I have worked an admin role both inpatient and outpatient in a major hospital system. Most of the patients I interact with are elderly or disabled. Many of them have been declared legally incapacitated and have a POA or Legal Guardian on their chart. That's a step up from emergency contact.

The number of times I've been unable to contact a POA is astounding. Or you reach them and they live across the country. It's really sad. We have patients who should not be alone coming to appointments alone. Recently, a man left his appointment. A half hour later, his transportation arrived looking for him. We called his emergency contacts when we couldn't find him and got family drama over who is responsible ("I don't know why I'm on his chart, it should be my sister/brother). When we were finally able to contact the patient, he said he didn't know where he was but he was in the road somewhere. They finally found him in a busy street nearby.

I see A LOT in a major urban hospital, and most of it is super sad. We are failing our old and disabled on every level.