Advance care planning is an important process for individuals of all ages, but it is especially important for those of us who are solo-agers. More and more of us fall into this category, either through choice or circumstance.
Solo-agers, or individuals who do not have immediate family or a spouse to rely on for support, will face unique challenges when it comes to making healthcare decisions and planning for our future care. This is because our legal and healthcare systems are designed to work within a structure where social and cultural norms are passed down between family members.
What’s Changing?
The answer here is multi-layered. “Family” can include biological connections, legally-recognized partnerships, shared work and housing situations, and financial networks. It may include familiar roles such as ‘parent/child’ and ‘partner/spouse’. It may also include ‘conservator/caregiver’.
One important factor of change is longevity. When care becomes a need and how long that care needs to be financed are vastly different than just a generation ago. Many Boomers will need to come to terms with money running out before their life does.
Where care is provided is also experiencing a metamorphosis. Thirty years ago, skilled nursing care was considered a probability for end-of-life care. Memory care wasn’t even a category. Now people want care delivered in their homes, but our healthcare system isn’t yet designed to provide services this way.
Legal issues are continually arising with regard to determining who can make a decision and what criteria should be used. Culturally, we are still reluctant to engage in conversations about whether a life can be ended based on a decision made by the individual when they decide they no longer want to live. Protections are only loosely in place for those who may be cognitively unable to make an informed choice, opening an already vulnerable population to euthanasia.
Wills and Trusts and Durable Powers of Attorney
These legal documents are designed to preserve and protect assets and tangible personal property. For many people, these documents, once signed, are not revisited until after a person dies and the named Executor or Trustee is tasked with managing the tedious details of death.
The issue here is that these documents take care of things after you have died. They may manage things for you up until you die, but they are focused on the “thing-ness”, and not your quality of life.
What Would a Good Day Look Like?
When Atul Gawande published his book, Being Mortal, he raised the core issue that now faces so many of us as we age: what does a “good day” look like? If we are pain-free, mobile, and have access to things we enjoy, a good day can be pretty much anything. But if we are physically challenged, in pain, and have lost our sense of taste and smell, a good day might just be sitting quietly, listening to Carole King, and petting our cat or dog.
How do you guarantee that you will have a say in what the answer to that question is? You need to complete Advance Care Planning documents in addition to Wills and Trusts. You will need to name someone or some several ones to act as your healthcare proxy or agent.
Current State of Advance Healthcare Planning
Only during the last part of the 20th century did naming a healthcare proxy become litigated and finally turned into practice. In 1975, Karen Ann Quinlan lapsed into a coma and remained in a persistent vegetative state. Her parents fought for the right to make medical decisions on her behalf and remove her from life support. The court recognized the right to refuse life-sustaining treatment and established the concept of surrogate decision-making.
Nowadays, most of us are familiar with the POLST, or Physician-Ordered Life-Sustaining Treatment orders, that tell emergency personnel whether we want CPR or not. Also known as a “Do Not Resuscitate” order (DNR), this gives you a say in how you want to be treated if you cannot speak for yourself.
Considerations for Solo-Agers
I am a ‘solo-ager’. I have no siblings, I never had children, and I am a widow. The default of having a spouse or child make healthcare decisions for me is not an option. And there are more and more like me in similar circumstances. We need to look outside the traditional network of folks in putting someone in charge of seeing to our quality of life as we grow older.
If we want a say in how we age, we need to take charge of our care planning! There is no cookie-cutter, just-check-the-boxes form to do this. But there are some wonderful guides and resources.
Here are some tips:
Choose from a Trusted/Reliable Support Network: While you may not have immediate family to call on, it’s important to identify folks from a reliable support network. This can include close friends, neighbors, colleagues, or even professional advisors such as attorneys or financial planners. Any of these individuals can serve as your advocate and help make decisions on your behalf when needed.
While it can be awkward to initiate such a conversation, you can start by asking them the question, “If I needed someone to help me out, could I count on you?” Then bring them all together so they can get to know one another and learn each other’s strengths and contributions.
Choose a Healthcare Proxy or Power of Attorney: Designate someone you trust to act as your healthcare proxy or power of attorney. This person should be familiar with your values, preferences, and wishes regarding medical treatment. It’s crucial to have open and honest conversations with your chosen proxy about your healthcare goals and to provide them with the necessary legal documentation to allow them to act on your behalf.
Communicate Your Healthcare Preferences: Document your healthcare preferences in advance directives, such as a living will or a healthcare power of attorney. Make sure you understand and can be specific about your desires regarding medical interventions, life-sustaining treatments, and end-of-life care. Make sure your designated healthcare proxy and other relevant individuals have access to these documents and understand your wishes.
Plan for Future Housing and Care: Consider your long-term housing and care options as you age. Explore retirement communities, assisted living facilities, or other housing arrangements that align with your needs and preferences. Planning ahead can help ensure you have suitable accommodations and support in place when the time comes.
Organize Important Documents and Information: Create a comprehensive file of essential documents, including medical records, insurance policies, legal documents, financial information, and contact details of key individuals. Keep this file in a secure and easily accessible location, and inform your trusted support network about its existence.
Engage in Financial Planning: Solo-agers should engage in thorough financial planning to secure their future. This may involve consulting with a financial advisor to assess your financial situation, plan for potential long-term care expenses, and explore options such as long-term care insurance or setting up a trust.
Consider Community Resources and Support Services: Research local community resources and support services available for solo agers. These can include social programs, volunteer organizations, meal delivery services, and transportation assistance. Such resources can provide social connections and practical support, enhancing your overall well-being.
Regularly Review and Update Plans: As your circumstances, preferences, and relationships may change over time, it’s important to review and update your advance care planning documents periodically. Revisit your healthcare proxy designation, living will, and other relevant documents to ensure they accurately reflect your current wishes.
Communicate Openly with Healthcare Providers: Foster open communication with your healthcare providers and ensure they are aware of your solo aging status and any specific concerns or considerations related to your care. Establish a trusted relationship with your healthcare team, which can contribute to more informed and personalized healthcare decision-making.
Take action today, even if it is just visiting one of the websites noted here. If you already have the paperwork completed, take it out and re-read it. If you have it completed, but not signed, invite some folks over and have a signing party. If you prefer to just let someone else take charge, make a date with yourself to re-visit this in the not-to-distant future and at least write down what a good day would look like!
2 responses to “Can You Help? I Need Somebody!”
Thank you Mary. I think this is a generally unaddressed issue, and I intend to change that. I feel the need to create a resource bank of younger people (who will more likely not predecease us) to have these conversations and be of service. I welcome others who would like to pursue this idea and help manifest it into a reality. We can do better!
Mary, terrific post. It reminds me of an old friend who was a “big-time” organizational “trainer” (teaching businesses how to much better plan and operate). Whenever he started up with a new company, up on the whiteboard he would write: “If you don’t plan where you are going, that’s where you’ll end up.” VOILA.