Elder Orphans: Steps that Block the Failures of Modern Death


Who will represent my last wishes if the family or medical team won't let death do its job? It's a question every person should address with their family members and health care team. But for elder orphans, the ones who live without an immediate family member, it's a crucial concern. For me, I have siblings who are older, and the chances are that I will outlive each one. However, if I go before them, the concern is they will hang on. I know my sisters.

In an article, Not Just a Death, a System Failure by Barbara Moran, it discussed the medical care system's enduring hold to prolong life. The hospital staff can be more eager to extend the life that the dying person is willing to relinquish. That was my family's experience with our dad. Years before Alzheimer's took control; my father executed the Do Not Resuscitate orders. After several days without water or food, the nursing staff insisted that he get sustenance through a feeding tube. The family vigilantly stood guard to make sure that didn't happen. Let me tell you, his physician at the time did not make it easy, either. On his last day, the doctor accused the family of wanting to kill our father. It's not the place that I want my loved ones when at death's door. It's their time to mourn not to make tough medical decisions on my behalf.

Individuals should be in control of their healthcare decisions, not the medical system. As of today; I have excellent health. But life changes on a dime. I'm turning 65, and live without a chronic condition; however, knowledge is power, and with it, you and I become keen advocates. To expect my siblings or dear friends to make the health care decisions is asking too much.

To start, I took the question to the Elder orphan group on Facebook participants for advice--Please join the conversations. (It's the same strategy that we use at Seniorcare.com to obtain expert help on long-term care.)

How did you determine who would stand for you to make health care decisions if you are not able? I don't want to burden my siblings. What other considerations did you think about when completing the legal docs?

Tips from the group

  • Read to learn each document's purpose and priority as it relates to an individual's circumstance

  • Attend free seminars offered locally by professional peers
  • Sign up for webinars
  • Learn about the organizations and businesses who will stand for you, the guardians. In NM, there is an organization called Decades. The one nice thing about not having a friend or family member stand for us is that a business is not emotionally involved: it will do what we want it to do when we need someone to step up
  • When considering the Power of Attorney, select someone you can totally trust. The attorney set up the Living will, health care proxy, and stores it on a site called Legal Directives.
  • When you visit the attorney to write the Will go alone so, no one can influence you.
  • Choose your health care proxy as someone who will fight for your wishes. Make it a person you trust with your complete medical history, someone who lives nearby. If an emergency should occur, have the person go with you to the hospital, so the doctors won't ignore your DNR orders. Share all of your wishes with everyone close to you so that your proxy has support for your desires.
  • Powers of Attorney expire the moment you die but the joint accounts do not. If you want a loved one to have access to your liquid assets immediately after you cease, make them joint account holders.
  • List beneficiaries on annuities, investment accounts, and insurance policies and keep them up to date.
  • The Will does not automatically change the beneficiaries on these investment accounts.
  • If you own a house or real estate, put the name of the person who will inherit it. In most states, a nursing home or assisted living can seize the property to pay for your care.
  • Tell the family all of your wishes and about the assets. Give the executor of your will a copy and keep everything current by reviewing at least once every three years.
  • Let the strategy itself be your guide. Seek people who have the capability to honor your final wishes and discuss all the "what if's" to build a plan for contingencies. Create a TEAM, not only POAs but advisors.
  • Nothing is permanent. You can revise and revisit as life changes.
  • Resources for end of life decisions

    A member of the Elder Orphan Facebook group introduced me to a Transition coach, Birgitta Kastenbaum, of Bridgingtransitions.net. Birgitta works with older adults on illness, dementia, and end of life. She says,

    Advanced Health Care Directive is not just for the end of life or as simple as a two-page form. It's a gift to those you love to ensure that we get the treatment we want. We carry guilt and insecurity as we commit to helping our loved ones. When people talk, great things happen. We get to the root of what we want. Sharing our fears and hopes is an act of intimacy. Without a plan, we panic. We need to be empowered to be a guide for those we love.

    And a few weeks ago, an end of life advocate suggested a website that offers help and recommendations. It's called Compassion & Choices.org. You can receive a free consultation from trained professionals.

    What you receive:
    • Guidance in all areas of end of life decision making, including health care directives, riders, and dementia provision

  • Advice to navigate the medical system, hospice and palliative care, social services agencies, support groups, and local resources
  • Education on how to advocate for loved ones
  • Infomation about dying and receiving aid
  • Referrals to trained client support volunteers
  • Guidance from doctors, counselors, social workers, pharmacists, and others professionals
  • After reading the tips and materials provided by people like me, the advocates, and websites, my next steps are:

    Create an Advance Directive

    Its purpose is to guide the end of life strategy issuing the "living will" to declare, WHAT I WANT, and a health care proxy to proclaim, WHO WILL CARRY OUT the preferences. In my case right now, it's between my older sister and my sister-in-law. The latter may better serve my plan since she works for the Adult Protective Services Department. My sister may have trouble letting me go.

    The questions I take to the elder law attorney:

    1. How does one write the advance directive document so that it does not become active until such incapacity occurs?
  • What standards trigger the legal paper that determines disability or incapacity?
  • After execution, I will share them with the family and my physician. Since the documents can change depending on circumstances, I will review and adjust if needed. What's important right now, is to put one in place.

    Since this is new to me. let's dialog here. Please share your stories and what you learned when setting up the legal docs. How did you come to the decisions? If you're an authority on the topic, feel free to share advice and tips.

    And if you have similar concerns about growing older without support, please join us our Elder orphan Facebook group.