The pdf for the issue in which this article appears is available for download: Bifocal, Vol. 39 Issue 3.
Meeting the Challenge of a New Generation of Solo Agers
The demographic bulge known as the Baby Boom cohort is now more than half way through the life continuum. A growing portion of this group is composed of “solos.” These are individuals who cannot/do not rely on family to help navigate life events and make health decisions. Recent research by Dr. Maria T. Carney suggests that some 23% of older adults are at risk for becoming “elder orphans” (solos)1
A New Kind of “Solo”
One of most overlooked reasons for “solo-ness,” however, is the degree to which choice is becoming a major factor. Boomers prefer to rely on themselves rather than institutions and even other individuals. Solos of this generation, in particular, have spent their adult life funding their own mortgages, and getting themselves to the airport. Interviews with solos conducted over the past two years reveal the same independent streak as they think and talk about aging. Many are electing to limit the involvement of family and friends when support is needed, or not to involve them at all, even when relationships are solid. This generational preference alongside of the sheer number of older adults is creating new challenges when it comes to planning for long term care and the end of life.
The most obvious challenge is that the traditional model of having a family member to coordinate care and serve as a health care agent is not workable for solos. While some solos can rely on a close friend as a substitute for family, many more cannot. Close friends may be in the same age group and dealing with their own health and care issues. Just as likely, friends and acquaintances are simply not willing to take on the responsibility of making health decisions for someone who is not family. Unfortunately, too many existing laws, policies and practices related to late life support and decision making are still laced with assumptions about the availability of family and loyal friends.
In the absence of a single close friend to serve as a supporter and surrogate, solos are beginning to explore a multi-person strategy. Some are creating “teams” of supportive friends and acquaintances to be advisors and helpers, though not necessarily “deciders.” Others are piecing together a collection of volunteers and paid professionals. Still other solos, with adequate resources, are seeking out paid professionals to meet all needs, from home care to health decision surrogates. And, sadly, there are still far too many solos doing nothing — assuming “there is still time” or “the system” will take care of things. This does not bode well for the already overburdened public “safety net.”
The transition from the traditional family-linked older adult population to one that is more multi-dimensional, highlights the need to look critically at the tools, laws, and past practices associated with later life and end-of-life health decision making. Does what we have in place serve people with family and solos equally well? A few examples deserving attention include the following.
Default Surrogate Laws
About three quarters of all states have adopted statutes to assist medical professionals in dealing with unrepresented individuals who lack capacity. Typically, these “default surrogate” laws contain a hierarchy of people who can be consulted, and most often family members are prominent in such a hierarchy. Recently, however, states have begun to modify their statutes to create more choices and greater flexibility.2
2) Liability/Fear of Litigation
A common theme emerging from conversations with solos and those who might support them is worry over liability. Organizations, such as faith communities, are often reluctant to go beyond offering Advance Care Directive workshops. They are concerned about the potential consequences of taking on a deeper level of support. Similarly, individuals decline to serve as health decision surrogates because they “don’t want to get sued.” Are these fears valid? What is possible? Can any improvements be implemented to make more “free” resources available to solos?
Emergence of/Demand for Paid Health Care Surrogates
Overall, today those age 60+ are more accustomed to using paid expertise than the older adults of the past. Boomers have dropped their children off at day care, sent their taxes to accountants, paid people to deliver their groceries, and have interacted with consultants in the workplace. Such a history may be one of the reasons solos are expressing interest in and willingness to consider hiring a health decision surrogate. Currently there aren’t many to be found, but this may change as demand increases in the future. Would more professional health “fiduciaries” be a good thing? What issues might be created and need to be addressed for this to be a solid option for those who can afford to pay for resources?
Roles and Structures
Historically one or more family members have managed both short-term and long-term care for parents and other older relatives. Over time, though, families and solos alike have begun to look to professional care managers and health care advocates to serve in the coordinator role. In the future, solos who chose this option, may find that their care manager and/or advocate is the person who is most familiar with their values and preferences. Consequently, that trusted professional may well be the person best qualified to serve as the health care surrogate. Is it possible for a professional to play a dual role under existing statutes? Is it desirable? If the manager/advocate is one of several employees in an organization, can the organization be named as the proxy or
Starting the Conversation
Readers who would like to participate in the discussion around these and other “solo aging” issues, are invited to join the ABA’s new Aging Solo e-mail discussion list – COLA-AgingSolo. The list is scheduled to launch by March 1. This on-line group will focus exclusively on topics related to those who qualify as solo older adults, including solos with capacity and those who lack capacity. Participants will be invited to post questions and responses, share information, and help craft solutions. To be added to the list send an e-mail to COLA-AGINGSOLOemail@example.com.
 Maria T. Carney, Janice Fujiwara, Brian E. Emmert Jr., Tara A. Liberman, and Barbara Paris, “Elder Orphans Hiding in Plain Sight: A Growing Vulnerable Population,” Current Gerontology and Geriatrics Research, vol. 2016, Article ID 4723250, 11 pages, 2016. doi:10.1155/2016/4723250. https://www.hindawi.com/journals/cggr/2016/4723250/abs/. Accessed 2/1/2018 2:15 PM . This includes not only people who have no children, but those who are estranged from family, or whose family members cannot provide assistance for various reasons.
 Pope, Thaddeus Mason, “Unbefriended and Unrepresented: Better Medical Decision Making for Incapacitated Patients Without Healthcare Surrogates” (May 7, 2017).33(4) Georgia State University Law Review 923-1019 (2017).Available at SSRN: https://ssrn.com/abstract=2964521 Further review seems warranted in view of the new solo population.