Alone and sick: what is our ethical responsibility?

At a time when civic responsibility is a controversial issue, how do we collectively look out for those who are alone and living with serious illness? In the United States, 27% of adults 60 and older live alone. This is a jarring statistic when one realizes that living with an extended circle of relatives is the most common type of household arrangement for older people around the world, according to a Pew Research Center Study.

People are more likely to live alone in countries with “advanced economies.”  Less developed counties tend to have much larger households and older adults live surrounded by grandchildren, nephews and nieces, their adult children and their spouses.

When an older adult has a serious illness, living alone becomes more difficult.  As symptoms fluctuate, there may not be anyone to notice or help lessen the load of chores that are required to take care of personal health and the household. Pain can be amplified by loneliness.

Yet independence is a large national value, a cornerstone of the American identity. It is the thing most older adults say they want, to live independently at home. In the CAPABLE model a nurse, occupational therapist and handyman visit the residence and make changes to the home that support safer conditions to age in place. Innovative home health agencies are adding handymen to the team. John Hopkins , where the model originated, is now working on dissemination around the country.

What is your palliative care program doing to find support for patients who live alone with serious illness? How can community organizations be engaged to provide some of the non-medical supports a person may need? Can you set up a volunteer group of handymen and a fund for housing adaptations?

Can you tag the palliative care patients on your panel who live alone, so you can package a different set of services to reduce isolation? If we believe that Covid-19 vaccinations are not only for our health, but for our family and others, then perhaps we can also see that older adults living alone with serious illness are also part of the community that needs loving care.


 Pat Justis, Washington State Department of Health