The Game of End of Life

Steve Wishman
November 24, 2022

Three years ago today, I was sitting in a cozy Portland pub, sketching some rough ideas for a comic strip about the challenges my mom faced on the journey to affording long-term care. At times, it feels like the system is a twisted game designed to bleed you dry so that you have absolutely nothing by the time you are gone. I wanted to draw a comic strip that captured that feeling but I was struggling to come up with a visual way of telling the story. Suddenly it occurred to me that a board game (The Game of End-of-Life), played backward with unfair rules and penalties, would be a relatable and ironic way to visualize the feeling.

A comic strip about The Game of End-of-Life
Strip #099 from How Mom Died. Click HERE for the full-size comic

Anyone on the caregiving journey knows that long-term care options are insanely expensive, and that aging with dignity is a luxury afforded by surprisingly few of us. Pensions have largely vanished and Social Security can’t cover the high cost of assisted living. A whopping 48% of households over the age of 55 have no retirement savings at all. Government financial aid like Medicaid (or Medi-Cal in California) are only available if you have less than a few thousand dollars in total assets, so families often have to reallocate finances just to qualify for the program. Oh and the program isn't free, by the way. Once you're gone they will come back for their money, and paying the enormous tab usually requires families to sell their home unless they jump through some very specific hoops in order to protect it (there's an entire industry of elder law attorneys and medicaid planners whose job is to do exactly this).

Some people resort to options like reverse-mortgages to pay for long-term care, essentially selling the house slowly in order to afford the $4-5k/mo rent at a senior living community. But many families wish they could bequeath their homes to their children and grandchildren. The system as it exists today makes it exceedingly difficult for families to create generational wealth. Long-term care insurance is a great option as long as your start paying into the plan when you're in middle age (40s-50s) but we live in a myopic culture, focused on immediate concerns. We put off planning for our own retirement until it becomes imperative, and then we find ourselves pulled into The Game of End-of-Life when our mental acuity is at its lowest.

It's important to do research and start planning while we're still sharp and able, unless we want to burden our children with picking up the game pieces for us. Aging and dying are not topics that families are usually comfortable with, especially during the holidays, but we should prioritize having these conversations. Families who enjoy playing games together can even use resources like The Death Deck to make the conversation fun and profoundly insightful.

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Steve Wishman

Steve Wishman is the founder of Zen and the Art of Caregiving, and author/illustrator of How Mom Died, a webcomic/memoir chronicling his experiences as a caregiver for his mother at the end of her life.