Our mission, and the mission of many who are championing TCP’s cause around the globe, is to ensure that everyone’s wishes for end of-life care are expressed and respected. Yet, one group is particularly at-risk of being left out, those without a loved one with whom to have these crucial conversations. Approximately 22% of those over 65 in the US are or are at-risk of becoming “orphan elders/solo agers”, those without a spouse or child, according to a 2016 study.
What can we do to make sure this group is not left behind in our outreach efforts and messaging? How can we best support this group to ensure they are listened to and given opportunities to express their wishes for care through the end-of-life? And, how can we ensure they have someone to speak for them (health care agent/proxy) if they are unable make care health care decisions for themselves? We offer up the following four steps.
Read up on the topic and understand the issues faced by this growing segment. We’ve tagged a few articles below that may be of interest: 
- ‘Elder orphans,’ without kids or spouses, face old age alone: A 360 degree look at the issue via research/data, stories and expert accounts. Offers up ideas and further resources.
- Identifying the Unique Challenges of Solo Agers: Uncovers the preliminary data that brings clarity about the issues facing this segment of the population. Also notes these issues don’t solely affect those who are single and alone, but also those who have family.
- Keeping ‘Solo Agers’ Happier and Safer: Millions of people are growing old without children they can rely on for help. This article describes 3 ways they can prepare.
- Are You Ready for Solo Agers and Elder Orphans? :Provides further background and framing of the issues faced and what can be done to support this group.
Listen to our November 2019 Community call on this topic, review some of the key issues discussed, ideas and resources shared to support this segment (call recording, slides and chat can be found here on our calls and recordings page).
During our conversation on this topic, we spoke with an expert on solo aging about the kind of questions groups are grappling with as they seek to support this population and explored the issues solo agers face that should be considered right from the. Here is some of what we learned (see call slides/recording for additional ideas and resources shared).
- Some issues solo agers face: distrust in the system, worry about being taken advantage of, isolation, often frightened and fear dying alone, lacking someone to talk to, trust and help with proxy/decisions and health care in general
- Suggestions on how to approach solo agers:
- Connection before content: build a relationship, human connection first to build trust and get to know them; understand their social system and ask what matters most to you? Don’t come in with answers, a program or assume what you have is what they want or need
- Approach with curiosity and a place of inquiry for understanding: if they ask a question, dig deeper (“tell me more”) and understand why they are interested in this
- Don’t make assumptions: understand you bring your own biases and assumptions, check them at the door and be open to understand differences
- Some ideas on ways to support solo agers:
- Encourage and empower solo agers to think about existing networks they may already have, nieces/nephews, good friends, co-workers, etc. And, help those aging alone without a natural network to create their own supports (e.g. in their faith setting, through volunteer work, their neighbors) so they do not have to depend on just one person when help is needed. Promoting this at an earlier age is best
- Create a senior companion program that pairs folks together that are able to help support one another (e.g. can become each other’s health care proxy)
- If in health care settings, dedicate a point person to this population. For example, one health system with an existing community nursing program places a nurse to work primarily at a shelter for solo men
- Promote the need to have a proxy and conversation about what matters when it comes to end-of-life care earlier (e.g. in the 40 to 50 age group but even earlier from age 18). Planning ahead while individuals have “capacity” and continuing the message while aging in place. The earlier you learn about the importance of finding someone to speak for you, if you cannot speak for yourself to make health care decisions, the sooner you will identify someone to be your healthcare agent, and to talk with the about what matters most to you
- Tap into and learn about existing resources that may be available locally (e.g. some states have organizations for those who may want to pay for a proxy service).
Look within, learn from solo agers in your community and design a plan together
Learning from existing research, knowledge and best practices from others is helpful but remember, the answers often lie within your own community. Work with existing community groups/leaders that already have the expertise on what solo agers need based on direct experience (Local area agency on aging, senior centers, county/city department of aging, AARP, etc.). And talk with solo agers directly and learn together. Connecting, building relationships and learning about what matters most to these members of your community is the best way to truly understand what they want, need and how best to offer up and co-design support.
Share your ideas – what’s working and what’s not – with us and others so we can work together to build greater understanding and create best practices that can be spread widely
Some of the questions that surfaced during our above call are listed below. Have you tackled some of the below questions with success?
- How do you identify solo agers in the community? And especially, those who are home-bound, not active in the community, but are lonely?
- How can we approach them and speak about end-of-life? How should we counsel solo-agers to be prepared for medical emergencies and end-of-life (e.g. they often feel they have no support for “when that time comes”)?
- How to guide solo agers in choosing a proxy (who should they appoint) when they are truly alone in the community?
- What resources can we provide to our solo agers or soon-to-be solo agers?
- When they end up in a long-term care facility with no family and without an advocate, what can we do?
If you have ideas and experience can you share, please share them in the comments below. What is working or what are you still grappling with? If you are a solo ager, what do you hope community leaders would know?
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Hello,
I am responding to your well organized “conversation” and did not know that you exist.
I live as a SOLO AGER in Los Angeles.
I will be happy to follow your Conversation Project. I am recently “SOLO” and find it very difficult since most everyone I know has an extended family network.
Please put me on your mailing list.
I look forward to connecting you with some of my ideas as well as yours!
Best, Leslie Tuchman
Hi Leslie
Thank you for your comment! We have many resources to support you, please feel free to email us at conversationproject@ihi.org with any questions you may have. We would love for you to join our monthly newsletter, sign up here: https://forms.ihi.org/the-conversation-project-email-sign-up