Taking Control of Your End-of-Life Care
If you live a long life and eventually need help, who will be there for you? Where will you receive care? And if you are unable to make decisions for yourself, who will handle your financial, legal, and medical affairs?
These are difficult questions, and they often lead to uncomfortable conversations. But the alternative is having those decisions made for you, often in the middle of a crisis. Just as with other major life decisions like getting married, buying a home, or changing jobs, most of us would prefer to be thoughtful and intentional rather than reactive.
People age very differently. Some feel old in their 50s, while others remain vibrant into their 90s. Many of us still think we are 25. Regardless of age or health, these conversations work best when life is going well. Stress narrows our thinking and pushes us toward all‑or‑nothing decisions we would not normally make. Below are several important questions worth considering and discussing before a crisis forces the issue.
1. At what point would you change your housing situation?
Most people say they want to receive care at home for as long as possible. If that is your preference, think through what aging in place might require.
Do you need to widen doorways or bathrooms for a walker or wheelchair? Could you live comfortably on one level, or would a stair lift be necessary? How would your quality of life change if longtime friends or neighbors moved away or died?
Loneliness has been linked to higher risks of medical problems, including heart disease and cognitive decline. Community matters.
Cost matters, too. According to the Genworth CareScout 2025 Cost of Care Study, the national median hourly rate for non-medical in-home care is approximately $35 per hour. At that rate, the annual cost exceeds $80,000 based on roughly 44 hours of care per week. For many families, if extended daily care is needed, assisted living may be less expensive than remaining at home. Your financial situation, including whether you have long-term care insurance, will play a major role in determining which options are realistically available to you.
2. How do you want to handle the decision to stop driving?
My sisters and I eventually had to take the car keys away from our dad, and it was much harder than I ever expected. He was experiencing cognitive decline, and looking back, we should have stopped him from driving sooner. We waited because we hated taking away another piece of his independence.
Think about how you would want that decision handled for you. Would you want to rely on your doctor’s recommendation? Would you be open to input from family or close friends?
AARP offers a helpful resource for starting this conversation.
Once you are no longer driving, how will you stay connected to the people and places that matter to you? Ride sharing services like Uber and Lyft, help from friends or family, or living in a walkable community or retirement setting may all be part of the solution.
3. Who will help manage your bills if you need support?
Trouble with memory, concentration, or decision making can make everyday finances overwhelming.
Having a durable power of attorney in place allows someone you trust to handle legal and financial matters on your behalf. That same person may also help with day-to-day money management.
You can make things easier for yourself and for them by simplifying now. Consider consolidating bank or investment accounts, closing unused credit cards, and setting up automatic bill pay where appropriate.
If you ever need professional help paying bills, the American Association of Daily Money Managers can be a good place to start.
4. How do you define quality of life at the end of life?
This may be the most important question of all.
Do you want every possible medical intervention to extend life? Or is there a point at which comfort and pain management would matter more to you than longevity?
An advance health care directive allows you to name someone to make medical decisions for you, but the document alone is not enough. That person needs to understand your values, what matters most to you and what does not, so they can advocate for you when it truly counts.
Two helpful resources include the book Being Mortal by Atul Gawande and the Five Wishes planning tool.
My dad was 89 and physically healthy until just a few weeks before his death. Even as he declined, he was still my dad. He reminded me to eat, to go home and be with my family, and to get some sleep.
You can still parent your family to the very end by making these difficult decisions in advance. Doing so is one of the greatest gifts you can give to the people you love.
A simple next step
If this feels overwhelming, start small. Choose one of these questions and talk it through with a spouse, trusted friend, or adult child this month. If you would like to learn more about these topics or explore general planning considerations related to them, I am always happy to share educational information.
Sources:
Stress leads to bad decision making (Harvard Business Review):
https://hbr.org/2017/08/stress-leads-to-bad-decisions-heres-how-to-avoid-them
Social isolation and loneliness pose health risks (National Institute on Aging):
https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-health-risks
Genworth CareScout 2025 Cost of Care Study:
https://www.genworth.com/aging-and-you/finances/cost-of-care.html
This is intended for informational purposes only. You should not assume that any discussion or information contained in this document serves as the receipt of, or as a substitute for, personalized investment advice from Savant. Please consult your investment professional regarding your unique situation.
Patti B. Black
Financial Advisor
CFP®, CSA®