Should we be planning our deaths?
My father will turn 78 this year, and I've watched his quality of life drop like a rock over the last ten years. It's a story familiar to many Americans. For him it was stage four cancer and stroke, but neither have taken his life. Instead they have taken his autonomy and his happiness, as each day it gets harder and harder for him to navigate his world and communicate with those around him.
America is a competitive place to live in. We love to assign winners and losers to everything, and death is no different. The longer you live you more you've won, while to die at most any age is viewed as some kind of tragedy (despite the fact that, to date, every human has so far lost this game). I am not suggesting life is not good or worth continuing—I'm not that Millennial. But it's a financial planning blog, so what return are we getting for all the time and money spent keeping us alive?
A 2024 JAMA Network Open study of 183 WHO member states found the average person now lives 9.6 years in poor health before death. That gap has been widening since 2000. It's worse for Americans, though. We spend an average of 12.4 years living with disability or sickness, up from 10.9 years in 2000.
That decade is not cheap, either. Here is how long-term care costs affect different wealth classes in America:
Many financial news articles have been written on the "Great Transfer of Wealth" when the Boomers die off, but those numbers are skewed by the ultra-wealthy. For the rest of middle America, end-of-life and long-term care costs will eat a huge portion of their wealth before it ever makes it to their heirs. In other words, many Americans will spend down a lifetime of savings to extend years often spent in disability and sickness. Often they will only afford it on the estimated $600 billion in economic value provided by unpaid family caregivers.
When my son enters 8th grade next year he will have the option of studying Latin at Madeira High School. Perhaps one day he'll learn the phrase meditare mortem or "rehearse death," attributed to Epicurus. The Stoic philosopher Seneca repeated this advice: "To say this is to tell a person to rehearse his freedom. A person who has learned how to die has unlearned how to be a slave."
70% of Americans report little to no understanding of the concept of palliative care, but in a 2010 New England Journal of Medicine study on lung cancer patients, those who received palliative care alongside standard treatment suffered fewer symptoms of depression and even outlived those under more aggressive care. Hospice is often lauded as one of the most meaningful and beneficial parts of American healthcare, but median hospice care enrollment in 2024 was only 19 days before death when it's own model of care is to support those with up to six months of life expectancy. Medicare pays a lot for procedures, scans and hospital beds, but there is data that suggests a practiced acceptance of death can lead to better quality of life (and maybe even more of it).
As a financial advisor and CFP®, I help clients understand the risks of aging and strategize how to deal with them as they come. This could be through self-funding for care, long-term care insurance or a hybrid policy, spousal asset transfers or irrevocable trusts, or even Medicaid-compliant annuities. But I also hope we as a society can talk more openly about death in order to broaden our choices and improve the outcomes. As of this writing, 13 states and the District of Columbia allow medical aid in dying. Ohio, where my Dad lives, is not one of them. It will be difficult for his generation, and change may come too late for many Boomers. But if my generation can "rehearse death" even a little, first in our hearts and then with each other, it might be an easier conversation to one day have with my own kids.
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There is but one chain holding us in fetters, and that is our love of life. There is no need to cast this love out altogether, but it does need to be lessened somewhat so that, in event of circumstances ever demanding this, nothing may stand in the way of our being prepared to do at once what we must do at some time or other.
-Secena in Moral Letter XXVI to his friend, Lucilius
