Hey there, Legal Tea Listeners –This is your host, Jenny Rozelle. Welcome back for another episode today, episode one hundred and forty-three! Today’s episode is a “current trends” episode where we talk about things going on currently that is relevant and pertinent to my estate and elder law world, and/or maybe things I’ve seen on the news or stumbled across on social media that are also relevant to my estate/elder law world. Well, on today’s “current trends” episode, we’re going to chat about something called “elder orphans” and you may be wondering, “What the heck is that, Jenny?” Well, as soon as I heard the informal term, I knew exactly what the person mean. It’s basically someone older or aging that has little or no support system at all. We’re going to get into “what it really is” here in a second, but that’s what today’s episode is about, my friends. So, let’s dive in…
I found a really great article on the National Library of Medicine’s website that I heavily used for researching for this episode – and of course, it’s linked in the source links for this episode. The article shared some terms that are commonly associated with “elder orphan” that are perhaps a bit more relatable – those are: aging alone, patients without surrogates, social isolation, unbefriended elder, vulnerable elderly, lone elders, etc. So, I think when you think of all of these terms and kind of group them together – you may have a better understanding of what this term, “elder orphans.” The article specifically defines elder orphans as … “aged, community-dwelling individuals who are socially and/or physically isolated, without an available known family member of designated surrogate or caregiver.”
Now, as an estate and elder law attorney, this is a really fascinating topic to dive into – because I see this stuff in real-life. I see people come into my office – and a neighbor drives them or a dear friend drives them because they can’t. I also so neighbors, dear friends, other professionals even .. step up to help. I see this ALL the time. So, I not only was really interested in diving into this topic more than surface level exposure – but also because this will help spread some awareness of a major, major issue that is happening and is, sort of, flying under the radar. I’m sure we can all imagine people that fit this description –and you have to wonder, “Is ANYONE stepping up to help? What if the answer is no? WHO is going to step up and keep an eye on them, help them, etc.?”
The National Library of Medicine article goes on to provide a couple of case studies … I won’t go into both, but the first one is about a 92 year old female, who was widowed, and living in her home with her special needs son. The son is 65 years old and he, ironically, is dependent on her. She was able to “handle it” until recently when she started to realize she was slowing down and in fact, became unable to drive and do everyday household chores. Because of this, she attempted to hire in-home care, but quickly discovered that it wasn’t ideal – she was doing more supervising of them than them helping her and her son. So, she “cut them” and moved on. About that time, she met a social worker and they connected her with an attorney for legal guidance – like, making a plan of action for not only her, but also her son, if something were to happen to her. As the case study ends, it says, “The likelihood of medical catastrophe for this elder orphan and her son (who will eventually inherit elder orphan status) has deceased significantly.”
You know, as I read that story, I thought about how many “real life” examples of this I have personally seen. So many! Actually, just a week or two ago, I met with a client (it was a Mom) and Mom and her daughter live permanently together – and the daughter serves as her full-time caregiver. The daughter had hip surgery recently and has been on a walker for a while. So, transparently, I was thinking in the back of my head, “How does that work? How does this temporarily physically handicapped daughter care for her Mom?” The Mom is in a wheelchair … and has a type of condition that, without disclosing too many details, makes her essentially totally physically handicapped in more than one way. That was just a week or so ago – so I see this stuff in “real life” all the time – I even see it with parents who are estranged from their kids – or maybe their kid or kids have crazy enough passed away before them – leaving them as elder orphans. On this, one of favorite lines from the piece said, “Elder orphans are a unique subset of the aging population, as their inclusion in this category is often due to circumstance rather than choice.”
Now, this piece was written in 2016 – here we are, in 2024, getting really close to ten years later and I’m not sure we are any further ahead. Which is concerning, right? Their argument is that IF we can get more attention on the term, elder orphans, that it will create more awareness for EVERYONE, including and perhaps most importantly, to health-care workers and providers that the individual is vulnerable (since they may have absolutely no support system) and that providing care and an action plan for the patient needs to be done comprehensively and multidisciplinary. That’s a fancy way of saying that basically, they’re going to require a little more time, energy, support, and help!
As a way for this episode to be possibly helpful, I wanted to share with you guys that the article does provide a “ten step guide to caring for an elder orphan” and we are going to quickly hit all ten:
1. First, it is important to identify all medical issues. The article states that “this may involve speaking with the patient’s known providers and other personal contacts, telephoning pharmacies, and accessing old charts, laboratory work, and imaging studies.
2. Second, it is also important to identify cognitive and functional abilities. What this means is it’ll be critical to try and get them to do some assessments to see how they’re functioning mentally, emotionally, physically – i.e. the MiniCog Assessment, Geriatric Depression Scale, Activities of Daily Living, etc.
3. Third, it is important to obtain detailed social support information. What does this mean? Well, this is “any possible contacts that may be beneficial” and may include out-of-town family, friends, neighbors, significant others, etc. This also includes uncovering if they have a long-term care policy or if they are a Veteran (or surviving spouse) to explore payment options for care.
4. Fourth, it is critical to create a manageable and realistic treatment plan. The two more important words there are manageable and realistic.
5. Fifth, it is important to investigate and utilize service delivery to their home – think, home care, pharmacy, food delivery (like Meals on Wheels).
6. Sixth, it is imperative to make safety and injury prevention a priority. Consider having someone visit their residence (wherever they’re living) to see what can be added, removed, or changed to make their humble abode a safer place. Embedded in this one – can the person drive? Can they SAFELY drive? There are companies that will “test” the person’s abilities.
7. Seventh, it is important to address goals of care and advance directives. I, the estate and elder law attorney, fall here! This step is to ensure the individual has appropriate documents like a Health-Care Proxy and Living Will to make sure they have the ability to personally express their wishes as it relates to medical treatment and end-of-life decisions. Beyond the health care documents, though, are things like Power of Attorney, Wills, and maybe Trusts – make sure all Ts are crossed, Is are dotted.
8. Eighth, it is critical to understand privacy issues like HIPAA. Now, HIPAA is the Health Privacy Act – and it’s important to understand that health-care providers and workers have to follow these privacy laws, all while trying to reach out and provide support. The article says, “Health professionals must fully document that the purpose of outreach is for the safety and health of the individual, and, in so doing, privacy laws are respected, BUT do not form a barrier to coordination of care.” That’s a really interesting point for health-care workers/providers to know.
9. Ninth, it is important to assess decision-making capacity and involve the elder orphan as much as possible. This reminds me of something I face all the time – just because someone has dementia does not mean they cannot make decision. The piece echos that – they say, “Although a person may be failing in some cognitive abilities, it does not necessarily mean that they lack the ability to make certain decisions.”
10. Tenth and finally, it is imperative to determine if a guardianship is needed and if so, to start to process. A guardianship may be needed in a variety of different circumstances, so it’s just something to know and be aware of.
At the end of the day, the WHY this term is developed (the elder orphan term) and WHY we should be talking about it is two-fold: 1) Because it’s important for health-care providers and health-care workers to know that these individuals are lacking support and caregiving resources – which is critically important when a health event or emergency arises. Secondly, from a shear quantity perspective – the umber of elder orphans is continuing to rise … which will make all of these problems bigger and worse. Add that to the idea of people, generally speaking, living loger – so yeah, the issues that arise specific to elder orphans need to be getting discussed and planned for. NOW. For the health care system and the elder orphans, in general. Like I said earlier, the piece that inspired this episode was from 2016 and here we are, nearly 10 years later, and I’m not sure if we’ve made a ton of progress – nonetheless, as the article mentions, part of the initiative is really to get the term out there, so more medical, legal, etc. professionals know to “spot it” and know to rally the troops to help.
Alrighty, let’s wrap this episode up, shall we? Next week, we’re back to the “celebrity estate planning” type of episode – and during those types of episodes, we dive into a celebrity or “big name” person that has passed away and how their estate looked from an estate planning perspective. Next week’s episode is about George Carlin’s Estate. George Carlin – the comedian, the actor, etc. Well, I was supposed to do George’s episode a few weeks ago and had to make a bit of a shift, but here we are – back to George next week, I promise! So tune in to that next week, Legal Tea Listeners, talk to you then and stay well!
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