Setting aside all the (well-founded) financial discussions, an elderly person is simply less effectual as an adult. Even if no dementia is involved, they often have a harder time making decisions, a harder time doing practical things, a harder time hearing or using a telephone, and a much harder time learning about new things, such as changes to tax or financial legislation or products.
My late MIL was one such. Here’s the story of her last few years, which story came to an end in spring of 2021. Up to age 90(!) she was living on her own in a rented apartment and managing all her own affairs adequately. Had way more money than she needed for her simple middle-class tastes.
Over the next couple of years she became much less capable. Bills piled up unpaid although she had plenty of money. She quit cooking for herself and despite a lifelong disdain for any/all restaurant food as badly prepared, began to live on Meals-on-Wheels food. Which are little better than Swanson TV dinners.
At her request, and with her complete understanding, she relinquished day-to-day management of her bills, assets, & paperwork to us. She’d had everything in a trust for years, but we’d been inactive trustees and she’d been the one doing everything. Not anymore. Now she watched and we worked.
A bit later she decided on her own to move from a regular apartment into an elder care facility. “Independent living” specifically. Which is a great invention. You get a decent 1BR apartment with a small kitchen, basic maid service, a restaurant down the hall, recreational activities and some transportation. It’s like being back in the college dorms. Everybody is the same age, has the same interests and problems, etc. The environment is designed to help you succeed every day, even as you inexorably slide downhill towards your end.
But she needed our help to identify which facilities were around, take her there, help her evaluate them, and eventually help her decide which one. It totally was her decision, but we had to grease the process into something simple & small enough that she could handle it. A decent metaphor is feeding a 6-yo. They can operate a fork and a spoon and a napkin just fine. But an adult needs to pre-cut their meat & vegetables; that task is just too difficult for their small weak hands & flaky coordination.
Mom could eat fine; she couldn’t decide fine. Every decision task was simply overwhelmingly complicated, although all had been pieces of cake to her just 2 years previously. If we isolated the issues and explained the tradeoffs neutrally, she could and did decide just fine. But that upstream work was beyond her.
Of course we had to select and hire the movers, box the stuff she didn’t trust them to touch, etc.
Once she was moved into independent living, it ought to have been easy enough for her. It was a great facility, and everything there is geared to the needs of slowing seniors. At first she did great there, but as she got older and physically slower and mentally more forgetful (still no dementia), even stuff like getting a lightbulb changed became too hard. She wouldn’t call the front desk; she’d call me. In her explanation, they never understood her requests correctly, but they always understood mine.
Physically of course she was getting weaker too. SHe could no longer walk, and could only go about 10 feet with a walker before she was exhausted. Otherwise she used a power-chair to get around. And her hearing eventually collapsed to the point that the telephone was useless, despite ultrahigh-powered hearing aids. We communicated face-to-face or via email. And the face-to-face was none-too reliable. What she thought she saw / heard was frequently a lot different than what we said, even though we knew to keep it simple, enunciate like mad and speak very loudly at a measured pace.
etc. etc., etc.
At age 96 years 8 months she forgot to wake up one morning. She’d run her course and died in her sleep as she had wished. The week before she was mentally capable, watched the news, could talk about both ancient history and current events, was reading a 1000 page novel, still used her computer for email, but increasingly badly by mis-remembered rote, etc. Bravo Mom: you totally got your money’s worth out of life and stretched out the clock far better than 90% of American white women, much less the rest of humanity.
But there is no way she could have lived the last 4 years without us first installing “training wheels on her bike” and later on without us pushing that bike, along with all the help she was getting from the facility. The facility was a big help. She’d still have been utterly screwed without us.
Like some folks upthread, barring WW-III I’m not concerned about my ability to pay for elder care for myself & my wife. And I do recognize what a rare position of privilege that is.
What I’m deeply concerned about is being able to hire somebody to do for me all that we did for Mom. Somebody to pay her taxes, invest her funds, pay her bills, renew her library card, take her shopping, take her out for her birthday, help her buy new shoes, get a haircut, and a thousand other trivial tasks of adulthood that each eventually become too hard for any elderly person to accomplish unassisted. A good facility can help a lot. But they can’t do it all; heck they can’t do even half of it.
And the problem with all these arrangements is they don’t stay arranged. We’d get Mom a good helper, and 6 months later they’d quit, or their own child was in jail, or whatever, and they’d be gone. So we had to go find Mom another new helper. Again and again and again.
Bottom line IMO:
Unless you have the good fortune to drop dead while you’re still a fully capable adult, you’re going to live through a year or 3 of wallowing incompetence as an adult. Not necessarily legal incompetence, just practical helplessness. Like an 8yo suddenly forced to fend for themselves doesn’t stand a chance, neither will you / me. Somebody somehow needs to pick up the slack or you’ll fester into a lump in a trash-filled room with unpaid bills piled up. Even if you have the funds to pay them, you won’t be able to muster the effort.
