When Betsy had three moles removed from her back, a nurse told her that she’d have to change three bandages every day for 30 days.
“I just looked at her like she’s crazy, and she paused and asked me if I understood. I looked at her and said, ‘Yes, I understand it. I’m just wondering how I’m going to train my cat to do this, because I live alone,’” Betsy recalled.
Betsy* is one of many people in this situation.
People living alone accounted for more than 28 percent of all U.S. households in 2016, up from 17 percent in 1970, according to the U.S. Census Bureau.
Yet U.S. law and healthcare systems still tend to assume spouses or other family members will help us when we’re sick.
The good news is that nonfamily members — friends, neighbors, co-workers — are stepping up when needed.
In a 2017 poll of 1,864 American adults sponsored by the nonprofit Center for American Progress, 32 percent said they had taken time from work to care for a friend.
Among people with disabilities and people who don’t identify as heterosexual, 42 percent have helped a friend cope with medical issues.
Who will take you home?
Think of all the moments modern medical care requires patients to have helpers.
Law requires hospitals not to send you home alone if your functioning has been affected by anesthesia.
If you need to stay overnight after a procedure, according to the surgeon and author Dr. Atul Gawande, you should bring someone to watch over you.
Hospitals are also increasingly sending patients home from surgery when they still need care.
But what if you don’t have a spouse or other family member nearby to help?
Some 45 percent of all American adults — that’s more than 110 million people — were single in 2016. Most of them had never been married.
The typical American adult will spend more time single than married over a lifetime, usually living alone.
Singles adjust in a variety of ways.
Bella DePaulo, a psychologist, singles advocate, and author of “How We Live Now: Redefining Home and Family in the 21st Century,” reported hearing of people who delay procedures until a relative can fly in from elsewhere.
Others hire drivers and ask them to describe themselves as friends to hospital staff.
If they need care at home, they may lie about their arrangements to hospital staff or ask to stay in the hospital longer.
They may also hire helpers or look for assistance from volunteers or friends.
Telling employers who you’re helping
When he needed someone to take him home from a colonoscopy, Patrick* ended up asking a student at the college where he works.
“This is not my hometown,” he explained. “The few friends I have made have jobs and will only miss work for their spouses or children.”
Under federal law, your employer isn’t required to let you take sick days to assist a friend, or even your aunt.
But the Family and Medical Leave Act requires that businesses with more than 50 employees give most employees up to 12 weeks of unpaid, job-protected leave each year when they’re ill, need to care for the birth and care of a newborn or adoptive or foster child, or to care for an “immediate family member (spouse, child, or parent) with a serious health condition.”
But around the country, a handful of states and cities have passed laws that allow employees to use sick days to care for people who don’t fit the definition of an “immediate family member.”
“We’ve been seeing a positive trend in the last two and three years of new laws with broader definition of family,” Preston Van Vliet, a staffer at the nonprofits Family Values @ Work and A Better Balance, told Heathline. “We emphasize that people can care for people they love, their chosen family, regardless of whether they’re legally or biologically related.”
“People don’t know how prevalent it is to be single or live with nonfamily members,” he explained.
Los Angeles, New York, and Chicago — the nation’s three most populous cities — let workers decide who they consider family.
Similarly, broad rules apply in Austin, Texas; St. Paul, Minnesota; Cook County, Illinois; and Arizona and Rhode Island.
Other areas have expanded the definition beyond “immediate family member,” but not as broadly. It might include grandparents, for example.
Federal workers and contractors legally can take time for friends.
During the Vietnam War, a 1969 regulation that allowed employees to take leave for military funerals acknowledged the “equivalent” of family relationships.
That idea was extended to sick time in 1994 and to many contractors by President Obama in 2015.
You don’t get extra sick days for this purpose. But you don’t have to worry that you’re breaking the rules if you pick up a roommate at the hospital.
Getting information from doctors and hospitals
You can give anyone a “healthcare proxy” authorizing them to receive information and make certain decisions.
When Joan DelFattore had a six-hour liver operation, she had given one person a proxy and also signed the hospital’s release form naming people who could receive updates on her condition.
Despite those moves, a staff member repeatedly said she could only give information to immediate family. This was a violation of law and hospital policy.
“I don’t think we need new laws or policies so much as better training and systems to ensure that all staff follow existing policies,” she told Heathline.
DelFattore advises that before you’re admitted, speak to a patient care representative or a hospital social worker, and ask them to help you make sure your support people are recognized.
“My sense is that a broader sense of who counts as significant is slipping into our awareness, but not as quickly or as pervasively as it should,” DePaulo told Heathline.
Some places have community volunteers who can help.
The Village movement offers services to seniors choosing to stay in their homes.
Elderhelpers.org matches volunteers to elders in need.
Do singles get different medical care?
Some healthcare providers assume that all women want to marry and have children.
As Sandy* noted, “I’m not allowed to get my tubes tied or, even though I’ve had some chick cancer, have a hysterectomy. Because even though I’m 38, my imaginary future husband might want kids.”
At a gynecological exam, a nurse asked Nicky* what birth control she used.
“I said none. She stopped writing in my chart, looked at me and said, ‘Nothing?’ I said no. Then she thought to ask if I was active, which I’m not. Why is it assumed women are always sexually active? Do men get asked this when they go for checkups?” Nicky told Healthline.
Doctors may also assume single people don’t have enough support to handle aggressive treatment.
DelFattore tells a tale of seeing an oncologist for a quick-moving, deadly cancer. When he heard she was single, he was concerned about how she would manage her treatment.
She told him, “I’ve got friends and extended family.”
Still, she says, he offered her only one mild drug, saying that he wouldn’t risk the side effects of something stronger for “someone in your situation.”
She went to a different doctor, who gave her a more aggressive drug. She survived.
Sylvia Organ, who survived thyroid cancer while single, worries about this kind of bias against singles.
When she received radiation treatment, she was told her radiation could affect someone else.
Her instructions: Don’t drive or take public transportation or a taxi to get home. Instead, ask someone to help you who accepts the risk.
Organ asked her friends, but no one could take time from work. So she lied to the hospital staff and took a cab.
She spent the next five days alone in her room because the hospital had said she could irradiate people and pets for that long. She had stocked up on food and went to the kitchen when her roommates were away.
“I worry that I wouldn’t be offered all the options, just the ones they think are easiest,” she told Heathline. “If I had a diagnosis, I’d ask the provider, ‘Would you be proposing different treatment if I wasn’t single?’”
Editor’s note: Names with an asterisk (*) have been changed.