Is It Time to Talk? A Guide to End-of-Life Discussions

January 9, 2017

by: The My Medicare Matters team

Former Boston Globe columnist Ellen Goodman developed a program a number of years ago called The Conversation Project. Because of her own experience, she realized that many families were reluctant to discuss end-of-life choices with their aging relatives. She created the Conversation Project to help support and facilitate these crucial discussions. In the spirit of the Project, we offer our own tips for getting started with this difficult topic:

  1. To start, one thing to keep in mind is that end-of-life discussions don’t have to be 100% depressing. Some elements of the discussion can be handled with humor and grace.  Do you want “Nearer My God to Thee” played at the funeral because you were a fan of the movie “Titanic,” or are you more of a “send me off to the Rolling Stones” kind of person? Can you joke about how no one actually wants to inherit Great Aunt Mildred’s antiques?  It may sound inappropriate, but it can actually be cathartic to find a little levity during these difficult discussions.
  2. Stage two of these discussions should be focused on intermediate-term choices; i.e., what the plan is from now until the end. Are the elders in your family planning on aging in place, moving to a retirement community, applying for senior housing, or moving near younger relatives?  Different people have very different ideas of what it means to “age gracefully.” Create clear guidelines for how you can best support your loved one’s desired aging plan, and do this as soon as possible. And if their current health status or financial resources do not align with their plan A, now is the time to help them pick a plan B. For example, while many older people hope to age in place, if their home is not properly equipped for aging (ie there is a high risk of falls, or the hallway is too narrow for a wheelchair), it is important to help them either plan a renovation or find a new home.
  3. Now that you and your family have eased into the Conversation, you can begin to address the more intense issues surrounding their health and quality-of-life. Does your family have a history of stroke, heart attack or cancer that you may not be aware of? Do your family members have health care proxies in case a sudden crisis strikes?  Do your frail elders have Do Not Resuscitate orders on file, or do they want the doctors to take all possible measures to prolong their life?  Is there a gray area in between? If so, how does that person define “quality of life”? For some it’s the feel of sunshine on their skin. For others, it’s the ability to play bridge.  Sometimes it helps to talk about “friends” who have had to make these types of choices for their families, or discuss what more distant relations are doing to plan for the future. Speaking about these things at a remove often helps to get the ball rolling.

No two families will approach this exercise in the same way and no two individuals will react the same way to similar circumstances.  And people change their minds, and that’s okay too. What is important is to begin the Conversation, in whatever way feels right to you and your sense of  your family’s beliefs, traditions and sensibilities.