By Melinda Young
There is a caregiving shortage in the United States as baby boomers age with fewer children than previous generations.
A rising proportion of older patients are solo agers — adults who live alone. This phenomenon leads to challenges for case managers as they try to find safe places to transition patients who lack caregivers and family support. A Pew Research Center study in 2020 found that 27% of U.S. adults older than age 60 years live solo.1
The term “solo ager” is a framework that case managers can view as a description of older adults who are living alone and lack a reliable support system.
“It could be someone who didn’t have children, may not be married or partnered, who lives on their own, or who has children but for reasons of strained family dynamics or unwillingness to assist, the older adult is without that reliable support system,” says Ailene Gerhardt, BCPA, MA, CSA, founder of Beacon Patient Solutions LLC, and an independent board-certified patient advocate, solo aging educator and advocate, and certified senior advisor in Brookline, MA. “We have a professional caregiving shortage and a family structure caregiving shortage. The development of a strong support system is really key for solo agers.”
Those who are older than age 60 years and who live alone need a plan for handling their medical needs as they age. “Think about aging, who is available to help,” Gerhardt says.
Solo agers may hit barriers to even some routine medical care, such as screening procedures that require anesthesia. If a patient is incapable of leaving the outpatient surgery center or clinic without a caregiver to ensure they get home safely and know what to do post-procedure, then it would be difficult for them to be safe, Gerhardt explains. “Without [caregiver help], someone may choose not to have that screening or not to keep an appointment, and this can affect their health outcomes,” she adds.
Social Support Is Crucial
Solo agers also face barriers in navigating healthcare. When an older patient needs to transition from the hospital to a skilled nursing facility and is offered a list of available sites, they usually have a family member or caregiver help them go through the list and pick their priorities. The patient may be in too much discomfort or too distracted to do this without help. But solo agers might not have anyone to help them find the right place.
“If someone does not have a reliable support system, sometimes a discharge can be delayed,” Gerhardt says. “The ideal is for people to really start thinking about this way ahead of needing it.”
Solo agers also might need a healthcare proxy, someone designated to advocate for them and help them with medical decisions should they become incapacitated. “We have people living longer, and we have people who are choosing to delay marriage and choosing not to have children, or having children later,” Gerhardt says. “People don’t live in multigenerational households or neighborhoods the same way anymore. All of those are factors that contribute to people having limited support resources.”
Case managers can assess patients’ social support, especially if they live alone. They can help patients think about their resources in different ways. Instead of just focusing on the hospital and post-hospital settings where they may receive care, solo agers need to think about where they can get support in their homes and communities.
If the solo patient does not have children who can provide physical support, then maybe they have neighbors or church members who could visit them and ensure they have access to food and can take their medication.
“Speaking the language of solo aging can be helpful,” Gerhardt says. “I recommend case managers have a huge portfolio — especially when looking at discharge planning. They need to be able to ask people and help people think a little differently about their resources than they might initially.”
For example, the case manager can ask the solo patient if there are people who can assist in their care and help them take notes when the physician or wound nurse visits. “You want to maximize the questions and the plan but also ask questions in a way that elicits more than a ‘yes’ or ‘no’ and helps the individual think a little bit differently about what resources they might have,” Gerhardt says. “Are there people willing to assist and help you return home?”
In cases where the older solo ager does not have any assistance at home, he or she may need to be transitioned to a setting where they can receive help. “Is there an assisted living situation if someone is leaving a hospital or rehab and there isn’t someone to help them as they transition back to home?” Gerhardt asks. “What are the individual’s financial resources to cover that?”
These situations can be challenging for patients and case managers. “I’ve worked with many clients who choose, if financially able, to do assisted living for short term as they work on their recovery [until] they are able to return home independently,” she says. “Being a patient is a full-time job. It is critical people have the support they need as they’re navigating the healthcare system.”
Another issue related to solo agers involves advance care planning and designating someone to carry out their wishes if they are incapacitated. For solo patients who have no such guardians, a court might need to appoint one. But case managers could at least ask their patients about their plans in the case of a medical emergency or if they are unable to communicate their wishes.
“Ask patients, ‘If something were to occur as an emergency, do you have people in place to assist you?’” Gerhardt says. “Ask, ‘Who are the people you interact with?’”
Case managers can help fill in to alleviate some of the gaps in care for older patients. “We have a shortage of geriatricians who are trained in primary care specifically related to older adults, so it’s really important to shift around the approach so those questions and ideas are being prompted,” Gerhardt explains. “Place an idea in someone’s head to think about it, and hopefully they can act on it in time.”
REFERENCE
- Ausubel J. Older people are more likely to live alone in the U.S. than elsewhere in the world. Pew Research Center. March 10, 2020. https://www.pewresearch.org/sh...
A rising proportion of older patients are solo agers — adults who live alone. This phenomenon leads to challenges for case managers as they try to find safe places to transition patients who lack caregivers and family support. A Pew Research Center study in 2020 found that 27% of U.S. adults older than age 60 years live solo.
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