Judith Graham: Good morning, everyone. Thank you for joining us today. I’m Judy Graham, and I write the “Navigating Aging” column for Kaiser Health News, actually known as KFF Health News. I’m also the moderator for today’s event. We’re all in for treat: a conversation with five remarkable older adults about their lives and their experiences.

First, a few words of introduction. As many of you know, KFF is an independent organization that focuses on health policy research, polling, and news. It sponsors KFF Health News and partners with media organizations across the country. The Washington Post has been our partner for the series that is the subject of this webinar, “Going It Alone.” KFF Health News is committed to covering the greatest demographic trend of our time: the astonishing growth of the older population, now 60 million strong. And I’ve been privileged to be a part of that. For many years, The John A. Hartford Foundation, the co-sponsor of this event, has supported our aging coverage. I’ll let Rani Snyder, who oversees the Hartford Foundation’s grant-making to improve the care of older adults, tell you more. Rani, onto you.

Rani Snyder: Thank you so much, Judy. It’s great to be here. And thank you, especially Judy, for all of the work that you do for the “Navigating Aging” column, which is just terrific. Our foundation, The John A. Hartford Foundation, is really proud to support today’s event and KFF Health News and all that you do. I am Rani Snyder. I’m the vice president of program at The John A. Hartford Foundation. Our foundation is a nonpartisan national philanthropy with the mission to improve the care of older adults. We happen to reside in New York City, but we operate all across the country. And we work in three different areas: creating age-friendly health systems, supporting family caregivers, and improving serious illness and end-of-life care. And I really want to welcome our entire audience to today’s discussion about living alone while growing old. Our foundation invests pretty heavily in supporting family caregivers or older adults who are the backbone of care in this country.

And we also recognize, and even more so now, thanks to Judy’s excellent reporting, that millions of people don’t have a family member or a friend who are assisting them as they age and could potentially need care. So our foundation is working to make sure that all older adults, no matter where they live, no matter their background, no matter their family circumstances, have access to high-quality, age-friendly care that’s focused on what matters to all of us as we get older. So by funding programs that connect health systems, public health, and community-based services, and also by engaging when we can with policymakers and the public, our plan is to create systems of support and communities of connection that help people to age well as they’re aging alone. Speaking of aging well, right now we’re developing a new initiative to support social connection among older people, and we invite you to follow and engage with us at our website, which is johnahartford.org.

We’re really looking forward to this conversation today, actually. Our goal is not only to highlight challenges, but, honestly, to explore the resilience and the ingenuity of people who are aging solo. And that’s why I’m especially thankful to our panelists, five people who are featured in Judy’s series. We so appreciate your sharing your stories, and I would encourage everyone who is online on this webinar to engage with them and engage with Judy by asking questions and contributing to this discussion. So please carry this conversation forward to your networks and your communities. You also have the opportunity to shine a light on this topic that’s too often overlooked. So now let’s get started, and I want to hand it back to you, Judy, to introduce this fabulous panel.

Graham: Thanks so much. A little context before we get straight to it. The number of older adults living alone in the United States is truly unprecedented. In the past, there were fewer older people and they tended to live with family as they grew older. But with longer life spans, older people are outliving spouses; with increasing divorce rates, more people find themselves without partners as they age and with greater mobility. Even those with adult children find them far away and not part of their daily lives. How big is this group? We’re talking about more than 10 million older women and 6 million older men who live alone, according to the U.S. Census Bureau. Health issues are common in this group. Nearly 4 in 10 older adults who live on their own have vision or hearing problems, difficulty living independently, problems with cognition or other disabilities. Who’s around to help them or even notice when these older adults need assistance?

As Rani said, our health care system relies on spouses, partners, and adult children to be the backbone of our system of nonmedical care for seniors. What happens when there are no family members of this kind or they live at a distance? These are among the questions I’ve explored in my series “Going It Alone,” and I focused in this series on the real experts in this topic, older adults, who know better than anybody else what they live with. Today, you’ll hear from five of the older adults who appear in my series. As you can see, they live in different parts of the country, and they face different issues. We will talk for about an hour and then spend half an hour answering your questions. Please submit those via the chat function on your screen or the Q&A function. I’ll try to get to as many as I can.

This event is being recorded and will be accessible permanently afterward on YouTube, and we’ll of course link to it on the KFF Health News website. Now on to our panelists. I’ve asked them to introduce themselves before we dive into our discussion. Let’s start with Bill Hall in Seattle.

Bill, your sound is not working. Why don’t you try again and … OK, we’re going to go on to somebody else while you work with your sound. Let’s try Don Bell in Chicago.

Donald Bell: Good morning, everybody, and welcome to Chicago. My name is Donald Bell, and I am a resident of a unique senior residence, the Town Hall Apartments, which is Chicago’s first and the nation’s fourth LGBTQ+-friendly senior residence. Now, LGBTQ+-friendly does not mean LGBTQ+-exclusive. Our demographic breaks down by the following percentages: We have 30% of our neighbors are hetero-identified and 70% are LGBT-identified, but together we form one great community.

Graham: How old are you, Don? And do you live alone?

Bell: I’m 75.

Graham: OK, thank you.

Bell: Yes.

Graham: Hilda Jaffe of New York City. Why don’t you introduce yourself?

Hilda Jaffe: OK. Good morning — well, it is still morning everywhere, I guess — everyone. My name is Hilda Jaffe. I live in New York City, the crossroads of the world, and I live about one block away from Times Square, which is the crossroads of New York City. I am 102 years old, which astonishes me every day, I can tell you that. I have lived in New York City for the past 14 years. Before that, I had 60-some years in a house in New Jersey. After my husband died, I lived there for a short while and then moved into New York from an ordinary three-, four-bedroom house into a one-bedroom rental apartment in a high-rise building. I’m a widow, as I’ve mentioned. I have two children, my son in California, my daughter Tel Aviv, Israel.

I have five grandchildren and eight great-grandchildren who live in California, Philadelphia, Switzerland, and Israel. I’m in a centenarian study, and that is really an important part of what goes on in my life — to be a part of about 2,500 other people who are involved in this largest centenarian study in the world run out of New England. It’s called the New England Centenarian Study. And I do puzzles. Every day I do The New York Times crossword puzzle.

Graham: In ink, if I am correct.

Jaffe: Correct.

Graham: Ken Elliott, why don’t you go next?

Ken Elliott: OK, thank you, Judy. My name’s Ken Elliott. I live in Mount Vernon, Maine. I’m 78 years old. I’ve not ever been married nor had children, and I live alone. I think I’m the voice of a rural community here. My town is Mount Vernon. It’s 1,300 people. We do have an aging-in-place group, and I’m keenly interested and have been interested in the solution side of solo aging, and perhaps we’ll circle back to that later on in our discussion.

Graham: Great, thank you. Denise, tell us about yourself.

Denise Baker: Morning, everyone. I’m Denise Baker. I want to give you a few snippets about myself. I’m 81 years old. I live in a lovely house in Asheville, North Carolina, with my roommate, Yellow, the dog. I moved here 15 years ago after retiring from my job with the government in Washington, D.C. I have vascular and Alzheimer’s dementias and I have limited vision. I spend a lot of my time making pottery, which is my entry into the world. I have raised three daughters and a husband and am happily divorced for 35 years. My daughters live in Boston and Denver. I feel that I’m pretty self-sufficient. If I need help, I have neighbors and friends who are more than happy to pitch in. Sometimes too happy to pitch in. I like making my own decisions when I can. I’m a team member for Dementia Friendly Western North Carolina, and we do educational sessions for community groups who want to learn more about dementia. And that’s me in a nutshell.

Graham: Thank you, Denise. Now Bill, hopefully we’ve solved these sound problems.

Bill Hall: I hope so. Can you hear me?

Graham: Yes.

Hall: OK.

Graham: How about introducing yourself?

Hall: My name is Bill Hall. I am a Tlingit Indian from a small fishing village in Alaska called Hoonah. I am from the Raven Clan and I live in Seattle, Washington. I’ve been living with HIV and AIDS for 38 years now, and I live in a building that was built specifically for people living with HIV. It’s called Cal Anderson House. I am the community advocate for the Native American community here in Seattle on HIV, and I’m really happy to be part of this panel.

Graham: And how old are you, Bill?

Hall: I am 71.

Graham: Thank you. All right. Now that we’ve met all of you, it’s time to dive in. And Don, I think you’re going to go first. They say about raising children, it takes a village. I think that’s true for older adults too. Do you have a community of people you can rely on? Who’s part of that community?

Bell: Well, I do have a community of people on whom I can rely, starting with my church community, a very welcoming church, and that’s what we pride ourselves on. And, of course, I do have bio relationships too. I have two adult children and seven grandchildren. But it’s the friends and friends of long term who are really important because they’re people who go through the stages of life with you. And my long-term friends and I agree that rather than buying into the values of ageism that tell us that we are lesser as we grow older, we are leaning into the aging experience and claiming our years and our experience and enjoying that. We are not spending the remaining years of our lives just waiting to die. We are living them very actively and fully as we can.

Graham: Thank you, Don. Ken, I wanted to ask you the same question. Do you have a community that you can rely on in Mount Vernon?

Elliott: I’ll say 30%. I’ll try to be something of a realist in the group saying, “Not a very good one.” And that’s part of the paradox of living in the paradise, which is the Maine woods, is that your support systems tend to be few. So that it’s no coincidence that I’m interested in solutions, and I’m interested in the concept of do-it-yourself.

Graham: Bill, you’re a long-term HIV survivor and you have a lot of health issues. Can you tell us about the issues that you deal with and how you manage them on your own?

Hall: In the past year, I’ve dealt with back-to-back cancer — prostate cancer, and kidney cancer — and I’ve developed problems with walking. And I would say in the last 14 months, I’ve almost died six times. I’ve been in the hospital for internal bleeding, for extremely high blood sugars, and, along with that, I deal with HIV and AIDS, which brings up a lot of complications. I deal with diabetes, heart disease, and it’s been a rough two years for me because it seems like I’ve lived in the hospital every day. But you have to be adaptable, I’ve found, as I’ve learned from HIV. It’s that this is what you’re given, this is what you have to deal with, and you have to take what comes and deal with it as it comes. And I think it’s that adaptability that I have that I’m still here today.

Graham: That’s a lot to deal with on your own. Who helps you out when you need help?

Hall: Well, I’ve been alone all my life, and there’s a long story behind that, but I won’t get into it. And so I have a neighbor that is in the building. He helps when I need to be escorted from a test or that requires somebody pick me up, he does that. He brings me soup every once in a while. Always calling to check in on me. And I have another friend who gives me a ride to medical appointments. And so it’s a blessing to have them in my life because living alone with all these diseases is really hard, especially at night when the fears all come to you. And so I have a great medical team, and so I am, in every sense of the word, very well taken care of.

Graham: Thank you, Bill. I’m struck by what you said, which I’ve heard from so many older adults, which is you have to deal with the hand that you’re dealt and the need for adaptability, dealing with the problems that arise that come up. Now, Denise, you told us you have vascular dementia and Alzheimer’s, and I believe you’re the survivor of a stroke, and you have eye issues. How do you deal with all of that while living alone? How have you made things work for yourself?

Baker: I love living alone. I couldn’t do it without my dog. We talk. She doesn’t argue with me. Life is great. I think for most of us who live alone and are making a good job of it, I think a lot of it is attitude. If you think that everything’s going to be OK, you’re going to come a lot closer to that than if you think, “Oh, poor me. What’s going to happen to me?” I was diagnosed with Alzheimer’s about 14 years ago. I’m sorry, with vascular dementia, which it’s not unusual for vascular dementia to come years after having a stroke. But five years after the vascular dementia diagnosis, I was diagnosed with Alzheimer’s. I was used to having dementia, so the Alzheimer’s diagnosis didn’t really sink me, but it did make me more serious about my dementias, and I started taking a lot better care of myself, and I’m doing well. My memory is good. I get confused from time to time, but then don’t we all, and I’m happy. Things are going well for me.

Graham: Follow-up question. What helps you manage on your own? What kind of arrangements have you made to make your life possible while dealing with this on your own?

Baker: Well, I live in my own house, so I make all the decisions that I want to make. If I need help, if I’m confused about something, I’ve got friends and family and neighbors who are more than happy to help me. As far as long-term, I have long-term care insurance that, when the time comes, it will pay for someone to come into my house and help me out on a day-by-day basis. So I’m not concerned about having to go to a nursing home or something.

Graham: Thank you so much.

Graham: Hilda, when we spent time together, you told me that everyone you know, including your doctors, say there’s nobody like you at 102. How does it feel living by yourself at 102 years of age?

Jaffe: Well, it doesn’t feel any different today than it did yesterday or a year ago. So it isn’t really age that’s there, it is the surroundings and the circumstances. I often point out to people that there was a difference before covid and after covid. Before covid, life just went on from day to day and you kept doing the same things that you were doing before, and then you suddenly were stopped. You were paused in that. And life, if you were healthy, you continued to live, but the opportunities and the openness was not available to you.

But after two and three years, when things came back to supposedly normal, then it was time to make some decisions about whether the things you were doing before were what you wanted to continue doing again. What was important to put your time about? And so, I used to go to the theater a lot. My hearing deteriorated. I just stopped going to the theater. That is not something I enjoy anymore, but I can still enjoy music.

And so I go to opera and symphony and chamber music so that I can continue to be with people. And I do that with other people so that I have somebody to talk to. So it’s a question of every day accommodating. I travel. Public transportation within central New York City certainly is fantastic. And so I travel by bus. I don’t take the subway anymore, it’s not necessary. I take buses; if necessary, a taxi. But buses satisfy me and that’s how I get to doctors, that’s how I get to the opera.

But what I do, and this brings me among people, and Judy even participated. I volunteer at the New York Public Library, which is the main branch at 42nd and Fifth Avenue. and I’m a docent for their exhibits. And I give a one-hour tour about five or six times a month. So that gives me something to do, something to be among people … people to talk with, to have to do some research and come up as they make changes in the exhibit. I have to do research about new things that they’re putting in.

So there is enough to do. Read the paper every day, do my crossword puzzles, be on FaceTime and WhatsApp with my far-flung family and all of my eight great-grandchildren. The youngest is 2 years-old, the oldest is 13. They know me as “Gma,” which is short for great-grandma. And they know me on screen, so to some of them I’m a face and to some they visit and know me in person. But as I said, today it’s just another day.

Graham: A couple of things stand out, what people who are older adults who are living alone do to be among people and the importance of location in terms of providing opportunities for that. Ken, I wanted to get back to you. When you and I first spoke months ago, you told me that “solo agers,” when you began to be interested in this issue, weren’t on the radar screen in Maine. Can you talk about how you became aware that it wasn’t just you, it was a broader issue? And what kind of reception you met when you began to take this issue forward in Maine?

Elliott: Thanks for the question. It’s a helpful one, Judy, and certainly getting informed. I want to express my gratitude to you for the articles that you have written. They’re brilliant, they’re really good. I wish I’d written them myself. But to answer your question about what I have found as far as receptiveness in Maine. One of the things that keeps me going is, I don’t believe, and I can always be wrong or a new one can be established, but I don’t believe there is a study group or an advocacy group specifically for solo agers in the state of Maine.

And I have asked everywhere from adult services to the universities where I used to work and to others who are interested in studying gerontology. So that surprised me. And so what I found is that when people hear the term and become better informed, there’s small movement in the direction of, “OK, what are we going to do with this?” And one has to have a great deal of patience, but I think it’s possible, No. 1, to establish such an advocacy or study group. And No. 2, to have some very achievable goals, like, again, in the state’s aging plan.

I’d love somebody to do a survey on statewide aging plans and see how many of them actually identify solo agers as a significant group. So it’s milestones like that that keep me interested as well as the fact that the awareness is changing even as the age wave swells up, as it were, and one can confidently predict that this will be an important dynamic for us all. I really do believe that.

Graham: Now Hilda talked about making her way among other people, what brings her outside into the world. What does that consist of for you, Ken?

Elliott: Well, first of all, as I’ve mentioned, I tend to be a fairly introverted, solitary type to start with. Two, I have a work history for many years being a psychologist and working intimately with people in psychotherapy and so forth. And three, I’m not as patient as I used to be as far as people spending their time wisely. So that’s why solutions are far more fascinating to me than elaborating on the exploration of problems because something fruitful can come of it. I’m not sure if I’m still on target with your question, Judy, so …

Graham: That’s all right. I appreciate your thoughts. I’m going to switch to Don. Like Hilda, you live in a major urban area, Chicago, my hometown. What brings you in contact with people? And this is a two-part question. I guess that’s the first part and then I’ll give you the second part after you answer. And do you make that a priority?

Bell: Absolutely, I do. Social isolation is the No. 1 issue for all generations, but specifically for the aging generation. And our survival is based upon the fact that we have an anthropological need to be associated with one another. We experience in our aging group the same thing that mirrors what happens to a newborn who isn’t touched, who isn’t interacted or whatever, they can be medically viable, but they pass away from failure to thrive because of lack of contact. That happens to us.

So when I deal with the issue of being alone, there’s a difference between being alone and being lonely. And so as it happened in my life path, I was not partnered. So I am alone, but I’m not by myself. And that’s because of intentionality. I make it my priority to interact with the world and to associate with other people because I need them.

Graham: Can you give us some examples of how you do that?

Bell: Yes. I do benefit from some of the privileges of living in a large urban area. There’s a digital divide that exists between urban areas and rural and ex-urban areas, like Ken’s place. So we can be digitally connected and that’s important in this age. I’m a part of a group called The Village Chicago, and it’s part of a National group called The Village to Village Movement.

And what we do is, we have virtually created a community that brings us together, and we are committed to having programs that give us activities, making connections. And we have basically made a commitment that we are going to see each other through this third act of life. And that calls for dealing with one’s mortality. When you age, you got to deal with that. As far as I know, there’s no way that we get out of here other than through death.

But as we get older, we even look at death differently. And when we’re dealing with our mortality, we recognize that that’s a normal part of life and accept that. But on the meantime, we have one other decision to make, and that is whether we’re sitting around waiting for death or we’re going to live actively until we die. And I vote for that. So death’s going to have to catch me on the run, not in avoidance, but just because I’ll be engaged until I’m unengaged.

Graham: That’s so interesting. Thank you for that, Don. Bill, I wanted to shift over to you. So some of the issues that we’re talking about for you, HIV/AIDS. I know you are an advocate in the Native American community. And the question is how open is that community to hearing about your experiences of living with HIV/AIDS as an older person, living alone, and offering community support and assistance?

Hall: It’s a difficult journey because the stigma in the Native American community on HIV and AIDS is quite strong. And so I’ve tried to figure out why stigma is so strong. But I decided that I’m not going to find that answer, so I just need to keep getting my message out and hopefully one person will hear it. And so it’s just an ongoing process. It’s been a long process, and you just have to keep going because if you give up then nobody will hear your message.

Graham: So Don talked about social isolation and loneliness. Does stigma associated with HIV, has that impacted you personally in terms of being socially isolated and/or lonely?

Hall: It did in the early days of HIV, when HIV was first identified and nobody knew how it was spread. There was a lot of fear and there was also a lot of … we’ve all heard the stories about Ryan White being burned out of his house. And I’ve seen myself several people attacked because they were HIV over the years. And so there was great fear.

And what that did was it shoved us back into the closet and we hid our HIV ferociously. But so much has changed now that AIDS is 40 years old, that fear is gone. And when I stepped up to be an advocate for the Native community, I decided that every time I speak, I’m going to tell them I’ve been living with HIV and AIDS for 38 years.

Graham: Let’s stay on the subject for a moment of loneliness and social isolation. I’m going to open it up and ask, not direct the question to any one of you, in particular, but all of you. And you can raise your hand if you want to answer. A lot of people assume that if you live alone as an older adult, you’re isolated and you’re lonely. Is that true for you? Who’d like to answer? Denise?

Baker: I have all kinds of people around me. My dog walks me about an hour a day and I meet lots of neighbors. And we stand for a few minutes and talk about the day or the weather or what’s going to happen to western North Carolina next. I belong to a couple of wonderful groups. I’m a member of a co-op gallery in the River Arts District, and we get together at least once a month. And here recently, we’ve been doing what we can to help the artists in the River Arts District who have been displaced by the hurricane. And that’s been a wonderful connection.

Despite all the devastation around us, there is a tremendous sense of community and helping each other out that have come from this disaster, and we’re all hoping that it lasts. I’m also a member of the Dementia Friendly Western North Carolina steering team, which I mentioned. And we do a lot of work with the community in outreach and helping people understand that dementia is not a curse. It’s something that happens to a lot of us as we grow older. And these groups give me purpose. They’re very uplifting for me and they make me feel good about myself and my life and everyone around me.

Graham: Thank you, Denise. To Hilda?

Jaffe: Yeah. There are a lot of opportunities for people who live alone. Zoom classes and book clubs and telephone classes, and I’m on with a number of them. Organizations, museums, my synagogue, and I’m active on an adult education committee in my synagogue. So some of that happens on Zoom. You don’t have to be physically present. And some of these Zoom classes, people identify where they live and they live all over the country, although they are on with the Museum of Natural History in New York City. So there is always, on any week, I have a class of some kind on Zoom or telephone. So it’s possible to find things.

Graham: I think that addresses social isolation. What about loneliness, Hilda? Is that a piece of your life?

Jaffe: It is not a problem with me because the day goes pretty quickly and there are always things to do or something in my calendar that reminds me that I have a class or somebod