Ros and John know firsthand the particular challenges of navigating old age alone. The longtime married couple, who agreed to share their story but asked that their last names not be published to protect their privacy, are childless and without immediate family to provide them needed care as they age.

John, a software engineer, was diagnosed with cancer in 2005 at age 49, and had to stop working the following year. He now has difficulty walking, suffers from frontotemporal dementia and needs considerable care. Ros, who is in her 60s, looks after him at home as she continues to work remotely for Stanford University.

The pair immigrated to the United States from England 37 years ago, and without family, Ros worries about who will care for John should she become incapacitated.

"I'm coping on my own as we navigate his illness, which we've been doing for over 15 years," she said. "I have many friends, but you can't ask friends to do what you would ask family. It's a huge concern."

Ros and John are not alone. More than 15 million American adults over 55 — nearly 1 in 6 — do not have children, according to the U.S. Census Bureau. And the bureau projects that "levels of childlessness among older adults" will increase in coming years.

Without adult children to help in case they're no longer able to care for themselves, "solo agers" have particular challenges in planning for their futures, said Paula Wolfson, manager of social work and caregiving for the Palo Alto senior services agency Avenidas.

On Wed., Feb. 16, Avenidas will host a free, virtual discussion with retirement coach and author Sara Zeff Geber on how seniors without family or others to help can find resources and make an aging solo plan. "Meeting the Challenges of Solo Aging" is part of the "Aging Wisely" town hall series sponsored by Avenidas.

"Solo agers have literally called me from the hospital because they're going to be discharged and they don't have anybody at home, don't have any way to get food," Wolfson said.

For those with money, hiring in-home care or paying roughly $10,000 in monthly fees to live in a care facility are possibilities, but most do not have such resources, she said.

"Middle- to low-income solo agers — teachers, office workers, social workers — cannot afford to age here if they become frail," Wolfson said. "You can maybe have $200,000 or $300,000 in a Fidelity Investments account, but that's not going to last very long when you're paying $10,000 a month (for a care facility) or in-home care."

Wolfson knows of many seniors who have moved to lower-cost areas, such as Idaho and Oregon, or have moved in with friends.

Rich or poor, it's especially important for solo agers to focus on proactive planning, she said.

"Do you have a durable power of attorney designated in case you have difficulty with health care or financial decision-making? That is the key," she said.

Ros said she has researched options and has interviewed professional fiduciaries, who charge by the hour, to provide daily care and other services that a family member might typically take on.

"I've found one I'm very comfortable with," she said. "I'd prefer a friend to do it, but it's way too much to ask a friend to do."

She has yet to formalize arrangements with the fiduciary. She does take some comfort, however, in the fact that if all else fails, every county has a conservatorship process, which allows a judge to put a conservator in charge of making sure a person has proper food, clothing, shelter and health care.

The Santa Clara County Office of the Public Guardian, which handles conservatorships, was managing more than 1,400 cases as of November 2019, according to a 2020 Santa Clara County Civil Grand Jury report.

Geber said people of any age may temporarily or permanently lose the ability to care for themselves, "but the odds go up dramatically as we get older."

The proportion of solo agers will only increase in coming years because younger cohorts are increasingly not having children, according to data from the U.S. Census Bureau. For example, of all adults 55 to 64, 19.6% were childless, according to census data from 2018. Of those ages 65 to 74, 15.9% were childless, and of those 75 and older, 10.9% were childless.

"About 22% of adults are, or will be, their own sole caregiver in old age," according to the census bureau's "Childless Older Americans" report released in 2020. "Such adults have no known family member or designated surrogate or caregiver they can count on for support."

Much of Geber's planning advice — such as completing an advance health care directive or designating someone to have power of attorney — applies not just to solo agers but to all older adults, too.

For those without children, including Geber, "ties with friends, siblings, nieces and nephews and even community tend to be (and should be) more prominent," she said.

For more information or to register for the "Meeting the Challenges of Solo Aging" event, go to avenidas.org.