Childless and divorced, Linda Wiesman, 67, is apprehensive about her future. With two knee replacements, the retired accountant is having trouble negotiating the stairs in her three-story townhouse in Gaithersburg, Md. Wiesman says she and several friends who live in different cities have "seriously thought of communal living" -- a Golden Girls arrangement of mutual help.
Not long ago, Wiesman witnessed a bit of what life could hold in store for her. When her single and childless uncle broke his back several years ago, he turned to Wiesman and her sister for help. They moved him into a nursing home near his house in North Carolina. After he recovered, they sold his house, brought him to an independent living facility in Maryland and hired caregivers. Following a fall and a fractured hip, he moved into a group home, where he died a year later.
Who will care for Wiesman? "I worry about dementia and longevity because they run in the family," she says. Perhaps, she says, she can turn to her three nieces.
Aging seniors face all sorts of uncertainties. But older childless singles and couples are missing the fallback that many other seniors take for granted: adult children who can monitor an aging parent and help navigate a complex system of health care, housing, transportation and social services.
As baby boomers age, the number of childless seniors, both couples and singles, is rising. Close to 19% of all women ages 80 to 84 will fall into that category in 2050, up from 16% in 2030, according to a study by the AARP Public Policy Institute. Recent research by a geriatrician at the North Shore-LIJ Health System in New York coined a name for these seniors: "elder orphans."
People without children "need to start thinking early about their future housing and future caregiving," says Lynn Feinberg, senior strategic policy adviser with the AARP institute and a co-author of the study. She suggests that they consider "what life will be like when they can't live without assistance."
To be sure, aging parents can't always count on their adult children to lend a hand. For those parents, and for childless seniors, it's essential to start weaving a safety net that could last for years. The support system could include a network of friends and relatives who can keep tabs on you, advocates to help negotiate the health care system, a team of legal and financial professionals, and senior-friendly housing.
One of the first steps childless seniors should take is to draft legal documents that will protect them if they become incapacitated. On the financial front, you should create a durable power of attorney and choose an agent who will manage your financial, legal and tax affairs should you become unable to handle these tasks yourself. Childless seniors often pick a niece or nephew to whom they are close -- or a trusted friend, cousin, sibling or clergy. Because of the potential work involved, "include in the document that the person should be compensated," says Wynne Whitman, an estate-planning lawyer at Schenck, Price, Smith & King, in Florham Park, N.J.
If you do not have someone reliable who can take on the job, you could set up a revocable trust and assign a bank or trust company as trustee, says Martin Shenkman, an estate-planning lawyer in Paramus, N.J. You would move your assets to the trust, and the company would eventually take on financial tasks you assign to it, including paying bills and caregivers, processing medical claims, and overseeing your home if you're hospitalized or in a nursing facility.
You can even tailor the trust's provisions to ensure that your physical and mental health is monitored, Shenkman says. The document, for instance, could advise the trust company to hire a geriatric care manager to conduct periodic evaluations in the future, and to send a copy of the assessment to the person you choose as your health care agent.
A big plus for going the bank route: "The chances of elder abuse are reduced if you name an institutional trustee," Shenkman says. "The vast majority of elder abuse is committed by family members."
Whether you use an institution or a power of attorney, it's essential to build in checks and balances. You could direct the trustee or agent to send monthly statements to your accountant. If you create a revocable trust, you can appoint a co-trustee or, in many states, a "trust protector," who may be given the power to monitor, and perhaps override, a trustee's decisions.
You will also need to draw up health care directives. One is a living will, which will define your health care wishes under certain medical conditions. You'll also need to name a health care proxy, who will make decisions on your medical care if you become incapacitated.
As you age, the proxy's role could intensify. He or she must keep an eye on your mental and physical state, hire caregivers, and arrange for you to move to new housing if necessary. Your proxy "should be someone you have ultimate faith in and connection with," says Elinor Ginzler, senior director of the Center for Supportive Services at the Jewish Council for the Aging of Greater Washington, in Rockville, Md.
If you do not have someone who can pick up the role, you may be able to hire a professional. Some elder law attorneys can become a health care proxy. And depending on the state where you live, you may be able to hire a professional fiduciary to oversee your affairs.
Wiesman's sister is her financial agent and health care proxy, but her sister at some point could become too old to continue in that capacity. Wiesman is close enough to her three nieces to consider asking one of them to take over in the future -- perhaps moving to the city where the niece lives. "I don't expect my nieces to care for me on a daily basis," she says. "I would look to them to oversee paid help, and my funds would cover my care."
It's a good idea for a childless senior to widen the circle of potential helpers -- people and organizations that can keep an eye on you and pitch in if need be. Your network could include friends, volunteer organizations you work with, neighborhood groups and senior centers. "The social network you create will be your safety net," Ginzler says. Her aging organization sometimes gets calls from worried friends and neighbors seeking help for a failing senior.
Perhaps a group of neighbors or a church committee can rotate visits to your home after you've been hospitalized, for example. Or maybe the senior center where you play bridge may notice you're not doing well and arrange for an assessment.
Kitty Shuler, 68, a retired teacher who is divorced, says she is beginning to build her support system. Because Shuler's closest relatives -- a brother, niece and nephew -- live in Scotland, she turned to a neighbor to be her financial and health care agent. "We are the best of friends," says Shuler, who lives in Germantown, Md. "I have someone I know I can depend on."
Shuler is active in her church and her community. When she was in the hospital a couple of years ago, the rector visited her several times. She plans to speak with the new rector about help the church could provide as time goes on. "I know the people at church would step in, but I'm pretty sure the neighbors also would step in," she says.
Turn to a Team of Experts
A cornerstone of your support system should be a professional advisory team. The team would include a certified public accountant, a financial planner, an estate-planning lawyer or elder law attorney, and perhaps a geriatric care manager, says Lynn Evans, president of Northeastern Financial Consultants, in South Abington Township, Pa.
The financial planner would develop a blueprint to pay for long-term care and other services. A care manager could look for signs of dementia and arrange for services, such as home care. (You can find a care manager at the Web site of the Aging Life Care Association at www.aginglifecare.org.)
You could direct team members to exchange information, especially if your mental capacities decline. They can also watch out for financial elder abuse. "I've had phone calls from CPAs who say, 'I did this tax return and it looks a little strange,' " says Evans. If the team is concerned, it could call the persons you've named as your health care and financial agents.
Your safety net should include an array of aging-related community services. While you may not need resources now, you can start investigating what's available. Services could include care managers, visiting chefs, handyman firms, escorted transportation, home aide agencies and senior centers. You also should visit various types of senior housing to get an idea of the kind of place you would feel comfortable living in. You can file the information in a folder that you or your designated helpers can use in the future.
You also could turn to one of a growing number of companies that offer elder-related services. One is Life Management Services, a division of Wells Fargo's Private Bank. The service, available to clients with $2 million in investable assets, will assess clients starting in their sixties or so and arrange for assistance as their needs change. "We like to say that we walk alongside them," says Anne Tinyo, national manager of the program, which is available in 32 states.
A client in her sixties or seventies may start off just having Wells Fargo review and pay medical bills. As time goes on, a Life Management specialist could develop a plan of care, and set up meal preparation, physical therapy and other assistance. If the specialist determines a client needs assisted living, the specialist would find a suitable facility, coordinate the move and check in on the client regularly.
Tinyo recalls one client who at 90 took a fall after driving to a florist. She called her specialist, who visited her in the hospital and arranged to move her to a rehabilitation facility. He also had her car picked up.
Find the Right Place to Live
Wherever you live, you need easy access to health facilities, transportation and senior-related services. That may involve moving to a new location that "provides the support that enables you to live the way you want to live," AARP's Feinberg says.
Check out the more than 350 communities that have been designated as aging friendly by the Milken Institute Center for the Future of Aging, a think tank in Santa Monica, Cal. (Go to http://successfulaging.milkeninstitute.org.) Criteria include senior housing options, hospitals offering geriatric services and investment in public transportation. You can assess your own community's aging friendliness and compare it to others by using AARP's Livability Index at www.aarp.org.
If you want to live at home alone, you can build in extra support to preserve independence as long as possible. A care manager can conduct a periodic assessment. If the time comes for more help, the care manager can work with your health care agent to find a home aide, assisted living or a nursing facility. You also can install medical-alert technology, which will notify a designated person if you fall or if you don't seem to be following your normal routine. (Read Tech Helps Seniors Remain at Home.)
Another option is to live in one of 200 "villages," neighborhood groups that, for a membership fee, provide seniors with services such as transportation to doctor appointments, home repairs and meal delivery. (You can find a village at the Web site for the Village to Village Network at www.vtvnetwork.org.) You could consider, as Wiesman is, living with friends.
But understand that these are "interim steps," says Andrew Carle, director of the Senior Housing Administration program at George Mason University, in Fairfax, Va. "Over time, a lot of people will outgrow what the villages are capable of offering," he says. And shared living arrangements may fall apart as housemates become infirm or develop dementia, he says.
If you can afford it, a continuing care retirement community (CCRC) may be your best option for creating a support system, Carle says. Instead of hiring different people to, say, prepare meals, do housekeeping and find a nursing facility, with a CCRC, Carle says, "you can buy all the services in one package."
CCRCs typically charge an entrance fee and then monthly fees that cover an independent living unit, meals, recreational activities and other amenities. Depending on the CCRC, the community may move you, at no extra charge, to the on-site assisted-living unit or skilled-nursing facility if you need care.
This housing model appealed to John and Judy Gill. In March, they bought an apartment at Southampton Estates, in Southampton, Pa., one of 21 nonprofit ACTS Retirement-Life Communities. "We don't have any kids to take care of us, so we had to figure out how to do this ourselves," says John, 74, a retired advertising manager.
The couple has "tried to cover as many bases as we possibly could," says Judy, 75, a retired teacher. They "saved frantically" for years, and they hired a financial planner and an accountant.
Both of Judy's parents had dementia, and her mother died in her nineties after spending eight years in a nursing home. Her father died in a county home for geriatric patients. "I would hate to be in a place like that," she says.
The CCRC will refer residents to a bank or a trust company if their financial agent falls down on the job, says James Petty, an ACTS vice-president. "Once we see a behavior change -- perhaps they're not paying their bills on time -- we usually will ask if we can link them up for help," he says.
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