Lorene Solivan moved into the “Golden Girls” house in October after seeing an ad on Craigslist. An event manager at a food company, Solivan says she often cooks dinner for the group. (Maggie Starbard/NPR)

Today more than 1 in every 3 baby boomers — that huge glut of people born between 1948 and 1964 — is unmarried. And those unmarried boomers are disproportionately women. As this vast generation rushes into retirement, there’s a growing concern among experts on aging: Who will take care of all these people when they’re too old to care for themselves?

It’s a question many of the experts take personally. “That is what scares me,” says Sara Rix, who works for the AARP Public Policy Institute, studying the economic prospects of women in the workforce. “Because I am one of those people,” she says, “and I do think about it.”

“Oh, I’ve got wonderful nieces and nephews,” Rix says, noting that’s what a lot of her boomer peers claim, too. “Well, in fact, they’ve got their families. They’ve got their in-laws. They’ve got their parents. And I don’t think it’s reasonable to expect much out of them.”

Kathleen Kelly, who runs the Family Caregiver Alliance and the National Center on Caregiving in San Francisco, says she’s seeing the same sort of concern in her social circle. “I’m in my 50s, and my friends are all talking about, ‘Could we all move in together? Could we buy an apartment building and all live together?’ There are all sorts of permutations of this conversation,” Kelly says. “But it really is something that people are thinking about, particularly women.”

And, because boomers are boomers, some are doing more than just thinking about it. Already, there’s a small but apparently growing movement of boomer women forming group houses with their single peers.

One of those homes belongs to Bonnie Moore. She’s a pert, 60-something divorcee who lives in a well-kept, five-bedroom house in Bowie, Md., a cozy suburb of Washington, D.C.

In order to stay in her house after her divorce, Moore needed financial help. But she wanted to do more than just add boarders who would help pay the bills, she says. The home she’s organized instead is “a little bit like family, a little bit like roommates, a little bit like a sorority house,” she says from the sofa of her softly lit living room. “It just evolves.”

Moore, an attorney, isn’t actually childless. She has a grown son who lives in Utah and has been urging Moore to move there to be closer to him and his family. “He’s just sort of saying, ‘Well, Mom you’re old now; we have to take care of you,’ ” Moore says. “And I’m saying, ‘I’m not old. I’ve got 20 years out there in my yard, thank you very much,’ ” she says with a laugh.

Moore has been careful about selecting as housemates women who get along, but who also have a sense of independence. “All of us, we have our own separate lives,” she says. “We do our own separate things, but we’ll meet up in the kitchen and chitchat. And then we’ll all go our different ways, which makes it nice. None of us are joined at the hip, and yet we all live together and do our own thing and live in the same house.”

Lorene Solivan is one of Moore’s three current roommates — “the youngest,” Solivan says proudly, having just turned 60.

Solivan, an event manager for a food company, had been living in an apartment in Northern Virginia. But she was having financial troubles of her own and was looking to downsize.

“And then I saw the ad on Craigslist: GOLDEN GIRLS HOUSE. I said, ‘Oh, that looks like fun,’ ” she says.

Solivan, who does much of the group’s cooking, says it’s been a nice transition for her. To live with a built-in social group of people your own age is “a big plus,” she says, “whether you’re 20, 40, or 60 — whatever the case may be.”

That’s why Bonnie Moore is trying to take her concept and expand it. She already has a website and is working on a guide to help other single boomer women set up houses like hers. “I think it’ll be fun,” she says. “And I’d like to be part of various seminars and workshops for women [about] the whole idea of living communally and learning to get along in this kind of environment.”

Still, there are a lot of obstacles. One big one is that most boomers don’t realize they might need help getting or paying for long-term care if their health falters.

“I call it the 70-70-70 conundrum,” says Bruce Chernof, president and CEO of The SCAN Foundation, which focuses on long-term health care issues. “Seventy percent of people over the age of 65 will need some form of long-term care supports as they age,” he says. But when you look at polling, “roughly 70 percent of Americans don’t actually think they’re likely to need it, and roughly 70 percent think Medicare will probably cover it when they get there.”

The problem, of course, he adds, is that “those last two 70 percents are not true.”

Then there’s the numbers problem. “We know that … about a third of baby boomers are single,” says Kathleen Kelly. “But we also know that there’s a large percentage of those that are in their 50s and 60s [who] are getting divorced, and so we’re going to have more single individuals in the future. We just haven’t seen this before.”

At the same time, most boomers have had fewer children than previous generations did, and many boomers have no children.

“So there’s less adult children to take the place of the caregiving cohort that currently is providing … caregiving to their parents,” she says. And today, family caregiving provides an estimated $450 billion a year worth of unpaid care.

Sara Rix of AARP says a big problem for single boomer women is that they’re not financially prepared to hire the caregivers they might need if they don’t have family members to volunteer the time. “[These single women] are still likely to be concentrated in what we’ve traditionally called the ‘pink collar’ jobs,” she says, which are “the lower wage, low benefit occupations. So when they reach old age, they often reach old age without pension coverage.”

Most of these women will have Social Security, Rix says — assuming that they are eligible, and that the rules don’t change between now and when they retire. But for many older women, that will be all, or nearly all the money they have to live on, she says, “and it’s not going to pay for a lot of care — formal care. So it’s a frightening future for a lot of women.”

There are things women can do to make that future a little less frightening, says Kelly. Some suggestions are pretty obvious, like maintaining a healthy, active lifestyle.

But another bit of advice may be less intuitive, Kelly says, “and that is to invest in social relationships and networks.” She doesn’t mean the sort of social networks people create on the Internet, but rather, “a community of individuals [living with or near you, so] that you may be able to share tasks and responsibilities as you grow older.”

That brings us back to Bonnie Moore, who says that deciding to form a group house was about more than just financial necessity. “I think women naturally are more community oriented,” Moore says. “It’s just part of the woman’s nature.”

And besides, she adds, “to come home and have someone say, ‘Hi, how was your day?’ … That’s really nice sometimes.”

So if you’re a boomer and you liked that group house you shared in college or just after, good for you. The United States is one of the few developed nations that has no organized public policy for providing long-term care — so group living may be in your future as well as your past.

(Photo: Getty Images)

It’s late morning as Linda Kerr of Canyon Country helps her 85-year-old mother navigate the indoor hallway of her Hollywood apartment.

“Be careful, Ma,” she gently cautions as her mother takes tentative steps forward. “C’mon, get closer to the walker — you’re walking too far away.”

The going is slow and precarious as Martha Kerr, who is recovering from a cracked vertebra in her neck, inches along the corridor guiding the walker for her mom. Her caregiver, Virginia, walks behind her with the wheelchair that will be used to transport Martha after the journey to the elevator is complete.

They’re heading to the hospital to get help and become among the first to enroll in UCLA’s Alzheimer’s and Dementia Care Program. Funded by philanthropic dollars and a federal innovations grant, the program is designed to help patients and family caregivers deal with dementia.

Linda says she welcomes any assistance offered by the program. For more than a decade, she’s played the lead role in caring for her mother. While a full-time caregiver now assists her mother, Linda’s days nevertheless remain consumed by providing care for her mom — with her remaining time spent with her husband or on her career as voice actress and audiobook narrator.

“I have no free time,” she says. “No free time. You know how people say, ‘One day at a time’? A day is way too long. I take it an hour at a time. Sometimes, just this moment at a time.”

That’s a refrain shared by many who care for people with Alzheimer’s and dementia. In California, more than 500,000 people are now afflicted with Alzheimer’s alone. By 2030, that number is expected to climb to 1.1 million, according to statewide projections. Experts say that will place an even larger strain on family caregivers.

“The most important resource that a person with Alzheimer’s disease or other dementia has is their caregiver — much more important than their doctors,” says Dr. David Reuben, chief of UCLA Geriatric Medicine and head of the new dementia program, which is offering enrollment to all medical center patients diagnosed with dementia. Those who participate will get an individualized care program tailored both for them and for their caregiver.

“We see a lot of caregiver burnout,” Reuben says. “Once the burnout has happened, it’s almost impossible to try to retrieve people. That means a lot is riding on these caregivers, and they have to be supported.”

In addition to providing coordinated medical care for patients, the program is offering caregivers around-the-clock access to geriatric experts for help with sudden behavior changes and other unique challenges posed by dementia.

The program also features caregiver support groups, called Beyond Alzheimer’s that are organized by Patti Davis.

Davis is the daughter of former president Ronald Reagan — one of the world’s most famous Alzheimer’s patients. She says support groups are especially important for family members dealing with Alzheimer’s disease and other dementia because they affect families unlike any other disease.

“It’s a death before dying,” Davis says. “You’re losing everything that is familiar about that person in stages that are very unpredictable and you have no idea what’s going be lost next or when. You only know that it will happen.”

That’s a pretty accurate depiction of the journey Linda Kerr has traveled with her mother since 2001. The several strokes Martha has suffered have changed her personality and require medication to quell episodes of belligerence. But the drugs sometimes affect Martha’s coordination, as happened on a recent outing that Linda says devolved from a fun experience into another exhausting episode.

“It was like she had another major stroke,” says Linda. “Her brain went dead; she couldn’t walk right. She almost fell on us, and she still gets agitated.”

Martha’s drug prescriptions were among the topics of discussion at her dementia care enrollment meeting, which began with a medical technician checking her vital signs.

The female tech started by explaining to Martha everything she was doing. “I need one finger in here. It’s for your oxygen and pulse, OK?” she said as she held up the finger-mounted pulse oximeter. She then checked Martha’s weight.

The brief physical was followed by an assessment meeting between the Kerrs and geriatric nurse practitioner Leslie Evertson, who manages the dementia care program.

“The first thing I do is get a good overview picture of what’s going on with Ms. Kerr and the family and try to narrow down some goals that we can hope to attain — what would make their quality of life easier,” she says.

After about an hour, the Kerrs left the closed-door meeting with Martha enrolled in the program and with a prescription for Linda as well: to attend a support group. But the time constraints imposed by her mother’s illness right now make that step unlikely, she says.

“I wish I had more time to go,” Linda says. “If I have a day, I’m here with my mom giving the caregiver a break. So I have to choose, you know, it’s like it’s better off I’m here.”

That sentiment underscores a paradox that may likely pose one of the biggest challenges for the UCLA program as it expands into what organizers hope will be a model for dementia care nationwide.

California's aging baby-boomer population has policymakers and developers thinking about how to let them age at home. (Justin Sullivan/Getty Images)

California may be the sixth youngest state right now. But it has an outsized population of Baby Boomers.

“They are turning 65 soon,” says Adele Hayutin, a Senior Research Scholar at the Stanford Center on Longevity.

“We’ll have a doubling of our older population over the next 20 years,” Hayutin says. “That makes us aging faster than the United States, which I think is a bit of a surprise to people.”

In a recent paper, Hayutin wrote that projections show in 2040 California’s population will be slightly older than the nation’s as a whole. That has implications for policy makers, developers, and residents — everyone who lives here will feel the effect.

And the sooner the planning starts the better, says Henry Cisneros.

Cisneros is the former Secretary of the U.S. Department of Housing and Urban Development under President Clinton. He just co-edited a book with two scholars at Stanford – Jane Hickie and Margaret Dyer-Chamberlain – called “Independent for Life: Homes and Neighborhoods for an Aging America.”

“When we listen to older Americans themselves,” Cisneros says, “when they describe the things they fear about aging in place … it’s things like isolation, being left alone and not being able to negotiate neighborhood streets. Not being able to get to the doctor or grocery store.”

Increasingly the state has neighborhoods where entire communities are aging in place. Urban planners have a name for these: NORCs, or Naturally Occurring Retirement Communities. Cisnero says adapting to them can require some changes.

“Sidewalks that make it possible for people to walk safely. Slowing down the traffic on some of the adjacent streets and arterials so older people have a chance to be mobile as opposed to trapped in their home,” he says.

Some California cities have started taking these steps, a few even taking it further. Take Davis, California, says Cisneros, where the city government is working to change the zoning code. They want to allow for small “granny flats” or adjacent dwellings on single family lots so older people can live adjacent to younger families who occupy the main house.

Other policy changes could take into account health care delivery, changing the scale and citing of new houses or adjusting how communities are policed.

Some of the change, though, will come from residents organizing themselves. Cisneros points to San Francisco as an example. Specifically with the rise of a new phenomenon being called a “virtual village network.”

Cisneros says under the model, older Americans join a local network and then “have the capacity to be taken to the doctor, or get a ride to the grocery or have groceries brought to them as they need them, or to have a specialist drop in and help them with a particularly heavy task they have.”

Other points of progress he points to in San Francisco are its network of elder-oriented nonprofits, specifically strong in the Asian community.

“If you go into [the city] on some weekday mornings and drive by a San Francisco park you will see 30 people in formation,” Cisneros says. “Older Americans, doing tai chi and other exercises, organized by neighborhood groups. That’s the kind of thing we’re going to see a lot more in the future, recreation programs and fitness programs for an aging population.”

But the need for those might be very different throughout the state. Stanford’s Hayutin says California aging population varies dramatically by region.

“For example the northern California counties, Calaveras and all the Sierra, tend to be much older,” Hayutin says “Whereas Southern California … has a much younger population.”

Cisneros says one important aspect of making good aging policy is having a strong understanding between the generations.

“If we do not prepare our young people to be workers,” he says. “to make contributions in tax and revenues, then there simply won’t be enough resources to deal with the needs of older Americans … It will be critical for those in the workforce to be very productive.”

Just as young people need to support those policies that help the older generation, he says older Americans need to keep supporting public resources like education.

“Those are intergenerational compacts that are going to have to be achieved, not easy to do at all, they’re not easily understandable, they are very difficult to enact,” Cisneros says. “But important that people try to understand if we’re going to have anything that resembles a harmonious society when we are competing for resources going forward.”

Some paid caregivers are barely making ends meet. (Getty Images: Justin Sullivan)

Some people who care for vulnerable older adults are in dire economic straits, according to a new study [PDF] from the UCLA Center for Health Policy Research.

Hundreds of thousands of people provide care – from cooking and cleaning to bathing and dressing – for adults with disabilities or long-term illnesses who receive benefits from Medi-Cal. As it turns out, those who get paid for this work may not be pulling in enough money to make ends meet.

Geoffrey Hoffman, a researcher at the Center and lead author of the report said, “These paid Medi-Cal caregivers have incomes that are quite low compared to other Californians, about half as much monthly household income.”

He continued, “A third of them do not have health insurance. A number of them live in poverty or near-poverty, and, among those, a third of them have what is called ‘food insecurity’ – not enough food to put on the table every month.”

At issue is the amount that Medi-Cal is paying these caregivers. Even if you add income from other jobs, they earn a little over $11 per hour on average — close to minimum wage, and about two-thirds of the median income in California — making it difficult for them to live on their earnings. Many believe that the value of the care they provide is much greater than what they earn, but monetary constraints have led California lawmakers to decrease financial support for these services.

In 2011, the state budget cut the Medi-Cal caregiver reimbursement program – In-Home Supportive Services – by 3.6 percent. State officials had also planned a 20 percent decrease in the number of hours a caregiver could work, but that cut has been blocked by a judge for now.

Hoffman worries these trends could affect the quality of care available to those who need assistance. “If the caregivers are having trouble putting food on their own table, then they’re not going to provide the type of care we want for our grandparents and our spouses in this state.

As these caregivers themselves begin to age, Hoffman said he is also concerned that those who are economically disadvantaged will end up costing the system more money later on, making it even more difficult for Medi-Cal and Medicare to stay solvent in years to come.

“This aging population [of caregivers] is going to lead to great burdens on the health care system. So the sooner we address the problem today, the better off we are for our older adults’ health … in the future.”

(Patrick: Flickr)

Researchers and health advocates have long been encouraging people to make their end-of-life wishes known. While most people say they want to die a natural death at home, few actually put those wishes into writing.

But at least equally important is thinking about how to enjoy quality of life while aging. A new book seeks to help people address these questions. Kaiser Health News interviewed Nortin Hadler, the author of “Rethinking Aging.”

I especially like the book’s tagline: “Growing Old and Living Well in an Overtreated Society.” Hadler is concerned about the medicalization of aging. “We’re taught and marketed that all changes in appearance and in function in older people are forms of disease that demand treatment,” he told Kaiser Health News. “But often, that isn’t true. Much that is termed a disease is a normal aspect of this time of life and needs to be viewed as such.”

The Kaiser Health News interview goes on:

Q: You talk a lot about the importance of older people making informed medical decisions.

A: For the first time in the history of medicine, we have a tremendous amount of information about efficacy: what makes sense to do medically and what doesn’t.

What I want to teach people is that it’s perfectly appropriate for patients to ask their doctors, “How certain are you that what you are offering me will produce meaningful benefits? What does the evidence show about the possibility of harm?”

Q: Can you suggest some other questions people might ask?

A: People should want to know the likelihood that death will be postponed by doing something. What is the likelihood of the same outcome, or close to the same, if one doesn’t have the treatment? Out of every 100 people, how many are helped by this intervention?

This last point–how many are helped by an intervention–is particularly relevant. The doctor is referring to relative risk. You might hear a drug ad claim that “twice as many people” avoided a heart attack, stroke or some other dire health consequence. But if the likelihood of that dire thing happening to you was only one in 100 to begin with, do you really want to try an intervention and risk the side effects that go along with it?

In the interview, Hadler also puts the issue of informed medical decision making into context for people with a serious, life threatening illness:

You want to know whether a proposed intervention will be effective given your context: your age, your degree of frailty, other illnesses that you have. How much benefit will you get: an extra three months, an extra year? If it’s a year, what kind of year will it be? Will I feel absolutely awful? What will the quality of my life be?

I once took care of a very, very famous physician. He was an octogenarian with heart disease, but he was very active and sharp as a tack. Well, he found out that in his belly was an expanding aortic aneurism – a surgically treatable potential killer. He and I had multiple conversations about what to do and each time he would say, “I’ll be damned if I let them do surgery on me.” He knew there was a high risk of surgical mortality because of his age and his frailty. He knew that urological complications were almost guaranteed and cardiac complications were probable. He didn’t want to try to live through that. And he didn’t have to because he died of a stroke, unrelated to the aneurism, several years later.

You can read the entire interview here.