Most of us learned about health care the same way we first learned about other “life” topics—from our parents and older relatives. Except that health care has changed dramatically since we were younger and continues to change before our eyes. The choices people have today are simply different and didn’t exist not that long ago. Can you say “outpatient services”?

Health as you age is highly personal and seemingly random—a “mean Rubik’s cube,” I wrote in this space last time. A person with good genes can live to 90 while another with cancer is cut down at 65. Turn the faces of the cube, and you see a different perspective if that 90-year-old has Alzheimer’s disease, which would make the longevity less of a privilege. Turn it again and see that the 65-year-old retired early and enjoyed traveling and family while another person in his 60s passed away still saving and investing. You don’t have a lot of control over what happens to you, and sometimes the best plans go awry.

As I continue to explore “The Four Transitions of Aging” (see my article under that name in the February 2019 issue of Financial Advisor), it’s hard to imagine a more powerful variable in retirement than somebody’s personal health or to imagine a more important planning topic than personal health care. Medical science has created longevity without a guarantee of quality. Managing your health-care options and trade-offs is a complicated, complex and often emotional process. Especially as you age.

To begin making sense of health care with your clients, start with the most basic concepts and go deeper when appropriate. Don’t rush in with a scary-sounding dollar figure, saying, for example, “According to a recent survey, you should set aside $500,000 for your health-care needs in retirement.” Not helpful. Let’s spend some time instead examining what the clients think will happen, what could happen and what their preferences would be under different circumstances. Here’s a punch list of key issues:

• Life expectancy. Are there any known health conditions in the client’s family that would affect his or her “normal” life expectancy? There are a lot of talking points here.

• Health practices. How often does the client see a doctor? Get a physical? Does the client practice preventive care, and generally follow care instructions? The client’s attitudes about health care are important to know because they will drive his or her strategies, according to how engaged the client/patient is in the process of problem-solving.

• Decision-making. Does the client have a living will or health-care directive? Has the client shared care preferences with his or her entire family? Does the client have a health-care surrogate or proxy? Do the client’s written preferences include “quality of life” conditions for dealing with paralysis or dementia, or offer end-of-life instructions? Family relationships can be complicated and difficult. Who is trusted to help and who is really looking out for your client? Get those people involved.

Helping clients “peel the onion” of health care empowers them to share their preferences—a crucial step if you want to customize solutions and better estimate their cost. Some people might not like doctors or hospitals, but everyone has opinions about health care. They care a lot about where and how they receive care. They have thoughts about death, about losing independence, about retirement “homes,” about cremation and open caskets. They know if they want to be kept alive or be allowed to die peacefully. They care about whether death happens after a heroic operation or at home with hospice care.

They know all these things because they learned them from watching family and friends get sick, get old—and die. They know what they don’t want to happen to them. Many don’t want to talk about it, but many more really do.

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