Just as they've reinvented or modified every life stage they've entered, the Baby Boom generation is beginning to rewrite the way America deals with life's final chapter. A major new trend among Boomers is to crack open the taboo, question institutionalized approaches to death and replace them with a more personalized, more humane model. The geometric growth of hospice care and alternative approaches to funerals, including the increase in cremation and casket stores are indications that traditional and institutional approaches to the end of life are now undergoing Boomerization.
Economics accounts for part of this change. Institutional programs for end of life are just plain expensive two to 20 times more expensive than alternatives. But, there's more to it than cost. As they plan for the end of life, often for their parents these days, issues of control, increased choice and a new search for meaning and ritual motivate Boomers. The expense and sterility of extended hospital care and one-size-fits-all funerals no longer cut it. They want better ways to say so long.
THE LAST TABOO
In the way of that goal is a lack of knowledge. The end of life remains the last great taboo, about which much of our culture remains silent. As they do, Boomers are breaking the taboo, looking for choices and opening up a dialogue about end of life. As with the sexual revolution, the end of life is surrounded by myths and half-truths. For instance, today, in all 50 states, you can do a funeral at home, or in a church, without using a funeral home. For over 20 years federal rules have allowed consumers to purchase caskets and monuments from outside the funeral home, but few know this. Hospice care is entirely paid for by Medicare, and can save families thousands of dollars and a lot of grief, but again, many don't realize they have a choice.
One reason for this is a lingering discomfort with thinking and talking about death. Another is a self-interested unwillingness among health-care and funeral advisers to offer alternative information.
So the death-care industry is becoming polarized. Options are emerging: Home-based hospice care is providing an alternative to hospitals; individualized care is challenging institutional care and customized burial and memorial services are starting to replace prefabricated funeral home offerings. To imagine the amount and pace of change that could surround end-of-life options, think of the U.S. highways before minivans.
BOOMERS CONFRONT PARENTS' DEATH FIRST
Demographics are power, and the cultural impact of the Baby Boom is largely driven by their numbers. When 75 million people confront an issue, it becomes culturally significant. Currently, there are about 2.4 million deaths in this country annually. That figure has remained constant for years. By 2040, the total will double, to about 4.1 million deaths per year, as Baby Boomers themselves die in greater numbers. By then, odds are that the process of dying and the death-care industry will have substantially altered to fit the Boomers' needs. It is not the immediate death of the Boomers that will drive that change, but the need for them to address the issues that surround the death of their parents. Psychologically, emotionally, financially and culturally, those changes are occurring today.
Psychographic and socioeconomic forces that have shaped the cohort experience of Boomers and their parents are forging this new face of death. Evident among these forces is the extended life spans of healthy and ill people alike. When the first Boomers were born in 1946, their parents were unlikely to contemplate prolonged end-of-life care for their parents. The average life span for men and for women born in 1900 was 47. While many people did live to an older age, they didn't have the medical resources to prolong life as we do now.
At the same time, most of our grandparents lived as adults within 15 miles of the town in which they were born. Burial rituals were well-established and required little pre-planning or forethought. People who lived close together often shared similar ethnicity, religious beliefs and cultural traditions. So when their parents began to die, there was no confusion and little choice for the Greatest Generation cohort about what to do.
Contrast that with what Boomers face. The most geographically and culturally diverse generation in history, Boomers live in a world where interfaith marriages, divorce and same-sex relationships are not unusual, nor are the revised rituals and traditions that accompany them. Home births, home-schooling, self-written marriage vows, home offices and increased involvement in one's own wellness and treatment are Boomer-initiated trends that have become commonplace.
As cultures, ethnicities, religions and geography blur with the Baby Boom and their parents, there can be no simple guide to end-of-life planning as existed with their grandparents. What are the new rules for planning cross-religious, cross-racial or cross-country funerals? And how do you transform an institutional death into a meaningful end- of-life celebration and ritual?
NEW CHOICES: THE MONEY ADDS UP
Dramatic evidence of the shift in thinking about death is the rise of hospice care. Since the creation of a Medicare Hospice Benefit in 1984, the number of hospice patients has increased exponentially. In 1984, 154,000 patients were in hospice care. In 2003, the National Hospice and Palliative Care Organization estimates that 855,000 Americans received end-of-life care through a hospice. Dying is increasingly seen as a time for, in the words of Dr. Elisabeth Kubler-Ross, spiritual, emotional and financial help for final care at home, not isolation, institutionalization and staggering expense.
While compassion and opportunity for closure drive the hospice movement, it is bolstered somewhat by a third set of c's: cost containment. The Agency for Healthcare Research and Quality estimates that 30 days of acute end-of-life care in a hospital would average about $109,000. By contrast, 30 days of hospice care which includes far more one-to-one time with the patient and comparable palliative measures costs about $4,000.
The end of end-of-life care means attending to the dead. In this instance, too, the Baby Boom population is taking a closer look at practices in an industry that were once a given. The business and foibles of funerals is moving into the mainstream with quirky, ironic series like HBO's Six Feet Under and A&E's Family Plots.
It's little-known that no state requires use of a funeral home to bury someone. Church and home services are legal in every state, and sources exist from which individuals may purchase third-party funeral supplies and monuments. Nontraditional approaches which may include a church funeral and the direct purchase of a casket and monument, can save families thousands of dollars. Cremation, which represents about 28 percent of all final dispositions, is also a way families save. Groups like the Neptune Society perform cremations for very low costs. Still, there are 22,000 funeral homes in America, or one per 100 deaths.
Why are there so many funeral homes? Because few people know their options, which can range from traditional funeral home services to burial in the backyard in a hand-decorated casket and artisan's monument. For Boomers and their parents, the ways to say goodbye will increase as they gain more knowledge about end-of-life issues and the power that goes with it.
POLARIZATION AMONG SIBLINGS
The most significant impact of the passing of the Boomers' parents may be a psychological one as the Baby Boom generation is compelled to become the new head of the tribe. No matter what age they have been, as long as their parents were alive, Boomers were always the children at the center of their parents' universe. Internalizing that the world does not center on them, may be akin to a new Copernican revolution of the psyche.
Who makes the decisions concerning long-term care, funeral planning, hospital and hospice care for their parents and their spouses, will either polarize these families, or be new opportunities for coming together.
INDIVIDUALISM OR INSTITUTIONALISM?
A growing polarization between the institutional and personal approaches to end-of-life issues seems inevitable as there is a growing awareness of end-of-life choices. At the heart of the issue are decisions about who is in control at the end of life.
Given the extraordinary costs and economic consequences involved, an end-of-life revolution may be our next great cultural milestone, as the last life stage becomes the new center of gravity for the Baby Boom. And with this generational group, one thing is as certain as death and taxes: the status quo no longer applies.
Michael Rybarski, author and corporate strategist, consults worldwide on issues relating to the Baby Boom. He is Chairman & CEO of TributeDirect, Inc.
Burial by the Numbers
Number of states in which it is legal to perform a FUNERAL AT HOME.
Number of states that require a LICENSED FUNERAL DIRECTOR to oversee some aspect of body preparation or burial.
Number of days it takes to SHIP A CASKET anywhere in the U.S. by Fed-Ex.
Number of years since the FTC passed rules to allow families to PURCHASE CASKETS AND MONUMENTS from third parties.
Number of FUNERAL HOMES in North America.
Number of FUNERAL HOMES PER 100 U.S. deaths.
Estimated number of U.S. families who DID NOT USE A FUNERAL HOME at the death of a loved one.
Estimated percentage of U.S. families expected to use a THIRD PARTY to purchase funeral products or monuments for a loved one by 2020.
Soruce: TributeDirect. Inc.
The Sibling Wars
Average number of Baby Boom siblings per family who could be EXPECTED TO BE INVOLVED in death-care, financial and inheritance issues.
Estimated percent of Boomer siblings who will be FULLY INVOLVED in major aspects of their parents death-care and funeral arrangements.
Median size of inheritance received by Boomers from their parents, to date. Due to longer life expectancies and increased health-care costs for their parents, the INHERITANCE BOOMERS RECEIVE will be much smaller than many have thought.
INHERITANCE, as percent of their income, that is projected to be received by Boomers on average through 2020.
Soruce: TributeDirect. Inc.