Navigating the Roadblocks of Long Term Care

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Aging is a reality, and so is long term care. And an undeniable part of that reality is that most people, especially those who live to an advanced age, will need assistance in some aspects of their lives. The Kaiser Family Foundation estimates that 70 percent of Americans 65 and older will eventually need assistance for an average of three years.

Yet what is undeniable in terms of demographics is easily deniable when it comes to our own lives and those of our older family members. A study conducted by the Associated Press-NORC Center for Public Affairs Research in 2013 found that about half of Americans over the age of 40 believe that “almost everyone” is likely to require long-term care at some point, but only a quarter think they themselves will need it.

Why people resist planning long term care

It isn't hard to understand why there is so much resistance to thinking about care for the long term. The usual suspects are societal attitudes that glamorize youth and promote ways to erase signs of aging, denial of mortality, fear of dependence, and other anxieties.

Another reason for resistance to planning is the high cost of long-term care, which is usually described in terms of nursing homes or extensive home care services. Search the Internet for “long-term care” and you will be directed primarily to articles on its financial aspects, written by business writers and offering suggestions about financial planning.

Paying for long-term care is a major topic, but it is by no means the only topic to consider. Sometimes the focus on the high cost is in itself a deterrent to planning. It may seem impossible to save or obtain that much money, so why try? Again, costs are a reality but should not deter planning.

Only about a third (35 percent) of the respondents in the AP-NORC survey cited earlier had saved money to pay for long-term care. Moreover, their understanding of costs was wide of the mark, both in underestimates and overestimates.

Benefits of planning for long term care

Decisions made in a crisis situation are often hasty and ill-considered. This is true in many aspects of life but is particularly problematic when a person's health and well-being are at stake. Not all crises can be avoided, but when they do occur, having a plan in place reduces the likelihood of the most severe unintended consequences.

For example, an important part of a plan is an advance directive. In a medical emergency, if you can't speak for yourself, an advance directive and a healthcare proxy (a person legally authorized to speak for you) can make it more likely that you get the types of treatment you want and, even more difficult to achieve, don't get what you don't want.

Certainly it can be hard to think about this kind of situation, but the alternative is worse. Without some form of advance directive, no one will know what you want or don't want, and it will be unclear who has the authority to speak for you.

If your family can't agree, the decision will be made by strangers, and in the worst-case scenario, there will be litigation. The effort involved in creating an advance directive is minimal compared to the consequences of not having planned ahead.

This example also underscores another benefit of planning — making decisions for yourself instead of leaving them to others or to chance. Having absolute control is unrealistic, and possibly even undesirable, but letting family and other intimates know your values and preferences about long-term care is very important.

Planning allows you to investigate more choices more thoroughly. You will still have hard decisions to make, but you will have the benefit of information, discussion, and time. Still, your planning has to be flexible. Try to build in as many alternatives as possible to allow for changes in health, finances, family situations, and all the other elements that can make a difference.

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