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Critical Conversations

October, 2007

Everyone agrees that family members need to talk about health planning and end-of-life issues before there is a crisis or someone is no longer able to communicate. More often than not, however, we fail to initiate these critical conversations because we feel overwhelmed and do not know how to get started talking, planning or taking action.

Discussions about advance directives, wills, estate planning and funeral arrangements aren't just for the end of life. They really should be part of family life - a part of how we live our lives fully. Communication and advance planning can reduce feelings of burden, guilt and misunderstanding. It can also lessen the potential for conflict that family members often experience when they are put in the position of making decisions for others.

Older adults may not be inclined to talk about end-of-life issues. You may assume that they have made plans when they haven't. On the other hand, they may have plans in place, but they have simply chosen not to tell you or have forgotten to do so.

Pre-planning is important for financial issues and "peace of mind" and could be presented that way. For example: "Mom and Dad, we've been thinking about a series of life concerns, such as wills, estates, funerals and things like that. Have you thought about making plans on these matters? We would hope that you do and let us know so that your wishes can be followed correctly."

Questions you may want to ask your loved one about his or her end-of-life care wishes include:

• If you were diagnosed with a life-limiting illness, what types of treatment would you prefer?
• Have you named someone to make decisions on your behalf if you become unable to do so?
• How would you like your choices honored at the end of life?
• What can I do to best support you and your choices?

Understand that it is normal to encounter resistance the first time you bring up this topic. Don't be surprised or discouraged; instead, try again at another time.

Having critical conversations with your loved ones about their end-of-life wishes can be a sensitive discussion. Respect that they may not be ready or able to face their own or another's mortality. Adult children are just as likely to refuse to talk about the topic as parents or in-laws.

Keep it a conversation, not a debate. Be sure to make an effort to hear and understand what the person is saying. These moments, although difficult, are important and special to all of you. Some things you can do to help all parties be open and honest:

• Listen for the wants and needs that your loved one expresses.
• Make clear that what your loved one is sharing is important to you.
• Show empathy and respect by addressing these wants and needs in a truthful and open way.
• Verbally acknowledge your loved one's rights to make life choices - even if you do not agree with those choices.

Having these critical conversations is the best way to protect your loved one's independence in unpredictable situations.

A good way to convince someone is by example. Do you have a will and other end-of-life plans?

Your Area Agency on Aging (1-866-243-5678) is a good resource for information about long-term care options and legal assistance.

Barbara E. Riley