What is your most important asset as you enter retirement? Is it your home? Is it your financial portfolio? Is it your long-term care policy? Is it your close-knit family?
No, no, no, and no.
Your most important asset in retirement will prove to be your health.
Your ability to live your retirement dreams is 100 percent dependent on your health status. Without your health, you won’t be sipping wine in Napa, biking in Tuscany, parasailing in the Mediterranean, or playing pickup basketball with your grandkids.
The greatest wealth is health, as the saying goes.
As you’ve already seen, your retirement plan fails when one of these three things happens:
- You’re forced to move into institutional care
- You lose money paying for unexpected long-term care costs
- You become a burden on your family
Nearly every case of retirement plan failure began when the older adult’s health failed.
Why Is a Lawyer Talking about Healthcare in Retirement?
In case you’re wondering, I’m not a doctor. I don’t pretend to be one.
So, why am I talking about healthcare in retirement?
Failing health isn’t a legal problem. However, failing health causes legal problems. Likewise, failing health causes financial problems, and failing health causes housing problems.
As I looked into the many cases where retirement plans failed, they always started with an illness of some kind. Ask yourself this question: Who do you not find in a nursing home?
Failing health is the root cause of retirement plan failure.
Failing health is the falling domino that sets into motion the cascade of housing , financial , legal, and family problems that leave older adults broke, a burden on others, and stuck in a nursing home.
My reason for talking about health is simple. I want to help you minimize your risk of retirement plan failure, which means prolonging your independence for as long as possible.
As long as you are healthy and can live independently, you don’t have to worry about going to a nursing home. That’s why I’m talking about health.
The Problem with Healthcare in Retirement
How does the average American plan to address the health needs that may arise during their retirement years?
Traditional planning involves getting the right insurance. You enroll in Medicare when you turn 65, and maybe buy a supplemental insurance plan. You expect this insurance to cover all your health care-related expenses.
This is the mainstream approach. This is how my in-laws Bill and Vivian Wallace planned. It’s how our parents planned. It’s what we are all told to do. The traditional way to plan for your health in retirement is to make sure you have insurance so you can access care after you fall ill.
We all feel safe and secure, certain that America’s vaunted safety net is protecting our health.
Except, simply having a good insurance plan to cover health care costs isn’t the answer, especially if we hope to avoid institutional care.
The problem with focusing on enrolling in Medicare and investing in a supplemental insurance plan, and then identifying the physician who will become your primary care physician is that it is all about accessing medical care after you fall ill. And after you fall ill, you are already halfway to a care facility, a burden, and losing money to uncovered medical and care costs.
A better focus would be to learn to use the health care system NOT to fall ill in the first place. Healthy people don’t end up in care facilities; sick people do. The longer you are healthy, the longer you are not in a care facility, a burden, or losing assets.
Sadly, far too little is done to see that you don’t fall ill in the first place. See the point?
This is the hole you must fill if you want to avoid ending up in institutional care against your wishes.
Why It’s So Important to Choose the Right Healthcare in Retirement
You may even have a doctor you’ve been working with for years, perhaps even decades.
Your primary care physician is likely a board-certified internist or family medicine physician, both specialties that focus on the adult population. Your doctor is familiar with you and your health history. He or she is likely the quarterback of your medical team, supported by various specialists you may see for specific issues.
If you have a great relationship with your primary care doctor and you’ve been seeing him or her for years, your plan is most likely to stick with the same doctor after you’re retired.
That may not be the best move to make.
Though most of us know that older adults end up with certain kinds of conditions not often seen in younger people, few of us give much thought to changing our health care provider as we age.
Think about it. It’s not like our culture doesn’t already offer specialized medical care based on the unique needs of people in certain age groups.
If you’ve had children, I’m reasonably confident that you didn’t take them to your regular internal medicine doctor or family medicine physician. You took them to a pediatrician, because you recognized that the physiology of children under the age of 18 is different than that of the rest of the population. Treatments and medications that are good for adults may not be appropriate for children.
The same applies to older adults. The physiology of people over the age of 70 is different than that of the rest of the population.51 Medication that worked well for you at 30, 40, or 50, may not work so well when you’re 70, 80, or 90. Problems with medication could be the reason why you start exhibiting signs of dementia without having dementia.
Age isn’t the only issue. When you look at children across the board, they are all very similar. They are growing and developing. They are curious and eager to learn. As we move into our later years, however, these similarities decrease. One 65-year-old might have significant memory loss and be living in a nursing home. Another 65-year-old might still be healthy, working, and living an active life. A one-size- fits-all approach to health care for older adults doesn’t take these differences into account.
How many times have you heard your health insurance company, your health insurance agent, or even your doctor tell you that if you’re over the age of 70, you should be working with a physician who specializes in the care of older adults?
I know the answer to that question. It’s precious little beyond an admonishment to lose weight, exercise, and eat better.
If you want to avoid the nursing home, working with a doctor who specializes in the care of older adults can make a real difference. A research study led by physician Chad Boult from the University of Minnesota backs this up.53
Dr. Boult focused a part of this study on 568 retirees, all over the age of 70. This group included individuals who, in his opinion, faced a high probability of experiencing a decline in their health in the near term. He divided this group into two segments. One group was directed to continue seeing their regular doctors, which included internal medicine, family medicine doctors, and general practice physicians. The other group was assigned to see a team of specialists.
Eighteen months after the study began, Dr. Boult looked at the results. Ten percent of the people in both groups had died. The people who were seeing specialists weren’t living longer.
Then Dr. Boult noticed something else. People who were seeing specialists were 50 percent less likely to be dealing with depression. They were 40 percent less likely to need home health and homecare services. They suffered 33 percent less chronic illness and disability.
Let me repeat: those in the group who saw the team of specialists were 40 percent less likely to need home health and homecare compared to the group who was seeing internal medicine physicians or family medicine practitioners.
What does life look like when you don’t need home care or home health? Nowhere close to a nursing home; that is what life looks like.
The “specialists” in the study who were able to generate the impressive results were board-certified geriatricians, otherwise known as geriatric care physicians.
If you’ve never heard of this specialty, you’re not alone.
Have you informed your insurance company that you will only pay them your hard-earned money by way of insurance premiums if they can offer a board-certified geriatrician for you to choose as your primary care provider?
Probably not. That’s not how most of us buy insurance.
Traditional Health Planning Isn’t Proactive Enough
As I investigated how planning for health in retirement can either help or hinder your ability to stay out of the nursing home, not lose money to long-term care costs, and not become a burden, several realities became clear.
The way Americans plan for health during retirement isn’t working. Signing up for Medicare when you’re 65 isn’t enough. Going to the doctor when you get sick isn’t enough. This reactive approach to managing your health overlooks the simple fact that healthy people don’t end up in nursing homes. Working with the same doctor when you’re 70 that you did when you were 40 isn’t necessarily the best idea. These are just a few of the challenges of planning for healthcare for retirement that I discuss in my book Your Retirement: Dream or Disaster.
How do you get what you need from a system that is more about “sick care” than “health care?”
If you are serious about not ending up in the nursing home, not going broke, and not becoming a burden as you age, you must start by addressing the root cause. Good health is your most important asset.
Is it possible to get what you need from a system that is more about “sick care” than “health care?” Yes! Where traditional retirement planning is silent on the issue of healthcare, the LifePlanning approach to retirement planning gives you a way to preserve your most precious asset—your health—so you’ll avoid or greatly postpone the need for long-term care.
From Your Retirement: Dream or Disaster? by Rajiv Nagaich, published by Hasmark Publishing. Copyright© by Rajiv Nagaich 2023.
 Amy Jamieson, “‘Medication Fog’: What It Is and How It Can Cause Dementia-Like Symptoms,” Health News, Healthline, March 14, 2020, https:// www.healthline.com/health-news/medication-fog-can-produce-dementia-like- symptoms-in-seniors.
 Chad Boult et al., “A Randomized Clinical Trial of Outpatient Geriatric Evaluation and Management,” Journal of the American Geriatrics Society 49, no. 4 (April 2001): 351–359, https://doi.org/10.1046/j.1532-5415.2001.49076.x.