I am an elder law attorney. I practice a type of law that often involves helping people pay for long-term care. Since I’m often intimately involved in the process of determining where an older adult will live, I consider myself also in the housing business.
An older adult’s health problem almost always creates a housing problem when he or she can’t return home. That’s the point when people usually find their way to me, so the topic of housing is where I want to start in this deep dive into what’s wrong with the way Americans plan for retirement.
For most Americans, housing is the single most under-planned issue. This creates a pressing planning opportunity, yet there is no professional group who is discussing this issue with their clients in any actionable way. Physicians don’t discuss this. Financial advisors don’t discuss this. Realtors don’t discuss this. Neither do lawyers .
People aren’t talking about how to avoid a nursing home with the professionals they are relying on to help them plan for retirement, yet about 90 percent of Americans say they want to remain at home [i] as they age. Information published by Stanford University shows that even though well over 80 percent of the people polled expressed a strong preference to be able to die at home, less than 30 percent of Americans actually get to experience that ending.[ii] Around 70 percent of all Americans will die in either hospitals, convalescent homes, nursing homes, assisted living facilities, adult family homes or boarding homes—someplace other than where they wanted to be during their last moment on earth.
I also think that most Americans understand that though they may want to stay home, they may not be able to do if they become incapacitated and their care needs cannot be met at home. In my opinion, there’s a collective sense of resignation; a belief that nothing can be done. Nobody wants to move to a care facility, yet most accept that this is likely their future. That’s just the way it is.
Why Aren’t More Americans Focused on How to Avoid a Nursing Home?
Nowhere is my desire for answers stronger than on the subject of housing. Part of my relentlessness comes from my radically different cultural perspective on the aging issue. I grew up in India in a large home with most of my extended family under the same roof. I lived with my grandparents, and I saw them dealing with issues similar to those we deal with in the U.S. As my grandparents grew older, they developed the same issues that older adults develop here in America. However, despite the incontinence, their inability to get around, and their inability to care for themselves, in India, we didn’t put them in a nursing home. The family manages their elderly loved ones’ needs at home by bringing in outside help.
As I worked with clients in my elder law practice, I started paying close attention to the housing choices they were given. I started watching where they ended up. For most, their final destination was a nursing home, a memory care facility, or a similar setting.
Why were none of my elder law colleagues talking about this? Why did no one else view this as a problem? Why did I see things differently?
The answer lies in my perspective.
My elder law colleagues had the American perspective. My perspective was that of a person born in India, a place where there were no nursing homes.
This differing perspective has made things interesting for me, to say the least. Thanks to my different perspective, I push back. I don’t always quietly accept the status quo. I make waves.
In the process, people have drawn all sorts of conclusions about me. Among other things, I’ve been accused of being opposed to putting anyone in a nursing home at any time for any reason.
While that’s not true, I can’t hide my bias toward caring for elderly loved ones in the home if it’s at all possible.
During a legal conference in 2021, one of the elder law attorneys gave a presentation that included a story about moving his frail elderly father into his home. This is what we elder law attorneys should do, I remember thinking as I listened to him speak. Then, the attorney said that his father needed too much care, so he placed him in a facility. Though this attorney discussed in detail how difficult this decision was, he failed to mention whether his dad went willingly.
I thought to myself, “You’re normalizing something that is abnormal to every older human being.”
Was I the only one having these thoughts? There was more than enough empathy in the room for this attorney, and almost none for his father. The general reaction after this attorney’s presentation was, “You poor guy. You did so much. You did the right thing.”
Even elder law attorneys have normalized institutional care in America, I thought. It didn’t sit well with me.
I couldn’t find any empathy for this attorney. After his presentation, I tracked him down.
“This is a cultural issue,” I said. “Elder law attorneys are the ones people should be able to look up to when it comes to finding ways to avoid institutional care. We should be setting a higher standard. We should be the ones saying that institutional care is not normal, yet we make it normal.”
Several years ago, I was at a retreat with a group of attorneys. Between sessions, I went out for a walk with an attorney whom I greatly respect.
“Why do you rail so much against nursing homes?” this attorney asked me. “I just put my mom in a nursing home. I couldn’t take care of her. What’s wrong with that?”
“Oh, there’s nothing wrong with it,” I replied. “It’s fine. The only thing I worry about is when your time comes to go to the nursing home, will you go willingly, or will you fight it?”
She never did answer my question.
Aging in an institution is now considered the norm, even by elder law attorneys, yet if you ask any older adult where they want to live as they age, no one replies that they hope to end up in an institution.
If the professionals charged with advising families can’t offer a pathway to a different housing option, who can blame the general population for thinking nursing home care is inevitable?
Staying Healthy is How to Avoid a Nursing Home
The day your health fails is a bad day. You have a heart attack. You cause an accident. You start a fire. You’re wandering. You can no longer take care of yourself. Or you have a stroke like Susie did.
That day is probably one of the worst days of your life.
If your plan for housing is “I want to stay in my home as long as I can, and when I can’t, I will move,” you’re not going to like how things turn out.
Here’s how it usually plays out.
On the day your health fails, you will likely end up in an institution of some kind, a place that’s the opposite of home. You won’t know anyone. You won’t know where anything is. Everyone’s going to be telling you what to do. You will have zero privacy and even less control over your life.
Your misery will be a thousand times worse than it would be if you were dealing with your health issue at home.
After decades of practicing law, I can say with total confidence that what sounds logical today is the exact opposite of what you’ll be doing the day that you realize that home is no longer an option.
You will fight this. Over the years, I have seen patterns emerge. One that repeats itself over and over is this: very few people willingly embrace institutional care.
When we say this:
I want to stay in my house as long as I can…
What we really mean is this:
When my health fails, I want the care to come to me without creating burdens for my family or going broke in the process.
When the health crisis arrives, your vague hope to “stay at home until you can’t” turns into a one-way trip to the nursing home because you didn’t think through the mechanics of what it would take for your family to bring you back home after the crisis was over.
Is it possible to avoid being forced into institutional care during a health crisis? Yes! Where traditional retirement planning is silent on the housing issue, the LifePlanning approach to retirement planning gives you a way to make your hope come true.
Learn how to create your own LifePlan at AgingOptions.
[i] Joanne Binette, “2021 Home and Community Preference Survey: A National Survey of Adults 18–Plus,” Livable Communities, AARP Research, November 2021, https://doi.org/10.26419/res.00479.001.
[ii] Amos Bailey and VJ Periyakoil, “Where do Americans die?” Multi-cultural Palliative Care, Stanford School of Medicine, accessed August 15, 2022, https://palliative.stanford.edu/home-hospice-home-care-of-the-dying-patient/where-do-americans-die/.
From Your Retirement: Dream or Disaster? by Rajiv Nagaich, published by Hasmark Publishing. Copyright© by Rajiv Nagaich 2023.