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New Year’s Resolution: Have Those Hard Conversations about Long-Term Care

The New Year offers us the opportunity to start anew. We make plans to hit the gym, sleep more, and eat healthier. We commit to spending more time with family and friends rather than merely clicking likes and posting comments on Facebook or sending emojis via text. We resolve to save more and stress less.  Many of us even create plans with specific strategies to increase the odds we’ll be successful in reaching our goals.

Yet there are those areas of our lives we prefer not to think about. For millions of people, planning for the possibility of long-term care—that is, help with basic life functions like eating, bathing, dressing, managing medications and finances—is one thing we tend to avoid. In fact, we avoid even discussing the topic, and that goes both for care for ourselves as well as for loved ones. According to a survey by The AP-NORC Center, more than two-thirds of older adults have done little to no planning for their long-term care needs. In short, we are in denial, so we’re not preparing.

I know how hard broaching the topic can be. Some months ago, I was chatting with my aunt while watching one of her favorite TV shows. My aunt has been by my side and has borne witness to all my major milestones in life. From school plays and college graduations to my wedding and birth of my two kids, she’s been right there.

In the course of our casual chat, she suddenly got serious and turned to me. “Jean, I’m getting older,” she said. “We need a plan in place in the event I need help with taking care of myself.”

Given my professional background, you’d think I would have been eager to have this conversation. I’ll be honest: that was hardly the case. It’s one thing when you’re in your comfortable work realm of research and Power Point presentations; it’s another when the person who might someday need care is your beloved aunt. So, truth be told, on that day, I avoided the topic. She’s relatively healthy, I rationalized to myself. There’s plenty of time for that.

About 70 percent of people age 65 and older will need at least some form of long-term care, and 50 percent will need extensive services as they age.  I know, based on a recent report from Genworth, that the typical cost for a private room in a nursing home is about $100,000 a year. I am well aware of the fact that the average cost of assisted living is around $45,000, and 30 hours of home-care a week will run $35,000 a year. The latest edition of the AARP Scorecard, which examines the performance of long-term services and supports (LTSS) by state, found that the cost of LTSS is much higher than what even middle-income families can afford. In fact, in every state, the typical price of a year of nursing home care was twice as much as the typical household income among people 65 and older.

Despite all of this, I was not ready to face reality when it came to my aunt. The fear of the future and unknowns drove my denial. I suspect I am not alone and that many of you can relate to these feelings when you think of your own family.

Yet stories unfold every single day of families who never put a long-term care plan in place and are experiencing great challenges as a result. I surely don’t want to wait for crisis with my aunt to trigger these conversations. So starting this year, things will change. Countless resources and guides, such as AARP’s Prepare to Care Guide, are available to help families create a plan based on unique needs and circumstances. Rather than continue to live in denial, it is time to be proactive and face this head on.

There is no better time to start than today. I’m starting the conversation—yes, with my aunt, and with the broader community. Will you join me?


Jean Accius is vice president of livable communities and long-term services and supports for the AARP Public Policy Institute. He works on Medicaid and long-term care issues.







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