We’re all grateful for the periods in our lives when our loved ones are happy and healthy, but nothing lasts forever. Sooner or later we will be faced with family members and friends who are beginning their journey to the end of life, just as we eventually will.

This past month, I have come to appreciate the importance of having a plan in place when that time comes, thanks to two different clients in two very different situations.

Maria* is a 72-year-old who has been a client of mine for five years. She never married, has no children, and her only next of kin lives thousands of miles away. Having been diagnosed with Alzheimer’s about four years ago, she has deteriorated significantly over the last six months, ultimately losing the ability to walk. Maria made the difficult decision to enter an assisted living facility that provides case managers, nurses, and aides—but Maria made other arrangements in addition to the assisted living facility: She brought her own Care Manager into the equation. Now she has someone to oversee the various aspects of her care, and that person is doing a phenomenal job.

Care Managers can be useful to anyone, but especially people who don’t have any children or nearby family, like Maria. They have their own companies, they go to the doctor with their clients, they monitor their health, they provide them with a better quality of living—and they have working relationships with all the nearby nursing homes and caregiving agencies, so they can help figure out which is the best one. In essence, they are advocates for people who may not be able to advocate for themselves.

Rose* is another client of mine, around the same age as Maria, similarly in an assisted living facility and no family living anywhere near her. The other night I got a call from her, complaining that she was in pain, uncomfortable, and that no one was paying any attention to her.

As Rose’s Power of Attorney, I had arranged to place her in the facility she called me from. We put her there in anticipation of getting her on Medicaid, but she did not qualify. I worked with her attorney to sell her house, but that all went to paying for the nursing home. Unlike Maria, she doesn’t have a care manager. When I visited her last week, it was devastating. Nobody was paying attention to her, and she could no longer talk. According to what she wrote on a dry-erase board, nobody stays in her room with her. She said they they “run away,” as if she was a hot potato. Luckily, I was able to make the situation somewhat better by hiring 24/7 care for her.

Life is beautiful, but also very complicated. People fall out of touch with loved ones for a variety of reasons—if they even have loved ones. If you or a family member ends up all alone in a nursing home,  you’re (pardon my French!) screwed. The staff at most nursing homes are overwhelmed and simply do not have enough time to give every patient the TLC they deserve. If you are dying they are likely to treat you like a hot potato. Maybe it’s a defense mechanism on their part.

The takeaway to this story of two different journeys is that we all need an advocate to look after us, and who has our best interests at heart.

Do your end-of-life plans include a Care Manager?

*not their actual names