Choice Architecture

"Choices" about nonmedical aging-related matters, such as housing, are weirdly extreme in the long last stage of life in America. In my experiences accompanying my parents to consultations with physicians, elder-care lawyers, and social service providers, a middle-class older adult's presumed choices are the high-end assisted living facility-or the Medicaid spend-down. Nothing in between. Experts in aging and housing are calling attention to this "forgotten middle"-the millions of older Americans like my mother, people who are neither rich nor poor and whose needs in this long last stage of life cannot reliably be met through publicly funded health insurance or personal savings.