February 12, 2023

How will you afford to spend your final years of life?

My grandmother is a survivor.

She has survived strokes and cancer and the early death of her husband and political upheaval in her homeland and so much more. She is the face of strength and resilience and has been an inspiration to the whole family for decades.

She is, also, aging quickly. She is less vibrant than she once was, with health issues and age making it harder for her to care for herself and to live life as fully as she would like. She currently lives with my parents, who care for her surrounded by a team of caregivers and family who all chip in to make her life as comfortable as possible.

At some point, she will pass on; it is my hope, and most likely hers, that she will die a peaceful death at home surrounded by loved ones. This is not the reality for most people: because of our care infrastructures, its common to die in hospital or some other healthcare setting, even though a recent Kaiser Family Foundation poll found that 71% of Americans (and I assume the number would be similar for Canadians) would prefer to die at home.

Dying at home has become a luxury not many can afford: it often requires the kind of round-the-clock care that is not possible for immediate family members and their life situations, and can be extremely expensive when outside help is brought in. A recent story on WBUR by Sarah Romanelli highlighted this situation quite explicitly: where does one go when they need kind of care that can only be delivered in a healthcare setting or through always-on caregivers?

So, once again, my 89-year-old grandmother was in the hospital with no place to go. She was too weak for rehab and too dependent to return to assisted living. We felt like we were being held hostage by a broken system. Even as a nurse practitioner working in geriatrics, the situation felt impossible to navigate. I spent hours on the phone trying to figure out what the best next steps would be for my grandmother in Boston, all while managing my own patients in New York. At the same time, I was trying to support my mom as she was coming to terms with my grandmother’s declining health.

We ran a lot of numbers and considered several options. Ultimately, we figured out it would be less expensive for my grandmother to rent a one-bedroom apartment in Boston, close to my mom, and hire 24-hour care. That option was less expensive than going to a long-term care facility. And still, the total monthly cost was $16,200: $13,000 a month for the 24-hour care, plus $3,200 to rent the apartment. This is hardly a realistic solution for most people.

If all goes well, my grandmother will go peacefully surrounded by those she loves. We have strong family support and she’s getting the care she needs right now.

Questions about aging and dying are not ones we ask ourselves often in our family; they are questions we need to ask ourselves more often. Sarah Romanelli goes on to ask:

How will you afford to spend your final years of life? How much will your death cost you and your family? Can you afford it?

What happens as my parents age? As I get older? What instructions and structures am I leaving to my family? These are not easy conversations to have, but they are ones that we all need to start thinking about.

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