(AP Photo/Dr. Scott M. Lieberman)

 

One of the most important reasons for you to offer long-term care (LTC) planning services to your clients is to help them die a better death.

Having adequate financial resources gives us the flexibility to live our lives the way we want to live them when we have the capacity to come and go as we choose and the future seems to stretch on in to infinity.

Financial flexibility may be even more important after the years have rolled on, bad test results have come back, and money gives us the ability to choose between whether we want to get every last possible hospital test and treatment till the end, to die calmly at home, or to die calmly in a nice, well-lit facility where other people — not relatives — will wash the dishes, mop the floors and change the bedpans.

The Federal Interagency Forum on Aging Related Statistics recently included statistics on death and end-of-life care in a compendium of key indicators of older Americans’ well-being.

Here is a look at what the federal agencies have reported in the end-of-life report.


Places of Death: Americans Ages 65 and Older 

 

  1989 2009
Hospital – inpatient 49%  32%
Nursing home/LTC facilities 21% 27%
Residence 15% 24%
Hospice facilities, emergency rooms and other 15% 17%
Source: National Vital Statistics System/Older Americans, 2012


Where do Americans ages 65 and older die?

One of the obvious problems with statistics is that they don’t show what people were really thinking, but the statistics on the places where older Americans die seem to tell a positive story.

The reality is that, of course, 100% of all Americans still die: 1.8 million Americans ages 65 or older died in 2009 alone.

But the percentage who die in noisy, sterile hospitals has fallen sharply over the decades, to 32% in 2009, from 49% 20 years earlier.

The percentage who die in nursing homes and other LTC facilities has increased to 27%, from 21%.

The percentage who manage to die at home has increased to 24%, from 15%.

One question would be: How many of the older Americans who die in nursing homes do so because they want to die in nursing homes, and how many would have rather been in their own homes but followed the path of least resistance into the nursing home?

How many of those Americans who would have preferred to die at home could have done so more easily if they’d had LTCI policies with home care benefits?

 

Men and Women:

Where Americans Ages 65

and Older Died in 2009 — By Sex 

 

  Men Women
Hospital – inpatient 35%  30%
Nursing home/LTC facilities 21% 31%
Residence 26% 22%
Hospice facilities, emergency rooms and other  17% 16%
Source: National Vital Statistics System/Older Americans, 2012


How does sex affect where Americans ages 65 and older die?

Women tend to outlive their husbands, and that often determines where they die.

A husband falls ill. The wife cares for him at home, and he dies either in the hospital or at home.

By the time the widowed wife falls ill, she may be living alone, and moving into a nursing home may be the best option.

The result of the differences in men and women’s lifespans: Women are a little less likely to die in the hospital than men, a little less likely to die at home, and much more likely to die in a nursing home.

Some LTCI carriers have talked about being less idealistic about rates and more numbers-oriented, by eliminating unisex pricing where possible and charging different rates for men than for women.

The government figures drive home the point that LTCI or other LTC financing options may well be worth more for women than for men, even if the options cost more for women than for men, because women are, clearly, more likely to use formal LTC services and facilities than men are.

Who’s Married?

  Men Women
Age Group    
65-74 78% 56%
75-84 73% 38%
85 and over 58% 18%
Source: U.S. Census Bureau/Older Americans, 2012

 

Here’s another table drawn from the Older Americans report that shows why women have to take planning for LTC costs and other costs associated with old age so seriously.

A majority of older men share their lives and finances with wives: Even when men are ages 85 or older, 58% are still married.

Meanwhile, even in the 65-74 age group, just 56% of women are married. More than 80% of the women ages 75 and older who are single are living alone because because they are widows, not because they are divorced or because they never married.