lives, others take the approach that not sacrificing their work, health, and relationships are higher priorities.

When we think of an adult child caring for a parent, what comes to mind is a woman in her late 40s or early 50s. But now people 20 years older than that are caring for parents in their 90s and older. In addition to a chronic illness that may prevent an ailing adult child from performing eldercare duties, family caregivers of retirement age may decide to move closer to their own children and grandchildren, or to a more temperate climate or affordable living locale, leaving no family to provide eldercare when they leave. And yet, the fantasy of children caring for older parents prevails.

Jane is retired. She has two adult children. As a family, they agreed that Jane would sell the family house and take turns living with each offspring for 6 months of the year. The proceeds from the house sale were legally transferred and divided equally between the adult children to cover Jane’s living expenses and long-term care. This arrangement worked well until COVID-19 forced one adult child into joblessness, bankruptcy, and eviction. The other child informed Jane of a divorce, a relocation to a different state, and a downsize to an apartment. While Jane was not in need of care, no one had anticipated the personal and professional changes in the lives of the adult children. In a matter of months, Jane became homeless and penniless.

Modern-day work, family, and relationship complications, coupled with longevity and unexpected life changes, make it difficult for family members of all ages to fulfill caregiving responsibilities.

LGBTQ+ Solo Agers

“Reliance on relatives and friends as caregivers is a huge problem for people who identify as LGBTQ+ Solo Agers. Many are without the support of children, family, and friends,” said Paul Nagle, founding executive director of Stonewall Community Development Corporation (Loverde, 2023).

“Because the government does not, for the most part, afford a way to self-identify as LGBTQ+ at the point of service, Stonewall CDC has found it necessary to conduct surveys to measure the effectiveness of the housing and health industry and consequently offer evidence-based housing solutions” (Loverde, 2023). As a realistic solution to long-term care, Paul Nagle strongly recommends LGBTQ+-affirming housing, where people who identify as LGBTQ+ can live in an environment free from harassment and discrimination.

The number of LGBTQ+-affirming housing options has spiked dramatically in recent years, demonstrating an increased desire to avoid isolation and live in a safe space among accepting individuals while receiving quality healthcare. Many major cities—such as New York, Chicago, Philadelphia, Portland, San Francisco, and Los Angeles—have expanded LGBTQ+ housing opportunities to include assisted living, memory care, and skilled nursing services.

The Age-in-Place Long-Term Care Plan

When asked about long-term care planning, many people express the desire to remain in their own home for as long as possible. When care is needed, the plan is to bring services into the home. This plan has a name: age-in-place.

In terms of the viability of this long-term care plan, aging-in-place seems like a workable solution for Solo Agers until they find out the hard way that it isn’t. Advertisements enticing residents to install grab bars and motorized stair chairs are not helping matters with their simplistic messaging.

Home-share arrangements also present limitations. How many home-sharing agreements mention caregiving in the contract? And in the absence of caregiving conversations, how many roommates choose to stick around when the healthcare needs of the homeowner become more than they signed up for?

Solo Agers may not understand or have the wherewithal to give the age-in-place concept the forethought and planning it requires. The expectation that things will go smoothly when outside help is needed is a wish and a prayer. The Complete Eldercare Planner, Revised and Updated 4th Edition (Loverde, 2023) offers the following questionnaire as a guide to discuss the potential landmines of aging-in-place, and the possible need for long-term care.

Plan Ahead to Age-in-Place Questionnaire

• Are you prepared to be an employer? The day may come when care is needed but the nurse you hired doesn’t show up. Are you up to the task of hiring and firing paid care workers? What personal safety precautions are in place for you to allow strangers into your home?
   
• Will the money well run dry? You can get almost any type of help you need in your home—for a price. What are the going rates in your area for in-home care, housecleaning, and grocery shopping?
   
• Is forgetfulness a problem? Not remembering to take medications or turn off the stove could have serious consequences. Will installing monitoring and reminder systems be enough to keep you safe? Will forgetfulness put you at greater risk of being taken advantage of financially and otherwise?
   
• What’s for dinner? Eating nutritious meals is extremely important to sustaining health and independence. Are neighborhood meal delivery programs available? Are group meals available at the local senior center?
   
• Is illness in the forecast? Chronic conditions like diabetes or arthritis complicate daily self-care and personal hygiene routines. What’s the overall plan for increased medical attention and pain management? Who will accompany you to medical appointments?
   
• How will you get around town? On-demand transport services and public transportation make it possible for anyone to get anywhere they want to go. What’s the plan to get to and from medical appointments?
   
• Will isolation set in? Some people like to be alone; but for many, staying home alone for long periods of time is an extremely lonely and isolating experience. Research suggests that loneliness poses serious threats to well-being as well as to long-term physical health (National Institute on Aging, 2019). Is feeling depressed a concern?
   
• How deep is the local volunteer pool? Having access to people who donate their time to help others is essential to successfully aging in place. Are volunteers and ample resources readily available?
   
• What’s up, Doc? Managing a chronic condition and staying healthy requires a system of support—good hospitals, physical and mental wellness programs, physician specialists, access to geriatricians, and more. Is there an ample supply of specialized healthcare facilities and professionals nearby?
   
• Is the house age-friendly? Bathrooms on the second floor. Laundry facilities in the basement. Going up and down the stairs may not be a deal-breaker now, but what about later on? Think entrance ramps and first-floor access to the bathroom and bedroom. Will a wheelchair fit though doorways? Can you afford to upgrade the home environment to meet future care needs?
   
• Is the home wired up? Technology and tech-enabled services can help keep solo dwellers safe and connected. Is there sufficient Wi-Fi service that you can count on? What’s the backup plan if Internet services shutdown? Can you manage telehealth appointments on your own?

While some adult-living consultants endorse the concept of aging-in-place, many don’t. “Aging in place is not the way to go,” said Amy Schectman, president and CEO of 2Life Communities. “Suburban development patterns combined with weather conditions that limit mobility leave many older adults who are living on their own alone for many more hours than they should be. All this alone time leads to isolation, which leads to chronic loneliness. We need to stop thinking about aging in place and plan toward aging in community” (Loverde, 2023).

Care Is a Four-letter Word

Amid the challenges Solo Agers face in preparing for long-term care comes one existential hurdle. “Care” has a terminology problem. It is not unusual for me to be on the receiving end of angry reactions when the subject of needing assistance comes up in conversations about aging. In fact, I find no need to argue these sentiments. Not everyone experiences debilitating mental and physical decline as they age. My 92-year-old mother died in her sleep, living on her own, and never needing a day of care in her life.

The word “care” covers a lot of ground. The MacArthur model of successful aging (Rowe & Kahn, 2015) taught us that in addition to paying attention to our physical well-being, it is equally important to nurture our intellectual, social, and spiritual needs simultaneously. Knowing that care is not a given in old age, I have created a different communication approach as a way to get through to people who are averse to making plans for long-term care.

COVID-19 provided the perfect illustration for my point. While many of us did not suffer physical ailments during the pandemic, we confronted other demons—like mourning the death of loved ones alone during lockdown or staving off depression. When I ask Solo Agers to define what they did to sustain their quality of life under the worst of circumstances, they readily pinpoint the course of action they took “to stay sane.”

Going forward, substituting the word “care” with the words “quality of life” will most likely meet with less resistance. People are far more open-minded to planning for wellness than for care. Focusing on how to make new friends and tips on working with a life coach, for example, are among the many topics that help open the door to long-term care (read: quality-of-life) planning.

The underlying power of the word “care” also helps explain why the continuing care retirement community (CCRC) industry found it necessary to relabel their product as a “life plan community.” The word “care” is off-putting to prospective residents whose main focus is to improve the quality of their life by living in a community-focused lifestyle.

Role Models and the Importance of Connection

People age differently. The evidence is everywhere: There are older adults who use a cane to walk, watch hours of television, and pretty much keep to themselves; but then there are many others of the same generation running marathons, riding Harleys, and dating online. In addition to genetics, diet, and exercise, older adulthood is also influenced by a lifetime of experiences and belief systems.

“We have two basic choices that we can directly control—what we think and what we do. These two fundamental choices become increasingly important as we age. They are the secrets to remaining powerful, mentally healthy, resilient, and content with ourselves until we die,” said Jill Morris, co-owner of ChoiceWorks and co-author of Leadership Simple: Leading People to Lead Themselves (Morris & Morris, 2003). “Living consciously means being awake, alert, and engaged in life right up to the end.”

As Jill Morris advised, to be truly helpful to Solo Agers we must continuously model the advantages of staying connected and operating within myriad networks of support. To accomplish this goal, make an effort to partner with other professionals that you respect and can recommend freely.

Start with the workplace. Reported low usage of employee assistance programs (EAPs) is troubling. EAPs offer third-party counseling services to help employees navigate challenging situations affecting their personal and professional lives. Although there are clear benefits to an EAP benefit, employees rarely take advantage of this resource (Ramos, 2022). Connect with local companies and befriend human resource administrators and EAP professionals. Ask EAP providers to come to your workplace and present on-site programs and individual counseling sessions to employees. Educate staff about privacy law and confidentiality protections. Emphasize how employees can receive free counseling and have easy access to services.

Be aware that Solo Agers will look to you as a one-stop shop for obtaining trusted referrals and navigating the maze of life’s transitions. Though the cost of hiring an independent advocate is not covered by insurance, Solo Agers may find that paying for services will be worth it in the long run. Forge working relationships with the following resources:

Aging Life Care Professional: Care managers help create long-term care plans and find eldercare services; www.aginglifecare.org.

Independent Board-Certified Patient Advocate: Advocates help with medical transactions, early discharge, medical interpretations, medical billing, insurance, and complaints about care. This professional acts as a liaison between patients and the healthcare team; https://www.npaf.org/.

Medicare Advisor: Such advisors help employees understand Medicare and Medicaid. They also organize medical bills and negotiate coverage for medical services before and after receiving care. Research “Medicare consultant” on the Internet.

Veteran’s Benefits Consultant: These consultants offer assistance in qualifying for benefits and help complete digital forms to submit to the Veteran’s benefits office. Research “veteran’s benefits advisor” on the Internet.

Certified Senior Advisors (CSA): CSAs are certified professionals who come from a multitude of industries including estate planning, finances, insurance, and real estate. They are trained to work specifically with older adults; www.csa.us.

The world is in a dramatically different place now than it was a decade ago. In preparation for the years ahead, keep an eye out for the year 2030, which has been dubbed “The 2030 Problem” (Knickman & Snell, 2002) when the majority of Baby Boomer caregivers become care receivers. As Time Magazine reported, “No one is truly prepared for what is to come” (Newton-Small, 2019).

And yet, I am hopeful that you will meet the challenges that lie ahead. Partnerships with other professionals will get you there. Not only does collaborating with other advisors enhance your business credibility, joining forces is what will ultimately make a real difference in the lives of Solo Agers everywhere.

Joy Loverde is a business advisor, keynote speaker, media spokesperson, and author of Who Will Take Care of Me When I’m Old? and The Complete Eldercare Planner, https://elderindustry.com. She lives in Chicago.

Photo credit: Shutterstock/Victorpr

References

Administration for Community Living. (2020). How much care will you need? U.S. Department of Health and Human Services. https://acl.gov/ltc/basic-needs/how-much-care-will-you-need

Alden Network. (2021). Census figures show more older adults will be aging solo [Blog]. www.thealdennetwork.com/census-figures-show-more-older-adults-will-be-aging-solo/#:~:text=Today%20more%20than%2022%20million,children%20or%20siblings%20for%20care

Corley, C. (2015). Millennials now outnumber Baby Boomers, Census Bureau says. NPR. www.npr.org/2015/06/25/417349199/millenials-now-out-number-baby-boomers-census-bureau-says

Coughlin, J. (2020). This is why the Millennials’ singles lifestyle may be on a collision course with caregiving & retirement. Forbes. www.forbes.com/sites/josephcoughlin/2020/11/15/this-is-why-the-millennials-singles-lifestyle-may-be-on-a-collision-course-with-caregiving--retirement/?sh=86ac8035b6b1

Dychtwald, M. (2018). Aging Boomers aren’t financially prepared for widowhood. The Wall Street Journal. www.wsj.com/articles/aging-boomers-arent-financially-prepared-for-widowhood-1537754416?tesla=y

Knickman, J. R., & Snell, E. K. (2002). The 2030 problem: Caring for aging Baby Boomers. National Library of Medicine, 37(4): 849–884. http://dx.doi.org/10.1034/j.1600-0560.2002.56.x

Loverde, J. (2023). The Complete Eldercare Planner, Revised and Updated 4th Edition: Where to Start, Which Questions to ask, and How to Find Help. Aging Parents Books.

Morris, S. & Morris, J. (2003). Leadership simple: Leading people to lead themselves. Improex International.

National Institute on Aging. (2019). Social isolation, loneliness in older people pose health risks. U.S. Department of Health and Human Services, National Institutes of Health. www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks

Newton-Small, J. (2019). A growing American crisis: Who will care for the Baby Boomers? Time Magazine. https://time.com/5529152/elderly-caregiving-baby-boomers-unpaid-caregivers-crisis

Ramos, R. (2022). Why employees don’t use your EAP benefit. www.healthjoy.com/blog/benefits/mental-health/eap-program-utilization

Rowe, J. W., & Kahn, R. L. (2015). Successful aging 2.0: Conceptual expansions for the 21st century. The Journals of Gerontology: Series B, 70(4) 593–6. https://doi.org/10.1093/geronb/gbv025