Planning for frailty and future health needs

For all of us, the future will include a period — perhaps brief, perhaps extended — of frailty and physical decline. No one is immune. Broccoli and advice from relatives are things we apparently like to avoid, and clearly many people have added old-age planning to that list. I hope you don’t.

I would like to scare the stuffing out of you today but will try to lighten the tone enough so that you don’t kill the messenger. Still, I want you to feel a compelling need to spend just an hour or maybe two doing some planning for the future.

Historically, you would have relied on loved ones to look after you. Now you are increasingly likely to depend on the kindness of strangers.

Because when the inevitable day of your own frailty arrives, you will no longer be able to take care of yourself. Historically, you would have relied on family members and other loved ones to look after you. Now you are increasingly likely to find yourself depending quite literally on the kindness of strangers. These people will work in the health care business and many of them will be paid caregivers, either in your home or a nursing home or other type of assisted care facility.

Looking at the rising numbers of older citizens who will need care, and the shrinking numbers of younger people available to care for them, it has been clear for a long time that we are heading toward a serious shortage of caregivers. Changes in and fragmentation of the American family have made things worse.

These trends will put pressure on the price and quality of caregiving. They don’t come at a particularly great time for the companies that operate nursing homes, other care facilities and at-home caregiver agencies. The pandemic, of course, has made things much, much worse.

The cost of care has been steadily rising and can top $100,000 a year at some nursing homes. Medicare does not cover non-medical care, so consumers will increasingly be looking at big out-of-pocket expenses.

The quality of care is also a growing concern. Regular reports appear documenting people being abused by staffers at nursing homes, including unnecessary use of antipsychotic drugs. Getting qualified in-home care has become harder as well, including getting Medicare to pay for this very clearly approved benefit.