None of us is getting any younger, yet many of us prefer to ignore that fact.
“We tend to think of aging as something sad that old people do, when in fact we are aging from the minute we are born,” says Ashton Applewhite, author of the book This Chair Rocks: A Manifesto Against Ageism.
As a result, many of us don’t prepare for the realities of getting old: Less than half of American adults have a will, and many underestimate both the cost of long-term care and the likelihood that they’ll need it. About seven in 10 people need care at some point as they age, and that care is expensive: around $60,000 a year for a full-time home health aide, or more than $94,000 for a semi-private room in a nursing home. Moreover, falling birth rates mean that, in the years to come, America’s elderly will have fewer family members than ever to help them, making advance planning all the more important.
Experts suggest that people get legal documents like a power of attorney and living will in place by their 50s, but it’s never too early to start thinking about your later years, or to make preparations so your loved ones can follow your wishes.
Below are a few steps you can take whether you’re 25 or 95 to make it more likely that you can grow old the way you want to. You don’t have to have all of these items in place right away, but getting started can give you peace of mind about the future and make life easier for you and your loved ones later on. “Aging is living,” Applewhite says; the sooner we embrace that, the better off we’ll be.
Talk to your loved ones
Planning for aging isn’t just an individual task. Experts and current and former caregivers agree it’s important to involve your loved ones — children, partners, friends, and anyone who might be part of your support team as you get older. “Talk about how you envision wanting to age,” says Susan Sterner, a caregiver whose father has dementia. “How do you want to be taken care of? Who do you want to be near?”
Sterner and her husband have already talked to their children, who are young adults, about their advance directives. “We actually had a little dinner with our kids where we dressed up and made fancy food and we talked about things like wills,” Sterner said. She also advises having “an open, honest conversation about health and health care with your kids as you’re raising them, so they feel like they can also bring it up.”
Frank conversations are especially important if you think you might need or want your loved ones to help with your long-term care — a likely scenario, given that the majority of elder care is provided by family members. Sometimes people worry that they will be a burden on their family members by asking for help, says Regina Koepp, a clinical geropsychologist and the founder of the Center for Mental Health & Aging. But “if you get your care needs met in a timely fashion and well enough,” she says, “it actually reduces more care needs down the road” because chronic conditions can become worse if they’re not properly treated.
Another way to reduce feelings of guilt around asking for help is “to find ways to contribute even when you’re receiving care,” Koepp says. This could be as simple as being clear with your loved ones about your medical conditions. “There’s a lot of strained family relationships because family members don’t have all of the information that the older person has about their medical needs.”
You can also remind yourself that needing support is by no means unique to older ages. “We are interdependent from birth to death,” says Applewhite. “If you get sick, whatever age you happen to be, you’re going to need help. If I have a baby, I need help. If I break my foot, I need help. If I go broke, I need help. We need help lifelong.”
Set up advance directives
Advance directives are legal documents that allow you to set forth your wishes in case you become incapacitated. The following four types are especially important, says Eric Einhart, treasurer of the Executive Committee of the National Academy of Elder Law Attorneys:
- A power of attorney allows you to name someone else, such as a family member or friend, to handle your legal and financial affairs if you become incapacitated. You can give that person as much or as little authority as you want — for example, you could grant them the ability to do a specific task, like selling your home. However, Einhart suggests that you make the power of attorney as broad as possible to cover any circumstances that might come up, and choose someone you trust. A power of attorney should also be updated regularly because banks and brokerage firms won’t necessarily recognize the document’s validity if it’s several decades old. “You want the latest and the greatest,” Einhart says.
- A health care proxy allows you to name someone to make medical decisions on your behalf if you can no longer do so. That person should be acting on your wishes, Einhart said, so it’s important to talk beforehand about any health care decisions you feel strongly about, including your preferences around palliative and end-of-life care. It’s important to choose someone who has “the time, energy, and the wherewithal to handle the job” in the event it’s necessary, Einhart says.
- A HIPAA authorization allows someone else to access your medical records. This document can be helpful if a family member or another trusted person needs to handle your medical care or deal with your health insurance, Einhart says.
- A living will spells out your wishes around the end of your life, including whether or not you want to be on life support, and what treatments you want or don’t want in an emergency situation if you can’t communicate. Uncomfortable as it may be, it’s helpful to consider the different circumstances under which someone might have to consult your living will. The way we view medical decisions might change depending on the context and depending on how much and what quality of life we might expect.
All of these documents should be prepared by a professional; you can find one through the National Academy of Elder Law Attorneys (NAELA). That preparation can cost anywhere from hundreds to thousands of dollars, but you can also find pro bono legal services through your state or local bar association.
However you get it done, having advance directives can ensure your wishes are respected and help you and your loved ones avoid a stressful situation in the future. “If you don’t have those documents in place, you don’t have the legal structures that would allow someone else that you choose to make decisions for you,” Einhart said. “You can have a judge who you’ve never met before appoint somebody that is a complete stranger to make a decision for you.”
Make a will
Unlike a living will, a last will and testament (often simply called a will) spells out what you want to happen to your assets after you die. State laws typically establish defaults for how property is distributed after death, but “you may have different ideas in mind of who should get what,” Einhart says, and a will is crucial for making sure those are honored.
You need a will even if you don’t have a lot of money, Einhart says. The document allows you to designate who you want to be in charge of handling your affairs when you die and how any debts will be paid back. If you have children, it also allows you to appoint a guardian for them in the event of your death.
You can find an attorney to prepare a will through NAELA, or, if your finances are simple, you can use an online will maker, which can range in cost from free to $299, according to the National Council on Aging.
In addition to a will and advance directives, some experts recommend you put together a “life file” that also contains important passwords, banking information, and instructions for your possessions. The advocacy group Death With Dignity has a checklist for assembling a life file containing these items and more.
Make a financial plan for long-term care
Medicare doesn’t pay for most long-term care, and Medicaid only covers such care once you’ve exhausted all your assets. That means that most people who need assistance as they age will have to pay for at least some of it out of pocket. Even if you hope to be cared for by family members, there are expenses attached — as of 2021, family caregivers spent an average of $7,242 per year on costs related to care.
Buying long-term care insurance is one option, but it can be very expensive; some states have established or are looking to start public programs to lower the cost. You can also contact your local area agency on aging, a county-level organization that can help you determine what types of assistance you might qualify for. Your primary care doctor, if you have one, may also be able to put you in touch with a social worker who can help. If talking to your loved ones about money and long-term care is difficult or awkward, a social worker can also help facilitate those conversations, Koepp says.
An elder law attorney can also often share information about long-term care and other services, because they have experience helping clients age “in a position where they are comfortable and have maintained their dignity,” Einhart said. “We’re all going to get old — you just want to do it with a plan.”
Clarification, October 24, 11 am ET: For clarity, we’ve updated the cost of home health care and nursing home care to reflect 2021 numbers.