If you live alone and have no nearby next of kin, who do you call if there’s an emergency?
Sure, there may be friends or neighbors you could lean on for simple tasks, but older people may not have someone they trust who is willing to take on the responsibility of being your emergency contact, power of attorney or patient advocate.
It’s an issue for a big chunk of older adults. In the U.S., 27% of adults 60 and older live alone, more than the 16% of adults in the 130 countries and territories studied, according to the Pew Research Center.
Aging alone presents some practical challenges and people need to take proactive steps to make sure their health and finances are safe.
“We’re a lot more geographically dispersed now than in the past,” Katie Caverly, managing director of IKOR of Charlottesville, a geriatric-care manager. “Not everyone has someone to turn to.”
That’s where geriatric-care managers like IKOR can come in. IKOR’s services are vast and range in complexity from arranging visits by its registered nurses to serving as an emergency contact or being a fiduciary for durable and healthcare powers of attorney. They also can serve as court-appointed guardians, concierges that handle the mundane hassles such as getting a car inspected, handling downsizing or moves and providing end-of-life doulas.
“We function like surrogate family members but we do it professionally,” Caverly said. “Most people didn’t know they could outsource a family member, but you can. The very nature of advocacy is proximity and sometimes you need local feet on the ground.”
Not all geriatric-care managers offer the same services as IKOR. Some are licensed nurses or social workers who specialize in geriatrics and work with older adults and their families to identify needs, make a care plan and find services in the community, according to the National Institute on Aging. Care managers can be found through a doctor or lawyer — or through geriatric-care organizations such as the Aging Life Care Association.
But experts say it’s important to choose an emergency contact wisely — no matter who it is.
Genevieve Waterman, director of corporate partnerships and engagement at the National Council on Aging, encourages all older adults to do background checks on anyone entering their home to provide help or care.
“It’s a vulnerable position to be in asking for help in your own home,” Waterman said.
Waterman also encourages solo agers to try to maintain friendships or be involved in their community to try to expand the network of people they can turn to in an emergency or to be a second pair of eyes looking out for them when they’re receiving care.
Caverly urges all adults, especially adults living alone, to create “life files” that list their health issues, doctors, medications, emergency contacts and any people who should be contacted beyond that initial emergency call. List any pets and their needs. Tell the crucial contact people where the files can be found.
“If you’re unconscious in a hospital bed, help that person who is stepping in so they don’t fumble around in the dark,” Caverly said. “Sit quietly for a minute and think about what’s the crucial information someone would need to run your life during an emergency.”
Costs for IKOR range from $60 to $170 an hour, depending on the nature of the task and level of caregiver needed, Caverly said. Insurance does not cover care management.
The key documents you need to have are a will, financial power of attorney, health care power of attorney and a trust. These documents may have different names in different states.
“If you haven’t taken care of end-of-life planning, do that as soon as possible. People also tend to let those documents go out of date, so creating and maintaining them throughout your life is important,” Waterman said.
Joseph Fresard, an attorney specializing in elder law and estate planning with Simasko Law, says clients should be judicious about who they select as powers of attorney, because those chosen individuals have an enormous amount of influence over finances.
“If you’re living alone, you need to talk to the people you’re appointing to these roles to make sure they understand the responsibility and are aware of what needs to be done. They also need to be informed if you’re incapacitated,” Fresard said.
“It’s increasingly common that we see someone living alone who needs help,” Fresard said.
It starts with a will, which dictates how one’s assets will be divided upon death. Dying without a will, which is known as dying “intestate,” means state law will determine what happens to the assets.
In addition to a will, the financial power of attorney can make money decisions and handle affairs if one were to become incapacitated. A medical power of attorney, meanwhile, can be a decision-maker on medical issues if someone cannot do so themself.
“If you don’t get the documents done, you run the risk of someone taking advantage of you and your estate. It’s important to have these documents in place to protect yourself,” Fresard said.
A lawyer could be a fiduciary and be granted medical powers of attorney, but a friend or family member can also step into those roles. Those people should understand the responsibilities and burdens involved. Without the proper estate documents in place, incapacitation could lead to unexpected complications.
“Without any documents, if you lose the capacity to help yourself, adult protective services steps in. You’d get a public guardian, which is often a law firm with hundreds of wards that they can’t really provide individualized care for. You may get put into a nursing home and while they’re doing their best they might only be able to call once a month,” Fresard said.