While many boomers were born into an upwardly mobile world and have achieved more education and wealth than their parents and grandparents, the financial picture for this generation isn’t as rosy as some might think.

According to a 2016 survey by the Insured Retirement Institute, only 24 percent of boomers are confident that they will have enough savings to last throughout retirement. This is down from 36 percent in 2012. Only 55 percent say they have any money saved for retirement (although one in four expects significant income from an employer-provided pension).

More than half of boomers say that they are counting on Social Security as a major source of retirement income, although many of them are worried about the future of that program. Just over a quarter of boomers say they don’t plan to retire until age 70 or later. Only about a third think they have enough money for health care expenses.

Boomers aren’t responsible for their own expenses alone. Some are helping parents, and many are supporting adult children. For instance, in a 2012 study by the National Center for Policy Analysis, nearly 60 percent of boomer parents said that they were financially supporting their adult children, including paying living expenses, medical bills, and loan payments.

All of these statistics suggest that many boomers will have financial concerns and anxiety when they age, get ill and frail, and need long term or post-acute care. Increasingly, providers and practitioners alike will have to include the expenses related to various treatment options and how to weigh costs and benefits.

“We have been talking for years about the importance of addressing costs. We’re still working on this issue, but there are things we can do,” says J. Kenneth Brubaker, MD, CMD, medical director of Masonic Villages in Elizabethtown, Pa.

“For the most part, we want to treat everyone equally, no matter who they are. We always need to be helping patients make informed choices about care based on clinical evidence and protocols. Cost is an issue we should all be aware of, but we shouldn’t put a price on good medicine. As we are more accountable, we will be less wasteful.”

Nonetheless, he notes that sometimes patients without insurance—such as Amish communities—want to make decisions based on costs, and facilities and practitioners should be prepared to work with them.

“If I think a patient will benefit from a treatment, I will recommend or prescribe it,” says John Poterucha, MD, a gastroenterologist and professor of medicine at the Mayo Clinic.

“One problem with health care costs is patient and family expectations. If someone has a serious malignancy and chemo may add a few months to life, the majority of patients want it, and often families want it even more. At some point, however, we have to work with them to decide what is a reasonable level of care in this situation,” he says. “We need to do a better job of addressing this moving forward.”

“I’ve always said that geriatricians are also social workers, financial planners, therapists, clergy, and more. We look at the whole person,” says Mike Wasserman, MD, CMD, geriatrician and chief executive officer of Rockport Healthcare Services in Los Angeles. “Part of this is understanding their financial situation,” he says.

However, at the same time, health care in elders has less to do with money and is “more about listening to them.” Often, Wasserman says, elders are more interested in quality of life and purpose than expensive care and invasive treatments.