Talking About Old Age, Infirmity and Death
Old age, disability and death: not exactly scintillating conversation topics. Yet, if you are over 30, chances are that, in the past month, you have had a conversation with someone about old age or supporting a loved-one with age-related issues.
Perhaps you discussed signs of deteriorating health; trips to the emergency room; concern about living independently; red-tape in managing financial issues; or difficulties in finding and managing care providers. The emotional, physical and financial strain of caregiving was probably palpable; the desperation for some kind of relief heart-wrenching. Yet, you probably also saw a sense of determination to soldier on borne out of love and a sense of duty. Maybe the person sharing this experience was you.
These types of conversations are too common across our country where over 52M people are over the age of 65. As predictable as the greying of the U.S. population was, we are woefully unprepared to handle the needs of this changing demographic mix.
People who work in the “longevity economy” have long claimed that if we discuss and plan earlier and more comprehensively for the inevitable limitations of old age, we will face fewer aging-related crises and our later years will be far more joyous.
So today, I want to arm you with a set of facts to inspire the necessary conversations and to give you a short-list of questions to help you start or deepen your dialogue with your loved ones.
You will find these useful whether you are the adult child wanting to ensure that your parents are going to be well-taken care of in their later years; or you are the older adult wanting to make sure that your later years are as comfortable as can be for you and your family.
1. We are living longer, but with functional limitations
An average woman turning 65 in 2020 can expect to live to age 84; her male counterpart to age 821. This means that, thanks to advances in medical care and living standards, we are now living so long that we can spend more than a quarter of our life in “retirement”. But this longevity doesn’t come with perfect health. 61% of people aged 65+ report having at least some functional limitation2,3.
2. It is quite likely that we will need some form of long-term care
In fact, someone turning 65 today has almost a 70% chance of needing long-term care services4 for an average of 3 years at some point in their remaining years5.
3. Caregiving takes a toll on family and friends, particularly on women:
If you are helping with housework, chauffeuring to doctors' appointments, supporting personal care, paying the bills or advocating with insurance companies, you are a caregiver6,7. While some caregiving is provided by paid professionals, over 34 million people served as unpaid caregivers in a recent year8.
Sixty percent of these unpaid care providers were women, typically 50-year-olds who spent about 24 hours a week, for almost 4 years, taking care of older relatives, primarily parents or in-laws in their 70s. The majority felt that they had no choice in taking on the caregiving responsibilities8.
This intensity of caregiving takes a huge toll on the careers, health, relationships and finances of the caregivers.
4. Professional care is expensive for most people
The median cost of care in the US is about $50,000 a year for a homemaker or a home health aide, and about $100,000 a year for a nursing home (considerably higher in bigger cities)9. These costs will rise as we face a critical scarcity of labor in this sector10.
At current cost levels, assuming 2 years of homecare and 1 year in a nursing home, long term care can cost $200,000 or more per person. Dementia care is considerably more expensive. And that number doesn’t include the medical insurance premiums, copays, deductibles and other out-of-pocket health costs which can cost an average 65-year-old retired couple $285,000 after tax11.
So a typical 65-year-old couple may need access to over $650,000 to cover medical and long term care costs.
Medicare currently doesn’t cover long term care services. Medicaid does, but 85% of people over 65 don't qualify for it12. We estimate that less than 15% own long-term care insurance12,13. So the vast majority of people will have to pay for their care out-of-pocket and most will not be able to afford it14.
5. Most people want to “age-in-place” but our homes aren’t ready for that
The kind of care we will need and who provides that care depends on where we will be living at the time of needing care.
87% of people over the age of 65 want to age-in-place15,16. The vast majority do that17 until they have one health crisis too many and the family has to frantically search for more appropriate accommodations.
The number, severity and frequency of these crises is exacerbated by housing that isn’t designed for the vision, dexterity, hearing, mobility and cognition challenges that arise in old age. To age in place, it is important to identify what home modifications are needed, determine if those are feasible and affordable, and plan for putting them in place or relocating to a more senior-friendly home before the need arises.
6. Moving into “senior” housing requires planning
There is a range of housing options available for the 55+ population who choose not to age-in-place. These housing options vary in the type of services they provide (e.g. recreational activities, dining, homemaker and personal care services, 24/7 skilled nursing). They also vary in location, cost, quality, admission criteria and occupancy rates.
The healthier you are physically and financially, the easier it will be to secure one of the 3 million18 units in a senior housing and care property19 that meets your needs.
7. Retaining control over your life and finances also requires planning
All of us at some point in our lives - and always at our deaths - need others to step in to make decisions and take actions on our behalf because we can’t. These actions could be as broad-ranging as speaking with our physicians about the kind of treatment we should receive; accessing our bank accounts to pay outstanding bills; or deciding whom to invite to our funeral.
We all also have people we trust, or don’t trust, to take these actions responsibly and in accordance with our wishes.
If you want to live your life and manage your affairs in a certain way, you must both discuss your wishes with your loved ones AND document them in accordance with the laws in your state with the help of an elder law attorney. If you don’t, the default rules of the states will come into play. These could override your preferences and place undue burden on, or cause conflict among, your loved ones who may have different perceptions of your needs and wishes, as well as their own priorities.
That means that people you may not want involved may end up being the ones who decide when to pull the plug on you!
So stop procrastinating and talk to your family early, often and in-depth about old age, disability and death.
To get started, download our "10 Questions to Jump Start Your Confident Aging Plan". Use the link in the email you received from us or subscribe below.
If you would like more personalized guidance, please contact us to learn more about our services.
Definitions and Data Sources:
Life Tables for the US Social Security Area 1900-2100. Actuarial Study No.120. Table 10
Functional limitation is defined by the reported level of difficulty in six functioning domains: seeing (even if wearing glasses), hearing (even if wearing hearing aids), mobility (walking or climbing stairs), communication (understanding or being understood by others), cognition (remembering or concentrating), and self-care (such as washing all over or dressing).
National Center for Health Statistics. Health, United States, 2017. Figure 11
Long-term Care: Services that include medical and non-medical care for people with a chronic illness or disability.
US Department of Health and Human Services. Longtermcare.acl.gov Jul 2019.
Caregiving entails assistance with some combination of Instrumental Activities of Daily Living (IADLs), Activities of Daily Living (ADLs) and coordinating, negotiating and interacting with other professionals and businesses, such as physicians and insurance providers.
IADL is a term used by care professionals to describe activities required for independent living such as housekeeping, money management, medication management, driving and transportation and shopping for necessities. ADL is a term used by care professionals to describe activities primarily related to personal care such as toileting, bathing, dressing, feeding, transferring from position to position and ambulating.
AARP Public Policy Institute and National Alliance for Caregiving. Caregiving in The U.S. 2015 – Focused Look at Caregivers of Adults Age 50+. June 2015.
Genworth. Cost of Care Survey 2018.
Bureau of Labor Statistics. Occupational Outlook Handbook - Home Health Aides and Personal Care Aids. Number of Jobs, 2016 = 2,927,600. United States Census Bureau Quick Facts Population estimate 2018, Persons 65 years and over: 52.43M
Fidelity Retiree Healthcare Cost Estimate
Kaiser Family Foundation: Medicaid’s Role in Nursing Home Care, Jun 2017, Table 1.
NAIC: The State of Long-Term Care Insurance, May 2016, Table 1.
Federal Reserve Bulletin Sept 2017 Vol 103, No.3. Changes in US Family Finances from 2013 to 2016. Table 2. The median net worth of a family whose head-of-household is aged 65+ is about $250,000.
AARP Public Policy Institute: What is Livable? April 24
Aging in place: The ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level. Source: cdc.gov Healthy Places Terminology.
Federal Interagency Forum on Aging Related Statistics: Older Americans 2016: Key Indicators of Well-being, Table 36A.
NIC Investment Guide, Investing in Seniors Housing & Care Properties, FIFTH EDITION, Exhibit 1.a.
Senior Housing and Care Properties includes those providing independent living, assisted living, memory care and nursing care. Units are defined as apartments or nursing home beds in age-restricted properties with at least 25 units/beds that charge market rates for the housing and services offered. These estimates do not include many smaller “board and care” properties.