How can homecare and home health care providers help?
by Carol Marak

Data from the 2013 U.S. Census revealed that close to 33 percent of Americans between ages 45 and 63 were single and positioned to be alone. These adults live without a partner, spouse or descendants. Additionally in 2013, AARP discovered 11.6 percent of women ages 80 to 84 were childless in 2010, and that proportion will reach 16 percent by 2030.

The same AARP study found that the group of family caregivers will shrink significantly during the next few decades. Here is how the decline plays out:

  • In 2010, the caregiver support ratio was 7 helpers for every person above age 80.
  • In 2030, the support ratio will weaken to 4 to 1.
  • By 2050, the pool of caregivers falls to 3 to 1.

When people live and age on their own, the health risks become extensive. These individuals have a greater vulnerability when performing daily activities, as they are subject to cognitive decline, developing coronary heart disease and premature death. The risks increase at a higher rate because they live alone with minimal social connection. Other incidences occur, such as medical complications, mental illness, mobility issues and health care access problems, as well.

Dr. Maria Carney heads up the research at North Shore-LIJ Health System. Her team discovered nearly one-quarter of Americans above age 65 are currently at risk to become “elder orphans,” a group requiring greater awareness and advocacy efforts. They will need help with the following:

  • Loneliness and functional decline
  • Social isolation because they lack adequate long-term commitment from a health care proxy
  • Social support and interaction due to reduced cognitive and social skills and altered neurophysiological functioning

So where do you come in? Agencies and care sources are in an excellent position to deliver guidance and processes to take better care of patients without advocates. For example, as a family caregiver, it was difficult to find help for my parents in their local community. I did eventually find a homecare agency to assist them, but I was there to coordinate care with the service organization. Elder orphans do not have family advocates. Why not partner with local civic groups, nonprofits and volunteer groups to form the needed communities of care?

Older people who live alone must have companionship, especially if they live in suburbia or rural areas. Think about all the local groups that could pull together to help: colleges, senior centers, churches, libraries. What types of programs could be offered to the lonely elderly? A short time ago, a librarian and I began working on a program to help the local elderly leave their homes and connect with peers. Here are a few of our ideas:

  • A local church volunteered their bus to transport those unable to drive
  • An elder law attorney offered free advice and help with guardianship
  • A pharmacist hosted a program on managing medications
  • Several local artists gave free art classes
  • Technology instructors hosted Skype sessions at the library so the participants could speak with family and friends who live at a distance

Senior centers usually offer programs such as these, but people living in rural areas or suburbia have limited access to enjoy them, because it is unlikely there will be a senior center in a small town.

Programs for managing chronic disease are in high demand by all ages. Single seniors need advocates to help manage their conditions and to educate them on the particulars of their diseases. This can include pain management, diet consultation, exercise instruction and help with Internet research on the condition. To remain safe and independent is the key to successful aging. It’s time to escalate caregiver training so professionals think 
of themselves as lifelong disease advocates, and not just home helpers.

In some locations, such as the Mar Vista community in Los Angeles, the Community Council developed a mission to provide an empowering voice and network of resources that deliver programs for their diverse community of seniors. To that end, the mission includes:

  • Outreach—keeping the community aware of issues and providing information on resources
  • Collaboration—with the Chamber of Commerce, city and county departments, elected officials and local organizations on needs for aging in place
  • Advocacy—viewing issues that come before the Mar Vista Community Council and the City Council with specific attention to how they support the ability of seniors to age in place.

Dr. Carney also believes that providers could be a bigger help for the senior segment by screening for elder orphans before they lose function or are admitted to a health care facility.

“This is a population that can utilize expensive health care resources because they don’t have the ability to access community resources while they’re well, but alone,” she says. “If we can provide earlier social services and support, we may be able to lower high health care costs or prevent the unnecessary use of expensive health care. With greater awareness and assessment of this vulnerable population, we can then come up with policies to impact and manage better care for them.”