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

January 9, 2017

by: The My Medicare Matters team

Discussing “end of life” choices with an aging loved one can be incredibly difficult–not to mention upsetting and uncomfortable. Former Boston Globe columnist Ellen Goodman developed a program called The Conversation Project that aims to help. 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 Project to help support and facilitate these crucial discussions. In the spirit of Goodman’s mission, we decided to offer our own tips for getting started with this difficult topic:

1. Try to Find Some Levity

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.  Does your father want to be sent off to the most ridiculous pop song he can think of? Can you joke about how no one actually wants to inherit Great Aunt Mildred’s antiques?  It may sound strange or inappropriate, but it can actually be cathartic to try to find a little levity during these difficult discussions.

2. Make A “Desired Aging Plan”

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 their current home, moving to a retirement community, moving near younger relatives, or some other option?  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 their current home, if said home is not properly equipped for aging (i.e. there is a high risk of falls, or the hallway is too narrow for a wheelchair), it is important to help them either adapt their home to their new medical needs, or move somewhere else. Check out NCOA’s “Use Your Home to Stay at Home” guide to learn more.

3. Discuss Health Preferences

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. To start, how does that person define “quality of life”? For some, it’s the feeling of sunshine on their skin. For others, it’s the ability to play bridge. Make sure you understand what maintaining a high quality of life means to the older person you are assisting.

Secondly, make sure you have the full picture of any health or legal problems that may arise. Does your family have a history of stroke, heart attack or cancer that you may not be aware of? Does your aging family member have a health care proxy in case a sudden crisis strikes?  Do they have Do Not Resuscitate (DNR) orders on file, or do they want the doctors to take all possible measures to prolong life? Ask them now these questions now so there are no surprises down the road.

Finally, remember that no two families will approach this exercise in the same way, and that’s completely fine. Sometimes it helps to talk about friends or distant family members who have had to make these types of choices for their families–speaking about these difficult topics at a remove can help to get the ball rolling. No matter what your approach, the most important thing is to start these discussions as soon as possible.