What Happens to Older Adults Without Family or Money?


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Growing old is challenging enough, even with family and money. But what if, as is the case for a growing number of seniors, you have no children, and little more than social security to live on? 

Throughout human history, elders have been cared for by families, but people are living longer today. Families are spread across long distances, and more adults are choosing not to have children. Despite the additions of Social Security and Medicare, more than seven million Americans 65 and older had incomes below the poverty line in 2017, according to the Kaiser Family Foundation.

However, if you’re an older adult with no family or money, creating community and strengthening your social networks are especially important. Volunteering, in particular, is a great way of creating community. 

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For older folks who are unable to volunteer or have no family or money to call upon, the state of California has a few options, like living in a conservatorship. Even with state resources, these opportunities can be difficult to find.

To learn more about these challenges, I spoke with Dr. Sara Zeff Geber, a former management consultant turned retirement coach and author, who focuses on “solo agers” who have no adult children, and Traci Dobronravova, director of Seniors At Home in San Francisco, which places elders who have no other options in conservatorships. Both concentrate their work in the state of California and offer specifics on how to get support.

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Relationships and Support Networks

Geber’s focus is on how to build relationships and support networks so that people won’t need conservatorship. Dobronravova and her team work with those who have fallen through the cracks.

Tell me how you came to be an expert on solo aging.

I noticed that a lot of my peers didn’t have children — my husband and I don’t either and I discovered that about 20 percent of the baby boomer population is child-free. I also watched friends taking care of their aging parents, and thought, “Who’s going to take care of me?”

I see that you dislike the term ‘elder orphans.’ Why? 

The term “orphan” has a victim connotation. I don’t like to think of myself as a victim and I don’t think we do service to this group of child-free older people by labeling them as victims.

That said, I recommend, for those for whom it’s appropriate, a Facebook group called Elder Orphans, run by Carol Marak. (Elder Orphans has more than 9,000 members and is restricted to individuals over 55 who live without the help of a spouse, partner, or children.)

So, worst-case scenario — you’re a solo ager, living independently, and something happens. You fall, you have a health emergency, and you can no longer continue to live as you have. You haven’t made plans. What happens? 

If you have no family, no money, you become a ward of the state or county. The state assigns a guardian to you, and that person makes the decisions about your living situation, your health care, your finances.  

Obviously, you’re a proponent of making plans. How does a person who anticipates getting older on their own avoid such a scenario?

First, I would encourage you to get my book — Essential Retirement Planning for Solo Agers: A Retirement and Aging Roadmap for Single and Childless Adults — which can walk you through a lot of options. 

I believe your first priority should be to bolster your social network. Consider who you trust to help you make these life decisions, or make them for you if you can’t. Cultivate those relationships.

How would you initiate that conversation?

Spend time with that person. Strengthen the relationship. When you feel comfortable, you might say something like, “I‘d like to talk with you about my plans for getting care and support as I get older. I’d like to involve you in my plans.”

If you have no children but have a niece or nephew, they might be a good option. Someone younger is best. You might be more comfortable with a contemporary of yours — you might agree to help each other — but then when one of you dies, the one left behind has a problem. 

If there’s significant money involved, Californians can engage the services of a professional fiduciary — you can start with an organization called PFAC, the professional society that supports the work of licensed professional fiduciaries in the state.

A fiduciary does not take the place of an estate planner or a financial planner — he or she takes the place of the kids you don’t have. They can be named as power of attorney for health care or finances, and if you can no longer make decisions, they can take charge of your life. 

If, for example, you’re living in an assisted living or other staffed living community, a professional fiduciary that you have hired would, by agreement and contract, check up on you regularly to be sure you’re getting adequate care. 

I understand that you aren’t a huge fan of “aging in place.” Is that because of the lack of community?

Exactly. I understand the desire to stay in your home, but so many elders end up lonely and isolated, especially if they live in a suburban neighborhood where they might not even know their neighbors. 

So much depends on where you live. That’s why I like cohousing, though those opportunities are limited. But there are also condo communities, mobile home communities. They are doing a version of aging in place, but with closer proximity to a potential community.

What about the village movement? Where I live, there’s a group called Mill Valley Village, a nonprofit that helps seniors “stay active, independent and connected.”  

I’m a supporter of the village movement, to a point. It’s great that you can access services and be connected. It’s only a stopgap. Especially if you’re living alone. 

Ideally, we are all social creatures and we belong in a community.

If that’s what you want, how do you plan for that? 

There are many levels. At the top end are the continuing care retirement communities (CCRCs), also sometimes known as life care communities.

The idea behind CCRCs and life care communities is that they will take care of you for the rest of your life, as your need for care increases. They tend to be expensive. People generally sell their homes and use the equity to move into these communities.

What if you don’t have money or you run out of money? What are your options? 

There are low-cost opportunities, like Burbank Housing in Sonoma County, which is government-subsidized housing for older adults. The units are not luxurious, but they’re adequate. Unfortunately, there’s a limited supply. Securing a unit involves an application process and getting on a long waiting list. 

What about the idea that retirement communities are not necessarily the best option, because they are segregated from the broader community? I’ve seen stories where there’s a senior residence and daycare in the same facility. Or universities that are renting out dorms to seniors. 

Those are innovative and positive directions. One objection I often hear from older adults who don’t want to move into a retirement community is “I don’t want to live around a bunch of old people.” In a way, that’s a peculiar form of ageism, but it’s also true that multi-generational communities can be richer environments. 

Any last words? 

Reinforce your social network while you’re vital and strong. Some people are still vibrant and independent into their 90s, but you don’t want to wait until then to build community.

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In order to learn more about conservatorships, I spoke with Traci Dobronravova, MSW, who is the director of Seniors At Home, the senior services division of Jewish Family and Children’s Services.

What happens to an older adult without family and without money if they haven’t made plans? What if, for example, he or she were to fall, or have a health emergency, and was no longer able to live as before? 

What happens in California, if someone is no longer able to make decisions for themselves and they haven’t named anyone to play that role, is the court appoints a conservator to serve as guardian — usually someone who doesn’t know them — and make their health care and financial decisions for them. (In California, legal guardianship for an adult is called a conservatorship.)

So where does Jewish Family and Children’s Services come in? 

We have contracts with some hospitals, so referrals may be made to us instead of the public guardian, which is a governmental agency. Our caseload tends to be smaller. The hospital social worker would get in touch with our social worker, who would assess the situation — where can they afford to live? What are their needs? Can they live safely on their own?

First, we try to find family to step in to help, but if there’s no family, or the family does not want to get involved, then it becomes a legal process. The court determines what happens next.

If people in this situation end up in the hospital, and can’t go back home, the hospital can’t discharge them, so they end up staying in the hospital, not because they need medical help, but because they have nowhere to go or no one to take responsibility.

They can be referred to private fiduciary, but that costs money. If the public guardian has a backlog and we don’t, or if we have a relationship with the person or the hospital, we help place them and take care of their ongoing healthcare and financial decisions. 

Do I understand correctly that the hospital pays your agency when they refer someone to you?

It’s a legal process — all this goes through the court. It’s a big deal — you’re taking away someone’s rights. We have to petition the courts, and what is paid, if anything, is determined by the court.

How long does the court process take?

It depends on the case. It can be weeks or months. 

And in the meantime, this person might stay in the hospital? 

That’s right. 

What if they can make their own decisions, but can’t go back to living as they were?

If someone can make their own decisions, then our social workers might work with the hospital social workers to manage the process.  

Some people can go back home. Maybe they are eligible for governmental assistance or have enough insurance or savings to cover a caretaker coming to their home a couple of hours a day. Those are the kinds of things the caseworkers assess. 

For some people, it might not be safe to go back home. Or they might not feel comfortable letting caregivers into their homes.  

So when going home is not an option, where do they end up?

If someone is unable to make their own decisions and can no longer live independently, they go through the conservatorship process with the courts and usually end up in a skilled nursing facility, covered by Medicaid. 

But are there enough nursing home slots for Medicaid recipients?

Not necessarily. Sometimes it means people can’t stay in the same city they lived in. If they’re from San Francisco, for example, they may need to move to Sacramento. Away from friends and community. 

If you don’t have family, what can you do in advance to avoid this situation?

The main thing is to name someone to take on power of attorney for health care and finance. Someone who knows what you want. Ideally, name someone younger. And spell out your wishes — what you want to have happen at the end of your life.

Otherwise, you’ll end up in the system.

How did Jewish Family and Children’s Services take on helping seniors without families face these challenges? 

About 20 years ago, we started seeing more of what we called then “unbefriended elderly” and we saw there was a need for services other than what the county offered. 

And you don’t need to be Jewish to be helped by your program?

That’s right.

Author’s note: While I am fortunate to have family and savings, as well as good health, I want to make a plug for volunteering as a way of creating community. I am fortunate to live in Tam Valley, an unincorporated part of Mill Valley, which is full of opportunities to volunteer — serving food and drinks at summer concert series, acting in community theater plays, helping with park cleanups and community yard sales, and more. There are many other places to help, from churches and synagogues to senior centers and daycare facilities to food banks and homeless shelters. Giving of yourself is one of the best ways to create community. 

Looking for more ways to help? Read our guide on how to start volunteering at a local nursing home.

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