Planning a Routine Doctor Visit

Are You an Elder Orphan?

I am. And it's not a comfortable thing to be.

In case the phrase is new to you:

An elder orphan is an old person who is single, lives alone, has no children or family member or friend who can act on his or her behalf in handling health, legal and financial issues.

An elder orphan has no one, or is uncertain of who, to list on that “next of kin” line in forms, no one deisgnated to carry out end-of-life wishes, and see to the funeral and burial.

Some of the media reported on this growing phenomenon following the presentation last weekend of findings on the situation at the meeting of the American Geriatrics Society:

”Dr. Maria Torroella Carney, who is chief of geriatric and palliative medicine at North Shore-LIJ Health System...estimates that nearly a quarter of all elderly Americans could be orphans...

“The outlook for the future is not any brighter,” continues the news story at CNN. “Based on 2012 U.S. Census data, about one third of Americans age 45 to 63 are single, and in a position to become orphans as they age.”

Further, a University of Michigan report referenced in U.S. News estimates that 22 percent of people 65 and older in the United States are elder orphans now or at risk of becoming so.

British Columbia's Seniors Advocate, Isobel Mackenzie, told news1130 that elders in that province of Canada depend on partners or children but like the U.S., that is changing.

“People who are single, people who don’t have children do need to think about how they are going to plan for their future and the aging process. It’s not going to be as clear who make decisions for them, who is their substitute decision maker, who gets their power of attorney who can be their representative.”

Dr. Carney began looking into the problem of elder orphans after she noticed that Super Storm Sandy left many old people who lived near the shore homeless, she told Bankrate, and she believes that single elders should not postpone making decisions:

”If you think you are going to be aging alone, Carney says now - while you still have the financial, mental and physical tools - is the time to figure out a plan. It could be a cooperative living situation, a shared household, a Golden-Girls' style commune or a formal assisted living facility...

"'It isn't a socioeconomic or intelligence issue. It isn't about race or ethnicity. It is the inability to reach out and make connections. That can happen to anybody at any time,' Carney says.”

She's right about that, and I think about it all the time. Hardly a day goes by that I don't.

I have no family. No husband. No children. I have friends I know I could trust but they all live 3,000 miles away. Not ideal but it might work; I just don't put my mind to it.

What else gets in my way (this is an excuse, not a reason) is that I think it's a good idea that advocate(s) be younger than I am – my most trusted friends are my age.

It embarrasses and pains me to admit all this publicly but perhaps it will impress on you (and me) the importance of designating a personal advocate because:

If I get hit by a truck and am hospitalized, there is no one for the physicians to consult.

If I have a stroke and can't communicate, there is no one who is authorized to speak for me.

I do not have a health care proxy. I do not have a durable power of attorney.

The only thing I have is a newly acquired emergency refrigerator card that lists my primary care physician but that “next of kin” or emergency contact line is empty.

So don't go by my lead. Listen instead to my New York friend, Wendl Kornfeld, who is married but has no children.

Wendl was on to this problem long before Dr. Carney's important advocacy. For the past year or so, Wendl has been conducting Group conversations for elders she calls “the unfamilied” - people like me.

As her notes state:

”The Group urges people without family to be their own strongest advocate and to support that by creating community as their family.”

Wendl, like Dr. Carney, says the time to do this is “RIGHT NOW” and, of course, they are both exactly right.

Stop worrying about which forms should be in place and just get them done – such forms as a will, durable power of attorney, health care proxy, a household handbook, medical history form, wallet card and that refrigerator card – filled in, for god's sake, not empty like mine.

Here's another terrific Wendl idea: “...the '2AM Team,' a couple of people you can call in the middle of the night if necessary. And offer to be on their 2AM team.”

This post doesn't begin to cover it all. For now this is meant to be an ALERT to get us started because, as I often say, if it's happening to me it's happening to millions of others.

Plus, with Dr. Carney's new report, many more - ageing professionals and people like you and me - will be paying attention and willing to help one another.

Let's not allow any of us to become or remain elder orphans.


Could someone in your Village Movement be your contact person? Or have the phone number in your contacts and on your refrigerator emergency card of a close friend, even far away, who has your directives?

Sage advice for everyone who hasn't made plans for their future.

The future has a way of sneaking up behind us like a cat in the night.

I keep a close watch on the kind of living that seniors my age and up choose. So far, not one configuration attracts me, except the Villages concept.

Or perhaps what Ronni described: an apartment building where everyone looks out for each other. I could see that working.

Nevertheless, we should all choose and delegate a trusted advocate for when our lights start to flicker.

I'm an elderly orphan, too. No children, no husband, close friends and my nearest relatives live too far away to keep tabs on me. I could be death in the house for weeks before anyone would find me and that would be the neighbors investigating a foul smell.

I do have all my medical directives and legal power of attorney in place for the worst case scenario but it keeps me awake at night worrying about not having a better safety net for my future.

I saw this coming years ago, as I'm the last of my line as was my husband. Now, I may not be efficient in all things but in this, oh yes!

First, I have maintained friendships with people of different ages, then after careful consideration and of course consultation with two of them, appointed them to act if/when I cannot. They know what I want and should not have to do much guesswork. I have also made provisions for them in my will. All documents are completely in order and I assess them every five years or so to make sure they remain in that condition.

It simply is not worth the worry-time.

"Just do it!"

You can have children and family and still be an elder orphan.

Not that it makes me feel any better, but now at least I know there is a name for people like us.
I too am an "Elder Orphan". However, I am not alone. In fact, for just that reason, I elected to live in an assisted living facility. Upon entering this facility I had to fill out a form listing all of my contacts, should something happen to me. Also on that list is the name and number of the Funeral Director where I have made my pre-arrangements. I urge anyone who has not already done this, to speak to somebody soon. Most folks our age have had some dealings with funeral directors over the years and these people can answer all of your questions. It'll be just one less thing to worry about.

This was an eye-opener, Ronni. Thanks for it and for your honesty about your own situation.
I am a widow. I do have children but all of them live 1500 miles away. No one where I live now is a close enough friend to do what needs to be done if I die or am incapacitated.
Hense, in a couple of months I'm going to start visiting elder communities back up north, even though I don't feel ready yet. It will be kinder to my children.

please someone tell me what is a household handbook. all the other items are familiar and ready. Household Handbook? Anyone?

Isn't it a book to tell you important things, such as where the water turns off, where the electricity box is, telephone numbers of significant people such as doctor, solicitor etc?

Yes you can still be an orphan and have family. I have no children, but a stepson and his wife, but they live far away and I don't really know them that well. My husband and I were never that close to them. I have a brother who is 8 yrs older and currently he has my POA and healthcare proxy, but we are at some odds now. The absolute main thing I worry about is the hospitals not honoring my desire for no life saving procedures. I need an DNR too right in the house, I guess. I have a friend coming to live with me and we both agree if either one of us finds the other passed out on the floor to just leave it be...let nature take its course...then call the authorities. I fear being in a nursing home for years being kept alive on machines. I so wish we could legally end it when we felt the time was right. We should have that choice. I have a will, so it not concerned about the money.

My sisters would be my health care proxy, and if not them, then a young attorney listed in my Will. On the other hand, I just can't make myself do "a power of attorney." I do have an updated DNR per my state, and funeral plans (cremation, etc). From the number of scams about funeral money I get in the mail, you'd never know I had pre-planned and paid for it already!

The only little niggling worry I have is that due to my sisters being so emotionally close to me, they might try to prolong my life when I'd choose not to do that. I think the legal DNR would take care of that, but partly that is why I hesitate on the "power of attorney." Thinking maybe that younger attorney might handle that better, not so emotionally invested.

I'm a widow, no kids.

Just a tip here about the "paperwork." An attorney advised us NOT to keep these documents in a safe deposit box. You need to have your advocate keep end of life stuff with them, in a (preferably) locked file cabinet in his or her home.

If one of us has a health emergency on a Sunday or in the middle of the night, the advocate will need immediate access to the paperwork.

If I was all by myself, I think I'd try to file a do not rescusitate order at the doctor's office and with the local hospital. I have heard of this, but have no experience with the procedure.

I'm not an elder orphan at this time, but one never knows--at 85 my husband is 7 years older than I am. We have all the legal paperwork, including a DNR/POLST, but our DPOA probably could use updating. I also worry about our two senior cats and am considering a lifetime care plan offered by a large animal rescue agency for a one-time fee of $1,000.

Attorneys in our area charge around $2,000 to review and revise a complete "elder plan", including will, DPOA and other paperwork required in our state. Now that I'm no longer working, that is a very significant cash outlay!

Like Mary, I fervently wish I could simply end it without pain or struggle when I felt that my time had come. There's VSED (voluntarily stop eating/drinking); it doesn't sound like a pleasant way to go, but for me, it would beat ending my life in a nursing home or hooked up to "life support" machines in a hospital.

For Stephanie & others interested: The Household Handbook may contain location & ID #s for banks, investments, insurance policies, licenses, subscriptions, credit cards; memberships; mortgage/property;contact info for doctors, attorneys, brokers; military records; organ donation info;birth/marriage/death certificates;cemetery plots;tax filings; wills,powers of attorney, health proxies and much more. Passwords for the above should be kept in a secure on-line password program. It's invaluable to have all these things documented in one place, especially if you live with someone who may die or become incapacitated and you don't know how the household is run or where things are kept. I designed a form to contain all this information for our home and keep a copy of it in the firesafe.

To the several asking about being an elder orphan even with family:

Yes, of course one can be an elder orphan even with relatives. There are all kinds of reasons family members may not be available or the right person for this kind of help.

It's not about counting noses; it's about who you can or want to trust.

I don't qualify as an elder orphan, but I'll input what my husband and I have done.

I have posted my "Health Care Directive" and "Authorization" (for three people to be given financial/health information on my behalf) on the bulletin board in my den. The business cards of all of my health care professionals are posted below those sheets. A copy of my Health Care Directive is at my primary physicians office in my file.

My husband has both of our powers of attorneys and health care directives in an envelope tucked into the mirror on his dresser. Family members know where those documents are, with the originals in our safe deposit box.

I knew a lovely lady who was more a Mom to me than my own mother who passed early in my life she lived to 92 and she was a fighter..She was forced to live in a POE place and she hated it I visited as much as possible she was the only person who got the newspaper and I always brought some hamburgers she loved and chocolate or strawberry milkshakes the real kind, I took our only child over there and we escaped to a lovely patio and I brought a coat to keep her warm and sweater to keep her warm in the hot humid summer,she outlasted what everyone thought she would a year or two, the state of Oregon got her lovely home lock stock and barrel after her thieving in laws got a lot of her possessions just up and took it and took her then they dumped her back in a home without most of her lovely furniture she fought and we did too and got some things returned..I think people who treat elders like crap there has to be a special place in hell right on this earth she outlived everyone she knew and loved except me, she adored me and my hubs & I like to think she lived many years after the birth of my only but to her it was her grandbaby doll, she was over the moon with her around..I have only one child if something happens to my hubs I will contact my child to figure out what is up next, I doubt I will ever see 92 at all, but I have loving memories of being with a lady who was more a mom to me and friend than any of my real blood relatives save my maternal grandmother who lived 2 years after I went at 18 to be with her in California..she stayed on this earth to make sure I got thru college and set up then poof she was gone, but she lives in my heart each & everyday she does as does my Lila who would now be going on 114 if she were alive, I learned and had so much love, it is not your biological people in your life that can love and care about you!!!!!!!!!!!

This is such an important post and well-researched as always.

I'm fortunate to have an adult daughter, but she lives about 3,000 miles away. So I don't see her often.

I'm also fortunate to have my husband The Engineer. We've been married for 2 1/2 years now after what he calls our "whirlwind courtship" of 6 years.

One of our concerns is that if I become disabled or die suddenly, he won't know the procedures for doing the things I do routinely. Such as paying the 3 utility bills which is not as simple as it should be.

And since he's my IT guy, I worry about how I'll handle any computer questions or problems.

I also keep what I call The House Book. It has information on repairs or replacements of items--such as furnaces, including date, cost, and company which did the work. It often comes in handy.

A friend of ours, an unmarried man almost 80 with no children, has had several strokes. His vision and hearing are poor, and he suffers from vertigo. His days are numbered, for sure.
We, his friends, all help look after him, because we have shared experiences with him, and he is part of our lives. A carpenter, he built our deck. He has been very smart: He got long term health insurance ages ago, and with the help of a lawyer has been able to make the company pay for a woman who cleans and cooks for him. This woman is someone who has known him since she was a young girl, and the relationship is good.
He loves his home, which is a big workshop, basically, where he has lived since the 70's. He has willed it to a man who comes over from Honolulu from time to time and takes care of projects, such as cutting the grass and making repairs. This man will move into the place after D. is gone.
Now he spends his days lounging in his hammock, reading, drinking a little, and smoking (!)He is as happy now as he has ever been.
I do like to think about positive solutions to aging, since I feel many elders are being boxed in and forced to accept poor solutions to end of life dilemmas. D. remains in control of his life because he made good plans.

Just reading today's post made my heart race.

We DO have wills, POA, MPOA, living wills, etc., but they need updating. We do not have a Household Handbook which I need to do immediately. Even though I have two step-daughters, a niece, and two sisters, none of them know where my passwords are, what bills need to be paid, where the above mentioned documents are, etc.

I know I (we) need to get these things done, but I am such a procrastinator. If I am not careful, I will procrastinate myself into an dire situation.

An excellent and thought provoking post, Ronni.....I have friends who are Elder Orphans and, though I've frequently advised them to subscribe to your blog, this may just be the essay that brings them to you!

It also made me feel so very fortunate. I have close family, from children and grand children to sister and brothers who, if necessary, I could designate.

My current living situation-I built a new house with my youngest daughters family-had exactly this sort if issue in mind. I was living alone and when I needed help after a fall, and no one was around, I realized that I needed to have a plan.

Now, living with 2 other adults and my youngest grand daughter, I have lots of potential assistance for future problems, should I need it.

Elle your neighbor in Beaverton

I spent a good share of last year formalizing all of my documents with a wonderful attorney. I fortunately live in WA state, which is reassuring if confronted with a terminal illness. The major share of my attorney's time was spent researching all the possible scenarios that could occur when I die or become permanently disabled -- my focus was safeguarding my beloved cats to ensure public authorities and/or animal control do not become involved in any way re my cats. A trusted animal professional has been appointed/provided with all possible legal authorizations/protection and financial resources to professionally care for/find trusted loving homes for my cats, with no time constraints.
Having witnessed what can happen with a sudden death (we found my dear neighbor dead in bed 4 days after her death, her cats were traumatized, no food/no water) I had to step in to prevent the authorities from calling animal control to take her beloved cats. If animal control took them they never would have survived, since the adoption rate for senior cats is abysmal.

My pertinent documents are posted on my refrigerator -- where EMS would first look -- the special cat care agreement/authorization, my medical power of attorney (a dear friend who lives in my condo building) and a very detailed explicit health directive. My cardiologist and intern both have copies of my health directives. Additionally I have already informed my doctors of my wishes should I develop a terminal illness -- I intend to pursue the provisions of WA's Death with Dignity Act.

When I celebrated my 71st birthday last year I knew I needed to finalize my documents once and for all, though I had initial documents drawn several years before (they had not included fool proof care provisions for my animals).

Yes it was not inexpensive; but the peace of mind knowing I have all possible provisions covered is priceless.

An informative and timely article. I have a POA and a health care directive, as well as a will and codicil that lists the things I want to give specifically to other friends and family.

But Ronni! What are you waiting for? Get thee to an attorney for a POA. Download a Health Care Directive form from the internet and fill it out. You are our canary in the coal mine with this blog, and if you don't do these things, then who will be our role model? Please, as another commenter said, Just Do It!

This is a terrific post, Ronni. Thank you. And thank you also for not having all your ducks in a row quite yet. That gives the rest of us laggards permission to not feel guilty if we also don't have everything covered (which I don't). I do have a will, terribly out of date but still valid. And I have a list on the fridge of how to care for all my pets should I suddenly become incapacitated. I've joined the fight for "Dying With Dignity" rights in Canada and have discussed in detail with my kids what I do and don't want to happen should I suddenly become deathly ill. But that's about it. I'll get on the rest of it now that you've inspired me to do so.

Very important information and comments to think about today. My younger sister died suddenly in Jan. with only her 43 yr. old son and no $$ to speak of to handle her cremation. I volunteered to write her obituary (and paid for it) in my local Calif. newspaper as she lived for approx. past 12 years in Montana but 45 years of her adult life in this county.
That experience made me vow to write my own obit. I already have DNR paperwork, and am a member of cremation society.....but will my husband follow up??? I need to get the personal wishes handbook together so he can find everything, if the need arises.

He almost died 2 years ago after suffering a sudden cardiac arrest, then recovered (miracle) to have quad bypass surgery...he is the picture of health today....thank God and his hard work re exercise and diet.

We have a family trust and my daughter has a copy of that and a key to my safe deposit box. But there are many other things to have to deal with at a difficult time - end of life - without a handbook to simplify all the details for the survivor.

Thanks, Ronni.

I don't want to appear to be giving legal advice, but IF I were to give such advice, it would be this: you don't need to buy the extremely expensive and dubious services of a lawyer. The Internet has everything the savvy person needs to do it herself---just be sure to use materials intended for your State.

In my family, there are four lawyers and I want to be clear there is nothing personal when I say I hate lawyers (and have a huge collection of lawyer jokes to back it up). The fact that I think they are blood-sucking money grabbers in no way reflects on my family.

That said, I spent an enormous fee to have a lawyer, recommended by my bank, draw up a revocable trust, POA, pour-over will & other documents for me. What I got was more than 100 pages of boilerplate, not more than ten pages of which applied to my personal situation and even those ten pages not quite what I wanted. When it came time recently to amend these documents to change my attorney-in-fact and certain legacies, I decided to do it myself.

Being fairly smart and somewhat computer literate, I knew I could do it. The process was exacting and exhausting, but not because I wasn't up to it. Most of the toughest tasks were because my attorney had given me such a garbled, complicated mess that going through all the "fine" print almost gave me a brain tumor. I left in a lot of crap that I decided was harmless, if useless, and only amended what was absolutely necessary. But just reading that s**t to make sure I found all the things that needed to be amended was mind-blowingly difficult.

When I finished (Trust, will, DPOA, Advance Directive, PERS POA, etc) and got it to my bank for notarizing, I felt GREAT! I now had documents that pertained to me personally and all that without having to see that a-hole again. A caveat---this is about what worked for me, not legal advice.

I am lucky enough to be part of a couple. While we are both around, we're fine -- lawyers pushed us though all the necessary legal documents (at least I hope so.) Since the lawyers in question are used to dealing with gay clients, they also pushed us through the different back up people who we might want if both of us were unable to make decisions or dead. We have different choices individually and also different health people and legal executors. All sounds rather complicated -- and it is. But I am glad to have been pushed into doing this and accept that when we get to our mid-70s, we'll need to do it again, in case any of the designees have died ...

Stop reading these comments and DO THIS NOW. My parents made sure we knew where "everything" was - which folder in which drawer. All the kids knew who had which responsibility. We had "the talk" about DNR.

As they aged, died, became demented and lived... we all knew where to go and what to do.

My 30-something children quake when we talk to them about these issues, but "been there, done that" makes me persist.

Your friends/relatives/loved ones will thank you for taking the time to get this done. I was so proud of my parents for sparing me additional heartache.

The responses to this article went off track. Many of the respondents have people they can count on. An elder orphan is someone like me who doesn't have have real friends /relatives/ loved ones to take care of these things. I don't do well at meeting people. I am plenty worried.

Luckily I am not an elder orphan. And I have all my papers in order and copies of them in my doctor's file. This is for the person who thinks 'maybe' it is a good idea to just stop eating and drinking--PLEASE don't. It is almost impossible--remember when you wanted to take off 5 pounds? All these things sound plausible when reading about them--they aren't! Get your papers in order and let life take its own course. We all want to die peacefully in our sleep and may those wishes be granted but if not, we have very little to say about it.
Just make sure your end-of-life papers are in order. NO Pain and the quicker the better! Good luck to all!

I am a 1950s babyboomer 'elder orphan' and it is a frightening daily reality I must face. Anyone else on here in Oregon, who might wish to team up?

Good advice for folks like me. I have friends and some family but as I get older, who knows which ones will be around to help. Right now, I count on my sisters but since I'm the youngest, I can't rely on them either.

I'M a Male "Elder Orphan" and it's my Own Damn Fault. Well, actually, I'm sort of a Dumb Pseudo-Nerd who became a Doctor, but, by a roundabout way, in a Foreign Medical School, and Lost a Bunch of years because of it. My mother Died relatively young, and there was a Lot of Bad Blood because I had not "made" it in my profession yet. I've been practicing 20+ years now. I never settled down because I have poor social skills and am embarrassed about my professional background. I've also Always been cynical about Marriage. My Father just died late last year. He was Elderly, and had me take care of him for most of the last two years of his life (I put him in Memory Care the last six weeks, but visited him every day, and was at his bedside the last week of his life.) I have trouble focusing, and have not taken all the steps to sell his house. I don't HAVE to sell it, but it is in a changing area and will not be worth much in five years.

I'm a female elder orphan with a terminal illness. My days are filled just sleeping and watching television. Eight years ago I had breast cancer which was put in remission. Two years ago I was diagnosed with multiple my lemons. I have heart disease, diabetes and the foot problems that come with diabetes. Basically my entire body is a real mess. I pray to God that he will take me so that I don't have to suffer any longer. I don't want to live like this, but on the other hand I would like to be around to assist my grand daughter and my three great grand children. My grand daughter who lives in another state is having a very difficult time. I guess this is the reason God keep me here for her. I have gotten to the point where it is almost impossible to manage daily hygiene. I have always been a very clean person but at this point I'm unable to manage anything but just laying around. I retired from my job due to MM two years a going after being on the job for 40 years. I did have a health aide come in for a short time which was paid for by my insurance. Because I'm so down, getting ready the days the aid came by got to be a chore. So at this time I'm paying for this decision. I went through chemo for my MM and the doctors wanted me to try the stem cell which only reduces the cancer cells. After the stem cell a person is on revilmid for the rest of their lives. I don't want anyone to feel sorry for me, I just wish orphaned seniors could be treated better. As a matter of fact I wish seniors could be treated with respect. I have one some who will shop for me; he is so stretched in his personal life that I do worry that he is taking on assisting me. I have a daughter who lives ten minutes away and don't even call. As a matter of fact she is not concerned with her daughter and grandchildren. I had another son who died fours years ago who had Down Syndrome. He was such a fighter with everything this life death him. It's hard when you are a senior and no one to communicate with on your level. The so called agency's that are to help seniors are just referral systems. The 211 number is also the same. I wish I had prepared to be a senior. I have no brothers or sisters since I am an only child. Thank you for letting me share.

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