What do Hurricane Florence and frail old age have in common? Millions of people know they are coming yet won’t do anything to protect themselves against a high-risk threat.
Several recent news items put this in focus. And all of them point in the same direction: Americans are unable to plan for a catastrophe, even one we know is coming. Our brains cannot, for some reason, process this. Thus, in the face of an approaching calamity many of us…do nothing.
Florence is about to crash into the Carolina coast. Residents have been warned for days to evacuate low-lying communities and barrier islands. Yet many don’t.
“The storm of a lifetime”
The National Weather Service warns of “the storm of a lifetime,” but people refuse to leave their homes. You hear them quoted everywhere: “I’ve been living here for 30 years and we’ve always done fine.”
Then there was Aretha Franklin, who passed away recently. By now you probably know that she suffered from a serious cancer for years, but never made a will. This despite complicated family relationships and what I imagine will turn out to be a very complex estate.
You may be less familiar with the third story. This week, the Centers for Disease Control released a report on whether participants at adult day centers have advance directives on file. These are documents such as living wills, where you describe whether you want aggressive treatment should you have a serious medical condition; do not hospitalize orders, where you say whether you want to go to the emergency department in the event of a health crisis; do not resuscitate orders that describe the care you want in the event your heart stops; and health care proxies (or medical powers of attorney) where you identify who should speak for you and make decisions on your behalf if you are unable to do so.
About your life
The CDC found that about 80 percent of centers maintained documentation on advance directives. That’s encouraging. But nearly six in 10 adult day participants had no paperwork on file. While almost half of those in the Northeast had advance directives, only one of every four participants in the West had prepared them.
For context, only about one-quarter of all older adults have completed advance directives, and only two-thirds of nursing homes residents have done so.
This is amazing, and deeply troubling. By definition, if you are spending time at an adult day program, you are frail and in need of a relatively high level of support. You need people to know what care you want if (no, when) a crisis occurs. If you are living in a nursing home, you are even more seriously ill.
In many ways, these documents are far more important than a financial will. After all, those are only about money. Living wills are, literally, about your life.
Do you want to end your days in an intensive care unit, with feeding tubes and machines to help you breathe? Or do you want to die quietly, though perhaps more quickly, at home? There is no right answer for all of us. But there is a right answer for each of us. And not writing down your choices invites tragedy.
Why we don’t act
So why don’t we fill out these forms? Why don’t we prepare for the financial costs of old age? Why don’t we talk to our kids our aging?
That gets us back to Hurricane Florence. In an online column in The Washington Post, Robert J. Meyer, co-director of the Wharton Center for Risk Management and Decision Processes at the University of Pennsylvania, explains. To understand where he is coming from, know that Meyer is co-author of a book called “The Ostrich Paradox: Why We Underprepare for Disasters.”
Meyer identifies five psychological reasons why people do not evacuate in the face of natural disasters. For those of us who live in the aging world, each sounds eerily familiar:
Excessive optimism. Curiously, people tend to overestimate the severity of a coming storm, but they don’t think it will affect them. Something like those who say, “Sure, I know people get old and frail, but it won’t happen to me.”
Herd thinking: Others you know don’t prepare so neither do you. Who talks about saving? We’d much rather show off our new car.
Myopia : Preparing for a disaster requires making short-term investments to stave off future losses. But we don’t plan ahead because it can be expensive or inconvenient. Just ask long-term care insurance brokers about that one.
Amnesia: Bad memories fade quickly. We don’t remember losing power for a week after the last bad storm. We forget what it was like when out dad was failing and didn’t have the support he needed.
Inertia and simplification: I’ve been arguing with the long-term care insurance industry about this one for years. Policies are insanely complicated. People don’t understand them. So they don’t buy. It is the same story with retirement savings plans. Faced with so many choices, we freeze, and do nothing.
In fairness, some people may wait out a coming storm because they have no choice. They have no transportation or are too frail to leave their homes. And many don’t prepare for the costs of frail old age because they do not have the income to do so. They must spend all they make. But let’s face it, many of us choose to ride it out because it is the way our brains our wired. And it’s true whether we are talking about a catastrophic storm or dementia.
Meyer has suggestions for how we can overcome these deeply ingrained psychological biases. But, a phrase I’ve heard for years in the elder care world still comes to mind: When it comes to aging, denial ain’t just a river in Egypt.