Americans Are Unprepared for the Expensive and Complex Process of Aging – a Geriatrician Explains How They Can Start Planning

November 26, 2025

The tragic deaths of actor Gene Hackman and his wife Betsy Arakawa in their home highlight critical gaps in America's preparation for an aging population. Hackman, who had Alzheimer's disease, was left helpless after his caregiver wife died days before him from Hantavirus complications. A geriatric physician uses this case to illustrate how most Americans fail to adequately plan for older age, despite nearly 70% requiring long-term care during their lifetime.

Who is affected

Gene Hackman and Betsy Arakawa (deceased)
Older Americans, particularly those over 75 (46% living with physical disabilities)
Nearly 70% of older Americans who will require long-term care
Family and friends serving as unpaid caregivers (who experience higher rates of stress, depression, and physical illness)
Only 25% of Americans over 50 who have completed advance directives
Low-income older adults relying on Medicaid
Medicare and Medicaid recipients
Nursing home residents and assisted living facility residents
Individuals with dementia and their caregivers

What action is being taken

The Centers for Medicare & Medicaid Services is operating the GUIDE Model pilot program, which connects caregivers with local resources and provides a 24-hour support line for dementia-related crises
The Program for All-Inclusive Care of the Elderly is providing comprehensive services including medical care, day centers, and home health services for dual-eligible Medicare and Medicaid recipients
Area agencies on aging are connecting older adults with local resources such as meals, transportation, and home modifications
The author is conducting research and clinical work focused on dementia and surrogate decision-making while caring for older adults in inpatient and outpatient settings

Why it matters

This issue matters because America's population is rapidly aging while most citizens remain unprepared for the challenges of older adulthood. The financial burden is substantial—long-term care can cost thousands of dollars monthly and is not covered by standard Medicare or medical insurance, leaving many families facing impossible choices between inadequate care and financial ruin. Without proper planning including advance directives and caregiver arrangements, older adults risk losing autonomy over critical medical and financial decisions, potentially ending up under restrictive court-appointed guardianships. The Hackman tragedy demonstrates the life-threatening consequences when caregiver support systems fail unexpectedly, underscoring the urgent need for comprehensive planning and backup support networks as the aging population grows.

What's next

The GUIDE Model program is slowly expanding with hopes of eventually providing enhanced coverage for dementia sufferers nationwide. Medicare funding has been extended through January 30, 2026, at which point funding may be reduced. The tax breaks and spending cuts bill signed in July 2025 will result in progressive reductions to Medicaid funding over the next 10 years, which will decrease eligibility and negatively affect nursing home reimbursements.

Read full article from source: The San Diego Voice & Viewpoint