Aging and Death in America: ‘I Basically Want to Burn It All Down and Restart’

When financial planner and author Elliott Appel put his life on hold for seven years to care for his father, he came away with lessons for helping aging parents, but also a conviction that how we manage aging and death in the US needs to change.

Elliott was our guest on The Long View recently. We invite you to enjoy the full episode, and we’re also highlighting an excerpt below in which he talks about what’s changed in his client conversations and what he’d want to be different.

The Importance of Trusted Contacts and DPOA

Amy Arnott: As you have thought about and written about your caregiving journey, how did that affect your thinking about managing your own aging process as well as helping your mother and the clients that you work with?

Elliott Appel: Yeah, so for my mom, funny enough, I think shortly after my dad’s experience, we put my mom on our cellphone plan. I wasn’t going another day. That was a quick thing that we could change, so we did that immediately.

For clients, it’s being more intentional about getting trusted contacts or DPOAs [designated power of attorney] set up, having adult children in meetings, or at least introductions, so they know who I am; looking through estate plans so we can talk about, for example, DPOAs. Are they springing? Are they effective immediately? Do people actually know how this works in the real world?

I think there’s a big disconnect between, hey, you go do your estate planning documents, but how does that actually happen when real life happens, and having those conversations and thinking through them, getting people to freeze their credit to maybe start these conversations or think about what sort of living environment they’re in. Because for a lot of people, I know they want to age at home, but for a lot of people, the reality is that it’s either going to be too expensive or too difficult, or a combination of both, to find the care that they need at a certain point.

Then for us, it hasn’t changed a lot. I’m still relatively young. Maybe this is more a do-as-I-say, not-as-I-do, but we haven’t changed too much. I am working on getting a better, what I would call in-case-of-emergency binder for my wife and me set up. I think the landscape’s going to look a lot different 20 to 30 years from now, when we might need to have these conversations more seriously as we’re getting up there in age for what we need to do next. But I think the big thing for us is getting that in-case-of-emergency binder. If something does happen to either one of us, the tasks that we do, the other is aware of, and how to access all the different accounts and everything that’s available to us both.

Rethinking Aging and Death in the US

Christine Benz: As you reflect on your experience with the aging process, if you could change one or two things about how we manage aging and death in the US, what would they be?

Appel: I don’t think I can change only one or two key things. I’m going to try to make this short, but I basically want to burn it all down and restart. I would like a complete restructuring of health insurance, healthcare spending, and the systems available to us.

It was a very frustrating thing throughout my dad’s illness. Insurance probably billed millions of dollars. Hospitals allowed hundreds of thousands of dollars to be billed. And I’m sitting here looking at my dad’s end-of-year benefits for healthcare spending, and they’re literally paying out hundreds of thousands of dollars, and I know other people have spent millions of dollars, for them to fix acute problems with my dad. And it didn’t really make him better. It just patched him up, to then go home and get sick again. It’s very frustrating that no money was really being spent to keep him healthy or out of the hospital.

I’d love to see more health prevention, and I’d love to see communities that are sort of mixed ages. A lot of times when I talk to older folks, they say, hey, and ironically a little bit, and they laugh and recognize this; they say, “Hey, I don’t want to go to that place. It’s filled with a bunch of old people.” It’s one of those things where what if we had some more mixed communities where you have younger folks, you have people with kids, you have older people. I see this happen sort of naturally in some condos or apartment buildings. I love to see some more intentional buildings around aging where it’s not just, “Hey, there’s an acute problem with me, and then I go somewhere and live.” It’s how do we be more fully supported and have that community, and rethink that aging at home maybe is the best option because often it just isolates people and they get worse. I’d like to see that.

Finally, I know I didn’t keep it at two things, so I apologize for that, but I want to see some nationwide changes around estate planning. As I was preparing for this, I was thinking once people hit 65, they get a Medicare wellness exam, or they’re at least supposed to. I don’t know how effective that is, but I think it’s getting more people to the doctor. What if we had something for estate planning where you have to have some sort of forced conversation at 65, or pick whatever age you want, where you have to do some estate planning? You can’t put it off anymore, or at least there’s some awareness of the importance of it, because I think this puts an undue burden on the people surviving when people pass away and/or when they get sick, or they don’t have the same ability to do things that they should.

I mean, there are constant posts on Reddit and elsewhere and in everyday conversations of, “Hey, I didn’t have a will. What do I do?” Or, “I don’t have DPOA for finances. Do I have to get guardianship? What’s involved with guardianship?” I think there needs to be more awareness, and I’d love to see more forced or some sort of organic way to bring that up with folks that’s part of our healthcare because I think it is part of graceful aging, and part of our healthcare system is making sure that those documents are in place.