St. Paul consultant helps 'solo seniors' deal with dilemmas of aging

All at once in 2021, Judith Coggins realized she was going to die. Not anytime soon, but eventually, as everyone does.

Well, technically, of course, she'd always known that. She just hadn't spent much time thinking about it. But when her younger brother died suddenly in August of that year, Coggins started considering aspects of her own death, whenever that might happen in the future, and wondering who would handle her affairs.

Coggins, a 78-year-old Minneapolis resident, is divorced, with no children, no living siblings or parents. Her brother had known her wishes — for health care, estate distribution and so on — and was prepared to make whatever decisions she couldn't, toward the end of her life and afterward. Now there was nobody in that role.

She looked around at the rest of her relatives and asked a nephew with a medical background if he could represent her in end-of-life issues.

"The first time I talked to him, his eyes filled up with tears and I thought, no, this boy is not going to be able to deal with that," she said. "Dying is complicated, it really is."

People in Coggins' situation are known as "solos" — those without anyone in a position to aid, support and represent them as they age and begin needing more help.

Linda J. Camp, a St. Paul-based independent consultant, is trying to spread awareness of solos' predicament, in a society that widely assumes everyone has someone who will be there when the time comes.

"All of the policies and practices out there are built on the assumption that somebody will be available," Camp said. "A significant portion of the population simply does not have that support. Yet the systems are not changing to meet those needs."

A solo — sometimes called "solo agers," "solo seniors" or "elder orphans," though they can be any age — is often someone without a spouse, children or other close family members. But any number of other factors can make people solos, including family estrangement, disability, homelessness, mental illness, poverty, reclusiveness or general unreliability. People who aren't solos now may become solos in the future — for example, after a life partner dies.

When Camp's father struggled to find reliable help after her mother died, Camp began thinking about how she herself, with no spouse or children, is a solo.

With support from the Bush Foundation and Citizens' League, Camp has researched and spoken widely on the subject. She has encouraged local organizations for older adults to form groups of solos to discuss specific issues, and offered guidance on matters to consider. But her focus is not on helping folks at the individual level; instead she seeks change on a systemic level.

"I'm trying to take a big-picture focus because I see this as a very significant public policy issue that is not getting addressed," said Camp, who retired in 2008 from the City of St. Paul, where she'd held various management-level positions. "We need to stand back and see all the different pieces and pull them apart and work on them."

Day-to-day help with transportation and meals are common needs for solos, and social isolation can be a problem. Solos also face some trickier challenges. Health care providers, for example, generally require that people undergoing medical procedures have someone accompany them, drive them home and often stay with them afterward.

Or, if solos reach a point where they can no longer manage their own finances, the financial industry requires someone to be legally appointed to access their accounts. If end-of-life decisions are to be made for a person who is incapacitated, someone needs to make them, or to supply the person's advance health care directive (living will).

"What I have discovered is that people are very hesitant to serve as a health care agent for somebody who isn't family," Camp said.

She has contacted organizations around Minnesota and the country to see what was being done for solos. "Pretty much everywhere I called was the same: 'Please tell us what you find out.'"

Solos have always existed. But there were fewer of them when people tended to live with or near family members and had more community connections. Now, they're more likely to live alone. They're having fewer or no children. Americans move more frequently. Memberships in churches and community groups have dropped. And people are living to older ages.

The number of solos is not specifically tracked and is hard to gauge because of the potential complexity of individual situations. Camp's research shows that 17% of Minnesotans are age 65 or older, a population that is expected to grow to more than 20% by 2030, according to the State Demographics Center's projections. Roughly a quarter of those live alone, with percentages higher in less-populated counties, where services are also harder to access.

Efforts to address the problems are "spotty," Camp said. Some local governments, aging organizations, churches, CaringBridge pages and even informal groups of friends and neighbors have established ride and meal programs and other assistance. But, Camp said, there's no big-picture look at "how do we need to work differently in our communities."

Often, people with worries about these issues are simply told they "need to plan better," Camp said. But "they can't plan better if they don't have anyone to plan with."

The Minnesota Board on Aging has taken steps toward recognizing and addressing the problem. Its State Plan on Aging for 2024-2027, which includes a white paper written by Camp and draws on her research, sets a goal of developing "effective supports for solos."

Camp is focusing primarily on Minnesota "because I feel like the climate is right for some changes here."

A handful of groups, inspired by Camp, have formed to bring solos together to talk about these issues. The groups haven't found answers to all the challenges, but just getting people to discuss their situations and share information has helped, group leaders say.

When Paula Fischer started a group in the Highland Park neighborhood of St. Paul, "some didn't even have anyone on their health care directive or power of attorney. So they were in this murky area of, 'Gosh, I know I should do all of these things.'"

Group members shared information like who they call for home repairs and how much their lawyer charged. They formed connections and have continued to meet quarterly, Fischer said.

A group at the Longfellow/Seward Healthy Seniors Service program in Minneapolis reached a similar level of success, said its leader, Julia Ockuly.

"People who were terrified because they didn't know what they were going to do, now they're in a place where they have the documentation they need and they feel a little bit more secure," she said.

But there are less obvious matters to consider, said Patsy Bartley, another Twin Cities group leader who has long been involved in services for older people. "As basic as, if you've got pets and something happens, who do you have take care of your animals for you?"

Then there are still more daunting dilemmas that few, if any, groups have attempted to solve, such as what solos can do when they're no longer able to perform what are called the "activities of daily living" — dressing, bathing, using the toilet and so on.

"People are going to say I can give you rides or I'll take you grocery shopping but they're not going to say, 'Oh, I'll come and give you a shower,'" Fischer said.

Even close family members may balk at tasks like changing diapers, and the discomfort can go both ways.

"Guess what? That is the reality as people get older," Bartley said. "Who are you going to feel comfortable having do that?"

But if the groups haven't ventured into such thorny territory, they've at least helped people get started on the basics. Coggins joined Ockuly's group in January 2022, and now feels better about how she'll handle things.

“I’m amazed how honest everybody [in the group] is willing to be about end-of-life issues,” Coggins said. “If you want to be in charge of your life, you have to be in charge of your death, too.”