Why is it so hard to have “the conversation” about long-term care?

Long-term care planning isn’t only about money and finances. It is primarily a family affair, as so many family members—the spouse or partner, the adult children, and of course the person needing care—are affected by decisions that are (or aren’t) made along the way.

Why ‘The Conversation’ is needed

Why is it so hard, then, to sit down with family members or with clients and talk through what would happen if a health diagnosis occurred that resulted in the need for extended care? It’s not easy to bring up topics that are unpleasant and downright scary, and many believe that they will die never requiring care. Yet we know that the need for long-term care increases with age and that debilitating accidents can happen at anytime in life. And if extended care is needed, it can derail an otherwise solid financial plan.

Most Boomers have been—or will be—caregivers for parents or a spouse or have had friends or other family members who are going through that heart-wrenching experience. How wonderful it would be if Boomer parents took the care planning initiative so that their children wouldn’t have the burden of giving up their own family life and careers to be caregivers. It would be a happier situation for an adult child to focus on their being their parent’s loving companion, helper and protector, not the person delivering (and possibly paying for) day to day care. And for those Boomers who will age without family members present, having a conversation about long-term care planning becomes even more important.

Ironically most people want to have “the conversation” but haven’t gotten around to it. According to a recent survey, 92% of people say that talking with their loved ones about end of life care is important, but only 32% have actually done it.¹ One reason why they don’t, the survey finds, is that they don’t want to upset their loved ones, but 53% state they would be relieved if a loved one took the initiative.

The timing

There may never be a perfect time to start “the conversation” with the family but it’s important to do it when the participants are in good health and can be objective about it. It isn’t a good idea to spring the discussion on parents or on adult children without warning or without some preparation. Taking the time in advance to think through the questions and what really matters helps to make it successful. Also thinking about where the conversation should take place and in what context.

For many, setting the stage and suggesting a time and place for the discussion in advance is the way to go. During the holidays or other times when families are together might offer that opportunity. There are some resources on the web that might be helpful to all involved. The conversation is essentially about values and about preparing the family emotionally, physically and financially should something happen. It probably won’t take place all at once, so a goal is to open the channels of communication for more discussion as plans change and life moves on.

The discussion

“The conversation” on long-term care has a number of layers to it. The easiest way to start, perhaps, is to talk with family members about legally binding documents medical advance directives such as a living will and a durable power of attorney for healthcare; whether they have been executed, and where they are stored. A list of key contacts and information on who has legal and financial responsibility is part of the discussion and an easy, unemotional way to break the ice.

There is more to “the conversation,” of course. The heart of it is about what a person really wants throughout the aging continuum and at the end of life. It’s both personal and financial. And it impacts the entire family, both young and old. The care planning discussion can eventually move to a discussion end of life, death and the impact on the survivors.

When planning for long term care, here’s a sample of topics that might be addressed in “the conversation.”

• Identifying the primary family caregivers
• Thoughts on the expectations (and realities) about the ability of a family member to provide care
• Living arrangement preferences, and how to make it possible to remain at home
• Paying for care, and how much money would be needed
• Combining family care, paid care and community resources as a way to stay at home?

For end-of-life planning, some discussion points might be

• Preferences about how much medical information should be shared with the patient and the family
• Attitudes toward continued medical treatment vs. quality of life
• Intention about residential or in-home hospice

Role of the Financial Advisor

Family members aren’t the only ones who avoid a discussion on long-term care. According to a survey of widows and widowers, only 18% of widows were receiving advice from their advisors on long-term care; the primary focus was on financial planning, investing and retirement income. And almost the same percentage of widows wished their advisor would talk with them about long-term care but it hadn’t happened.²

A financial advisor can play a key role by starting the long-term care conversation in the context of financial planning and then encourage their clients to go a step further with the family. They will be doing a great service for so many of us who avoid “the conversation” with adult children and parents, and put it off for another day. And by recommending insurance for long-term care needs and for end of life, advisors will rest easy knowing they have contributed to a more secure retirement for their clients.

Closing thoughts

My parents gave me the greatest gift. They were planners and spoke to me when they were in their late 60s about what they were planning for long-term care and end of life. In truth, they were the ones who started ‘the conversation,’ not me. I thought of them as invincible and healthy, and I realize I didn’t want to talk about the inevitable. They were the ones who knew it would give us all peace of mind to sit down and talk.

They let me know that their preference was to move into a Continuing Care Retirement Community (CCRC) when they reached age 75, making sure that they had care for life and resources to pay for supplemental care if needed. (They did in fact move in their late 70s but put their names on the waiting list earlier). They gave me the contact names for their attorney, their financial advisor, and those to call in an emergency since my husband and I did not live nearby. I had copies of their advance directives and knew where their other papers were stored. And they set up and paid for pre-arranged funerals, complete with memorial service instructions and their wishes for their final remains.

Not everyone is a planner so it is up to all of us – financial advisors, adult children and aging parents – to get ahead of a long-term care curve. Plunge into “the conversation. You will never know if it will work until you put your toe in the water.