Editor’s Note: The John A. Hartford Foundation is collaborating with ASA RISE to advance equity through a series of blog posts in support of the development and dissemination of equity-related, partnership-based thought leadership through ASA’s Generation platform. This blog post is part of that series.
The classic sitcom “The Golden Girls” first debuted in 1985. At the time, the concept of four older, single women creating community to maintain independence was unprecedented. One could argue that the network did not fully anticipate how deeply the show would resonate. Dorothy, Sophia, Blanche, and Rose were able to create the social support they needed. However, the reality for many aging adults today looks very different.
“Solo agers” is a term used to identify older community-dwelling individuals who do not have a spouse, adult children, or a designated advocate (Adams, et. al, 2023). Solo agers typically live independently until they are no longer able to manage their own care or daily needs. It is important to note, that despite limited data, approximately one in three of adults between 55 and 74 are solo agers, according to a 2025 study by AARP.
Leadership with an Equity Lens
The ASA RISE Fellowship Program trains participants to lead from an equity framework identifying inequities as the result of oppressive systems. When considering how we could apply an equity lens to aging systems, the solo ager crisis came into focus. Our research focused on Black and Hispanic/Latina women aging without an advocate during a transition of care.
Imagine a solo ager with impaired mobility and no transportation needing a ride to the hospital for a biopsy, or a solo ager with a same-day readmission due to care assumptions and unmet needs. We did not have to imagine. Our team had personally and professionally witnessed solo agers struggling to navigate care transitions. We began the process of informal qualitative research rooted in the idea that there is no equitable solution that does not include community voice.
When considering how we could apply an equity lens to aging systems, the solo ager crisis came into focus. Our research focused on Black and Hispanic/Latina women aging without an advocate during a transition of care.
Despite shifting cultural norms, solo agers are not readily identified in health systems. Our current health system is structured around the assumption that a family caregiver is present. Familial support is relied on as the default for informal caregiving (Kervin, et. al, 2021). Furthermore, health systems lack the organizational structure and guidelines necessary to provide specialized care coordination for this population. What happens to the 24 million solo agers when they have to navigate a health issue in a system that does not acknowledge they exist? Solo agers are at greater risk of hospitalization and poorer quality of care when hospitalized. Complex clinical needs and low social support act as barriers to access, negatively impact care navigation, and compound inequities (Kervin, et. al, 2021).
Transitions of Care and Swiss Cheese
Transitions of care present a dynamic and critical moment in care—one that often determines the difference between recovery or relapse. The National Transitions of Care Coalition has identified seven components to ensure safe care transitions. Ideally, each component serves as a protective layer similar to the layers in James Reason’s Swiss Cheese Safety Model. However, care transitions are inherently fragile with increased opportunities for system vulnerabilities to align and cause a dangerous cascade of system failures. This fragility is further compounded by a diffusion of responsibility seen in care settings (Balcezak, et. al, 2018). When team members assume that another provider, or a family member, is addressing care navigation needs, care coordination collapses.
Poor care transitions are not only harmful to solo agers, they have a significant impact on our health system. Failed care transitions often result in a 30-day readmission—a performance metric that costs approximately $26 billion dollars and affects 3.8 million people annually (Weiss, et. al, 2018 and Panagiotou, et. al, 2019).
Available research identifies the challenges solo agers face in the health system, but it does not explore the psychological implications of how solo agers experience care transitions. Our team conducted informal qualitative research with the purpose to identify themes and gaps in current research and to make recommendations that guide further research, standards of care, and policy recommendations.
What We Learned
Our research encompassed six focus groups across three states, and one thing was clear—the commonality in participant experience highlighted that their experiences are not isolated events but were indicative of systematic failures. The research participants’ experiences centered around five themes.
Poor Communication
“They don’t give you instructions. They give you papers.” — Participant
Participants reported frustration with poor provider communication. They described limited face time with the provider, along with confusing, incomplete, or incorrect visit summaries. The participants wanted simple explanations with written and verbal instructions along with time to ask questions without feeling hurried.
Impersonal Care
“It’s like getting to the Wizard of Oz. You see him once, then the curtain is drawn …”— Participant
Participants described rushed impersonal healthcare encounters expressing their frustration with the 15-minute appointment model. They did not believe that providers could manage their needs in so little time. They also expressed frustrations with clinical staff acting as gatekeepers limiting direct access to the provider.
Assumed Social Support
“They make assumptions that you have someone to help you.”— Participant
Research participants shared how assumptions of care reinforced navigation barriers, delayed procedures, compromised follow-up care and prolonged recovery. They also expressed a sense of stoicism about providers’ failure to adjust care plans despite knowing they did not have familial support.
Feeling Dismissed
“Because you’re old, they think they can walk over you.”— Participant
Participants described healthcare experiences of ageism, racism, and socioeconomic discrimination. They described having their care concerns dismissed as symptoms of aging, experiencing microaggressions, and care distinctions made based on perceived socioeconomic status. Participants wanted culturally competent patient-centered care in a health system that recognizes that inequity compromises patient care and safety.
The Importance of Preserving Autonomy
“The worst thing that can happen is for you to become disabled and dependent on someone else.”— Participant
Participants were astutely aware that their ability to navigate the health system is vital to preserving their autonomy.
Participants were astutely aware that their ability to navigate the health system is vital to preserving their autonomy. Participants expressed pride in their self-sufficiency, while being deeply concerned about what would happen if, or when, they cannot take care of themselves.
The focus group responses provided a heavy dose of reality about our health system’s ability to care for solo agers. Visit and discharge summaries have been minimized to an administrative task instead of tools used to inform patient-centered care planning for solo agers. Reimbursement models have incentivized 15-minute care appointments despite the negative impact to solo agers who require more robust care coordination. Our health system does not have a standardized solo ager assessment tool to identify solo agers, or the infrastructure to address their needs. Solo agers with diminishing autonomy are at risk of harm in an inequitable system.
What’s Next
Our research is just the beginning. Systems change requires solo ager representation and prioritization in aging discussions. Policy recommendations are also needed to address misaligned incentives in current reimbursement models that cause unintended harm. Organizations must commit to assess solo ager status, support them in care navigation, and act on their identified needs. We recommend universal nomenclature and screening, a cultural shift from care navigation as a departmental role to a health system ethos, and streamlining care resources with clear connection pathways. How do we build systems that visualize and support solo agers? The short answer is a system redesign that restores confidence and builds trust.
Adrienne Bridges, PharmD, MMHC, MPH, is the founder and CEO of Excel Consultant Pharmacist Services, a consulting group providing clinical and regulatory pharmacy services in long-term care facilities across Texas. Dr. Bridges integrates clinical expertise, business strategy , and public health principles to advocate for healthcare reform that improves access, quality and outcomes for older adults.
Yessenia Hafeezah Cervantes serves as a Bilingual Lead Community Health Worker at Rush University Medical Center in Chicago, where she provides direct health education programming to older adults, connects community members with social support resources and builds community partnerships to implement community led evidence-based lifestyle intervention workshops. She is also a recognized trainer for Rush’s Center for Health and Social Care Integration (CHASCI), Mental Health First Aid programs, SMRC Master Trainer and Tai Chi instructor.
Michelle Rios, MSHA,CPH blends her professional background with lived experience as a family caregiver to champion culturally responsive care, building innovative community and hospital programs that drive person-centered healthcare systems.
Andrea Williams, MPH, is the Chief Program Officer at CarePartners and an ASA RISE Fellow with nearly two decades of experience supporting older adults, individuals living with dementia, and their caregivers. Her work with solo agers, particularly those living with dementia, has strengthened her commitment to ensuring older adults have access to compassionate care, meaningful support, and the resources needed to age with dignity.
References
AARP. (2025, November 10). More older adults are living alone. Is that a good thing? https://www.aarp.org/family-relationships/solo-aging/
Adams, K. B., Parekh, R., Mauldin, R. L., Fortinsky, R. H., & Steffens, D. C. (2023). The Risk for Loneliness and Major Depression among Solo Agers. Journal of applied gerontology : the official journal of the Southern Gerontological Society, 42(5), 962–971. https://doi.org/10.1177/07334648221146770
Balcezak, TJ, Deshpande O. Diffusion of Responsibility Leads to Danger. PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2018.
Kervin, L., Teo, K., Churchill, R., Riadi, I., & Cosco, T. D. (2021). Barriers in health and social care access and navigation for elder orphans: a scoping review protocol. BMJ Open, 11(5), e043876. https://doi.org/10.1136/bmjopen-2020-043876
Panagiotou, O. A., Kumar, A., Gutman, R., Keohane, L. M., Rivera-Hernandez, M., Rahman, M., Gozalo, P. L., Mor, V., & Trivedi, A. N. (2019). Hospital Readmission Rates in Medicare Advantage and Traditional Medicare: A Retrospective Population-Based Analysis. Annals of internal medicine, 171(2), 99–106. pmc.ncbi.nlm.nih.gov/articles/PMC6736728/
Weiss, A. J., & Jiang, H. J. (2021, July). Overview of clinical conditions with frequent and costly hospital readmissions by payer, 2018 (HCUP Statistical Brief No. 278). Agency for Healthcare Research and Quality. https://hcup-us.ahrq.gov/reports/statbriefs/sb278-Conditions-Frequent-Readmissions-By-Payer-2018.jsp
Photo credit: Shutterstock/Hector Pertuz
