Senior Orphans

The word “orphan” usually conjures images of helpless children with no one to care for them, but that same term can apply to seniors as well.   It is becoming a growing problem with these seniors who fall through the cracks of the healthcare system.

Patient advocate Teri Dreher, R.N., explains that senior orphans are people over age 65 who have no family, are isolated from family either because of dysfunctional relationships or geographic distances, or who have family members who take advantage of them financially. Dreher is the founder of North Shore Patient Advocates, LLC, which serves patients throughout the Chicago area.

With more single adults and fewer women having children to potentially care for them, the plight of senior orphans is potentially a huge one. Nearly 25 percent of Americans over age 65 are at risk of becoming senior orphans, according to a study from researchers at the North Shore-Long Island Jewish Health System and the Hofstra North Shore-LIJ School of Medicine.

Dreher saw this problem first-hand with an elderly patient who lived with his sister. Both had made quite a bit of money in their careers, but once in their eighties, both developed dementia and mental illness. They had years of magazines and unopened mail stacked in their home, and had meals delivered so they could survive. A neighbor befriended them and had them sign over power of attorney documents so he could “help them” pay bills. In doing so, that neighbor also helped himself to money from their accounts. Dreher intervened by calling Catholic Charities, which in turn contacted the state guardianship office. The couple was moved to an assisted living home, where they did quite well with adequate support and treatment for their multiple medical problems.

This story had a happy ending. Unfortunately, not all do. But there are steps people can take, according to Dreher, to prevent themselves from falling prey to a “helpful” neighbor or family member.

Start planning early. 

People should start putting a care plan in place in their fifties or early sixties. The earlier the better, says Dreher, since the plans are cheaper when you’re younger. There are many different models of long term care (LTC) insurance. Some, for example, are whole life plans that convert to LTC, and if the policy owner dies first, the benefit still gets paid to the family.

Consider consulting an estate planning attorney. 

Many people benefit from asset allocation trusts developed with monies already available; this is particularly important when chances are that the senior will eventually run out of money and have to rely on Medicaid. An attorney can help clients prepare for Medicaid in ways that ease the transition.  Trying to plan without expert help can be a bad idea. 

Understand the costs. 

One of the biggest mistakes people make is giving away money to family members without understanding how much they may need that money for their own care down the road. Nursing home costs are expensive—typically from $6,000 to $10,000 per month. People often run out of money quickly once they enter skilled nursing care homes. Medicare usually covers only 100 days of rehab yearly but may ask you to leave a facility after three weeks if progress is not being made. After that, the patient is responsible for all of the costs.

Know that the best care comes at a price. 

The higher-quality nursing homes rarely admit people when their resources are almost depleted and they are in the process of applying for Medicaid. The reality is that the more money one has, the more choices there are.

Recognize that family members don’t always have your best interests at heart. 

There is, unfortunately, a big problem with elder financial abuse in this country. Healthcare professionals regularly encounter sons and daughters who are reticent to approve needed expenses for long-term care of their parents because they are experiencing financial stresses themselves. They are afraid that there will be no inheritance left for them if Mom or Dad gets transferred to an assisted living or quality skilled nursing facility. 

Seniors do have legal protection if people try to take advantage of them financially. Elder financial abuse is a felony. When abuse is reported, bank accounts can be frozen, a guardian appointed and perpetrators sent to jail. “But why get to that point?” Dreher says. With a plan in place, seniors can make sure their needs are well taken care—even if they reach a time when they can no longer take care of themselves.

Teri Dreher is an RN who—after 40+ years of critical care nursing—founded North Shore Patient Advocates, LLC (, the Chicago area’s largest health advocacy agency.