Abstract:
Considering solo older adults from a personal level is an important and valuable perspective. It is, however, an incomplete strategy. Understanding context is essential to removing barriers and developing the resources Solo Agers need to thrive during the second half of life. A broader view will help shed light on the kinds of assumptions, outdated practices, and customs built into policies, institutions, and financial tools. These often create barriers that can only be addressed through collaboration and collective action.
Key Words:
framing, risk factors, economic impact, collaboration, collective action
While there is a growing awareness of Solo Agers (see sidebar at end), current work and thinking tends to focus on Solo Agers through an individual frame. People, however, do not exist in a vacuum, but rather within a landscape of elements that interact and are interrelated, or interdependent. As noted by the Frameworks Institute, “when people understand issues as individual problems, they don’t see that policies, practices, and resources may be contributing factors and that collective action is required to make changes and craft solutions” (The Frameworks Institute, 2002). Viewing Solo Agers through a wider lens can be a powerful tool for building momentum and improving well-being for many.
Solo Agers—Who Are They?
Broadening the perspective starts with a better understanding of what may contribute to “solo-ness.” It is common to view Solo Agers in demographic terms—as individuals without children or partners, focusing on trends in fertility and family size. There are, however, other relevant risk factors, as illustrated in Figure 1 (see below). Overall, Individuals who cannot or choose not to rely upon family for support can face the same issues as those with no family. As suggested by a Minnesota task force studying solos older adults, people can be “functionally solo” if appropriate support is not available when it is needed—even those with children (Citizen League, 2019).
Figure 1. Examples of Risk Factors Contributing to Solo-ness
Three examples help to illustrate the rationale for a more inclusive view. They are based on personal interviews, but the names have been changed.
Mary is a retired, divorced woman who lives just outside of a small community in a rural portion of her state. Though she has two siblings, when their mother became ill, she alone provided care. Currently she is dealing with health issues of her own, again without family assistance. With roots in her community, she does not wish to relocate, but wonders who she can rely upon to care for her.
Bill is a single man in his mid-70s with a high school education who lives alone in a condominium. Very reserved, he spends a lot of time by himself and lacks close friends. Bill does not own a computer or cell phone and is reluctant to ask for help when he needs it. His mobility has been limited since a recent hip replacement.
Carlos and Maria left extended family members behind in Central America when they migrated to an urban area in the United States. They speak limited English and rely upon social programs for their daily existence. With no relatives in the United States to provide care, Carlos says, “I don’t know what we are going to do. We only have each other.”
All three meet the “solo-ness” test, but no single approach would help each of them build a personal safety net; more agile and nuanced solutions are needed.
Impacts
A critical reason to fully grasp the scope and complexity of the above risk factors is to understand the cumulative effect many more Solo Agers will have on our society. According to the U.S. Census Current Population Survey, in 2019 26% of those born between 1946 and 1964 (Baby Boomers) were widowed, divorced, or separated and another 9% had never married. Some 16.5% of those older than age 55 were childless, and 40% of Baby Boomer households held just one individual (U.S. Census Bureau, 2019a). Add to these numbers the data on a few of the non-demographic factors referenced in Figure 1 (above).
For example, an Associated Press/NORC poll found that 30% of respondents would choose not to involve their children in their care as they age (Long Term Care, 2016), while a Cornell University project found that 27% of adults said they were estranged from at least one family member (Pillemer, 2020). Even with just this snapshot, it is easy to see that the proportion of older adults who could be considered Solo Agers is not small and may well add up to be 30% or more of the older adult population.
When financial organizations discuss planning for retirement, they often reference the “three-legged stool” metaphor, which suggests retirement income will consist of Social Security, private pensions/401 (k) funds, and savings/investments. In reality, though, retirement support looks more like a four-legged stool, with the fourth leg representing the considerable unpaid support provided by family. One recent study estimated that in a single year, unpaid family caregivers in the United States provided 34 billon hours of care to adults at a value of approximately $470 billion (Reinhard et al., 2019). This element is rarely fully factored into discussions about finances.
One poll found that 30% of respondents would choose not to involve their children in their care as they age.
Going forward, the unasked question is what will happen to those for whom the fourth leg of the stool is missing or very weak—the 30-plus percentage of older adults who are Solo Agers? From now into the future, the number of available unpaid family hours likely will decline. Considering a scenario in which there is a direct relationship between support hours and dollar value, a 10% decrease in hours would translate to an annual support gap valued at around $47 billion. What if the decrease is 30% to match the estimated number of Solo Agers? How will we make up this gap?
Past practice and magical thinking lead to assumptions that Solo Agers can substitute friends and neighbors for family. But will such acquaintances be ready, willing, and available to provide all of the assistance Solo Agers need? In a 2017 Joint Economic Committee hearing, Harvard Professor Robert Putnam testified that those in the Baby Boomer cohort “are entering retirement with one third less social support than their parents had at the same stage of life” (U.S. Congress Joint Economic Committee, 2018). Friends may be able to offer some support but they are unlikely to become the same kind of safety net historically provided by available and committed family members.
Will Solo Agers be able to make up this support void by purchasing the services they need? All signs point to the answer “No.” University of Chicago research on middle-income older adults found that the average annual assisted living and medical costs are $65,000, but 72% of this group will have annual income of less than that amount. (Middle income was defined as annuitized income and assets ranging from $25,000–$101,000 in 2018 dollars.) (Pearson et al., 2019). This finding is further buttressed by the U.S. Census Current Population Survey results showing that only 14% of those ages 56–74 had personal annual earnings of $75,000 or more as of April 1, 2020. Most fall into the low- and middle-income groups (U.S, Census, 2019b).
Framing financial issues from the personal level tends to shift accountability to individuals. Certainly, individuals do bear some responsibility, but the large discrepancies between resources and costs cannot be completely addressed by better financial planning or more house sharing. We are all at the mercy of changes in values and policies at a larger level. In his 2019 book, The Great Risk Shift, Jacob Hacker describes how such changes have greatly shifted responsibility for “well-being” support. In Franklin Roosevelt’s day policy makers believed the public sector had an important role to play in financing the care of our elders and so Social Security was born. As time went on, views about who should be responsible expanded to the private sector in the form of employer-sponsored pensions and health insurance as part of compensation packages. But the mood has continued to shift in Washington and in the private sector, and individuals now are expected to shoulder a larger and larger share of costs using personal resources (Hacker, 2019).
Older Americans Act
One of the best illustrations of how the financial burden can be alleviated through collaboration and a wider vision is the Older Americans Act (OAA). First authorized in 1965, over the years this policy has helped to create an impressive elder-care infrastructure. Each year millions of dollars flow down to states and local entities to provide a wide array of services to help older adults thrive. But even though the OAA has been updated over the years, it has not yet caught up with the cultural shifts that have resulted in the growing number of solo older adults. Embedded in the goals and requirements is a hidden assumption that family caregiving will continue to be available as it has in the past. The latest version enacted in March 2020 contains no references—either direct or implied—to the consequences of an ever-growing number of solos agers (U.S. Congress, 2020).
Many Solo Agers struggle to find affordable, accessible, and culturally responsive resources when they fall ill or have surgery.
While Solo Agers can benefit from the services that are available because of OAA funding, the failure to specifically identify these individuals is significant now and will continue to be so in the future. Clear targets help to build awareness, commitment, and, most important, accountability for producing results. Many Solo Agers, particularly those at the middle-income level, struggle to find affordable, accessible, and culturally responsive resources such as emergency contacts, healthcare agents, and people to stay with them after hip replacement surgery. These challenges are especially acute in the less populated parts of the United States. By calling out these kinds of resource gaps for Solo Agers, the OAA could be better able to usher in the kind of future for older adults envisioned in the Act’s original objectives.
But not only public resources are out of alignment. Disconnects also show up in private-sector financial tools such as long-term care insurance and retiree health savings accounts. Time-use studies of those who provide unpaid care from the Bureau of Labor Statistics and AARP tell us that caregivers routinely spend time helping with things other than activities of daily living and medical tasks (U.S. Bureau of Labor Statistics, 2019). Many log hours spent planning and coordinating support, advocating on behalf of care recipients, performing financial tasks, and providing transportation, to name a few. Solo Agers cannot rely upon unpaid family support when these kinds of needs arise for them, yet the available financial tools typically don’t cover such expenses. This is another place where creative thinking and collaboration at the systems level could help to address the mismatch.
Part of the solution is another kind of reframing—coming up with a more comprehensive definition of what constitutes care and the time period when it is required. At present, care is often seen as support related to activities of daily living (ADL) and medical assistance, such as medication management. That definition must be expanded to include money management assistance, decisional support, advocacy, coordination, research—other kinds of help critical to overall well-being. Additionally, we need to recognize that care and support are essential all across the second half of life, not just in later life. Stuff happens at all ages and even small events, left unaddressed, can become consequential.
Legal Barriers
Systems are often complex and, therefore, slow to change. Outdated, incorrect, and/or biased assumptions become embedded in policies, customs, and practices, creating often invisible barriers for individuals. A prime example is a little-known component of statutes governing end-of-life practices. In the District of Columbia and all but four states (Massachusetts, Minnesota, Rhode Island, and Missouri) the statutes include a section governing what is known as “default surrogate consent.”
Such a provision guides medical providers in the event an incapacitated individual is not represented by a healthcare decision surrogate and has not otherwise provided applicable healthcare instructions in the form of an Advance Care Directive or Living Will. Guidance of this kind is significant in view of the many studies documenting the low percentage of people who have engaged in end-of-life planning. It is particularly relevant to Solo Agers who often have difficulty identifying someone to speak for them if they lack the capacity to do so for themselves.
'The ability of Solo Agers to thrive depends greatly upon the context in which they live.’
Default consent laws delineate who a healthcare provider may turn to make care decisions in the absence of a named surrogate. Generally, the guidance directs the healthcare provider to choose from a family hierarchy, with spouses and adult children seen as having a higher priority over siblings and grandchildren. Thirty-five states include “close friend” among the choices, while three add a religious official to the list. Providers have flexibility in who to consider first in some states, in others they do not (American Bar Association, 2019).
Two potential barriers arise from these laws. The first—which impacts Solo Agers—is the built-in assumption that a family member is the logical choice to serve as a surrogate. The laws fail to consider emerging data about the number of people who are estranged from family members and/or would prefer not to have family involved in their care. The second issue is the implicit Western cultural definition of family. With diverse cultures increasingly represented in the United States, the notion of who is considered “family” also is becoming more varied. But end-of-life statutes are not the only place where hidden barriers for Solo Agers can be found. In the quest to create a better future for Solo Agers, it will be essential to take a critical look at other types of laws.
Final Thoughts
While it is important to consider solo older adults as individuals, by itself this is an incomplete approach. The ability of Solo Agers to thrive depends greatly upon the context in which they live. Focusing on Solo Agers from a personal level has and will continue to bring many benefits to them. However, an overreliance on this kind of framework can lead to “otherism,” stereotyping, and the belief that Solo Agers are responsible for whatever situations in which they find themselves. Additionally, focusing on the person level does not help people to see Solo Agers in a larger context—as part of the overall demographic landscape.
Solo Agers are not a special interest group and solo-ness is not about bad choices, but rather another dimension of diversity. As we work to better understand and accommodate people of different cultures, incomes, and educational levels, we also must see that solo-ness can be paired with all of these. Considering Solo Agers from a broader framework is not about making a case for special treatment, but rather about creating a level playing field for all older adults. And, what we create to help those without family support can also benefit those who care for family.
Linda J. Camp, MPS, is an independent consultant, writer, and researcher living in St. Paul, Minnesota. She has been working since 2015 on strategies and solutions to better support solo older adults.
Photo credit: Shutterstock/Robert Kneschke
References
AARP and National Alliance for Caregiving. (2020). Caregiving in the United States 2020. www.aarp.org/ppi/info-2020/caregiving-in-the-united-states.html
American Bar Association. (2019, September). Default surrogate consent statutes. Commission on Law and Aging. Health Care Decision Making (americanbar.org)
Citizens League. (2019) Backup Plan for Solos: Supported Health-Care Decision Making for People Aging Alone. Backup Plan for Solos—Citizens League
Hacker, J. (2019). The Great Risk Shift: The new economic insecurity and the decline of the American dream. Oxford University Press.
Pearson, C. F., Quinn, C. C., Loganathan, S., Rupa Datta, A., Burnham Mace, B., & Grabowski, D. (2019). The Forgotten Middle: Many Middle-Income Seniors Will Have Insufficient Resources For Housing And Health Care. Health Affairs, 38, 5. https://doi.org/10.1377/hlthaff.2018.05233.
Pillemer, K. (2020). Fault lines: Fractured Families and How to Mend Them. Avery.
Reinhard, S. C., Feinberg, L. F., Houser, A., Choula, R., & Evans, M. (2019, November.) Valuing the Invaluable 2019 Update: Charting a Path Forward. www.aarp.org/ppi/info-2015/valuing-the-invaluable-2015-update.html
The Associated Press–NORC Center For Public Affairs Research. (2016). Long term care in America: Expectations and preferences for care and caregiving. 2016 poll. www.longtermcarepoll.org/long-term-care-in-america-expectations-and-preferences-for-care-and-caregiving/
The Frameworks Institute. (2002). Toolkit. Framing public issues. www.frameworksinstitute.org/publication/framing-public-issues
U.S. Bureau of Labor Statistics. (2019). Time spent providing eldercare and percent of eldercare providers engaging in caregiving by sex and caregiving activity, averages for the combined years 2017–2018. www.bls.gov/news.release/elcare.t05.htm
U.S. Census Bureau. (2019a). Households by type and age of householder: 2019. www.census.gov/data/tables/2019/demo/families/cps-2019.html
U.S. Census Bureau. (2019b). Marital status of people 15 years and over, by age, sex, and personal earnings: 2019. www.census.gov/data/tables/2019/demo/families/cps-2019.html
U.S. Congress. (2020). Older Americans Act of 1965, as amended through P.L. 116-131. Washington D.C. Administration on Aging, Office of Human Development Services, U.S. Department of Health, Education, and Welfare.
U.S. Congress Joint Economic Committee. (2018). Social Capital Project Brief: A Future Without Kin? www.jec.senate.gov/public/index.cfm/republicans/2018/1/a-future-without-kin
