Posts Tagged ‘end-of-life planning’

10 Steps to Communicate Your End-of-Life Wishes



Communicating your end-of-life wishes is often among the most difficult conversations you can have with your family and loved ones. It’s also a conversation that many avoid until it’s too late.

The importance of clearly laying out your end-of-life preferences cannot be overstated, however. And doing so before you a suffer a life-threatening illness or other crisis will help reduce anxiety and doubt for family members who may be confused about final wishes that haven’t been clearly expressed.

Perhaps the most important question when it comes to communicating end-of-life wishes is, “how to do it?” Fortunately, there are a variety of steps you can take and proven methods that should make the process easier for you and your family. Getting started now, before it’s too late, should be a priority.

  1. Plan ahead

There’s no time like the present when it comes to letting your loved ones know about your final wishes is now. You can start by drawing up a living will that states your treatment and care preferences if you should ever be in a position where you can’t speak for yourself.

It’s also important to have a durable power of attorney in place that appoints one family member or other trusted person to make medical decisions for you in the event you’re unable to do so. Take all the time you need to reflect on what’s most important to you, then get the paperwork started.

  1. Be clear about what you want

It’s not easy to think about becoming too ill to make healthcare and other important decisions. But a critical injury or debilitating illness can happen to anyone at any time, and it’s vital to be clear about your wishes as soon as you can in case the unthinkable happens to you.

  1. Finding the right opportunities

While finding the right time to talk about your end-of-life issues can be a challenge, here are some events that can present opportunities to sit down with family and loved ones:

*Gatherings or time spent related to milestones such as the birth of a child, marriage, death of a loved one, retirement, anniversaries, etc.

*During holiday gatherings when many family members may be present.

*When creating your will or other estate planning.

*When a major illness requires that you or another family member move out of the home and into a long-term care setting – such as an assisted living community or a nursing home – or when a friend or family member is facing a serious illness or end-of-life situation.

  1. Talk often

It’s important to have end-of-life conversations early and to ensure that everyone understands your wishes. Moreover, your preferences may change over time and create the need for regular discussions on the subject.

  1. Ask permission

Again, discussing end-of-life issues isn’t necessarily easy, and it may make some of your family members uncomfortable. Asking your loved ones for permission before diving into the topic reassures them that you respect and honor everyone’s desires.

  1. Keep the purpose in mind

Your conversations with loved ones should address two important goals: making sure that your financial and healthcare wishes are expressed and honored, and providing them with the information and confidence they need to make future decisions.

  1. Find an Appropriate Setting

Find a quiet, comfortable place to have discussions about end-of-life wishes – preferably somewhere private and without distractions. A noisy restaurant or other public places is probably not the right setting to broach this tough topic.

  1. Be a good listener

Whether you’re discussing your end-of-life wishes, listening to another family member express theirs, or getting feedback from family and friends, it’s important to listen carefully. Make every effort to hear and understand what your loved ones are saying, and make clear to them that it’s important to you. If you’re listening to someone else,express their wishes, try to reaffirm what they’re saying and acknowledge their right to make life choices, even if you disagree with them.

  1. Know your audience

Some loved ones and family members may want to discuss end-of-life wishes in private rather than in a group setting. Use your knowledge of the people involved to figure out the best way express your wishes.

  1. Let others set the pace

If you’re in the role of listening to a family member express their wishes, follow their lead. Avoid correcting the person or becoming argumentative if they say something you don’t agree with.

End-of-Life: Starting the Conversation

My beloved grandfather was a life-long smoker. As a direct result, he struggled with emphysema in the last years of his life and it was a miserable condition to die from. Of the many wonderful things he passed down to me, one was indirectly from him but from how he passed.

My father watched his suffering in and out of the hospital over several weeks. We didn’t know about hospice then and it was a cycle of going to the hospital, get feeding tubes to feed him, then send him home where his body was shutting down and didn’t want to eat and then back to the hospital once again. This was repeated two – three times and my poor grandfather was so miserable. My dad helped him as best he could through it all and determined he would never go through the kind of misery my grandpa had to deal with, but more importantly that he would never put me through what he and my mom went through.

My grandparents never really talked much about “the end of life” with my parents. It just happened. My parents remembered that and chose to be wonderfully proactive about discussing this topic with me several years before my dad died, as he saw the direction his Parkinson’s Disease was headed.

We talked about and implemented both a Living Will and a Power of Attorney. We also discussed how they wanted to handle all the different steps involved with a positive “end-of-life” for both parents. Thanks to an article I read, we even talked about my dad’s favorite Bible verses and hymns which we used for his memorial service after he passed away.

And yes! As hard as his last year was for him, for mom, for our families, and for myself, all that pre-planning made this difficult season of life much easier than it could have been.

Of course, you or your senior parents don’t need to have a disease to talk about this tough topic. Even if you are in excellent health, it is an important discussion to have.Senior and Loved One Holding Hands After the publicity of the Terri Schiavo case, my kids and I all discussed who would be in charge if one of them – or I – was injured and unable to express our wishes in that situation.
Hopefully, we will never need to deal with anything like that, but if we do, we are definitely better prepared to do so.

My parents and I didn’t discuss these topics over dinner. We usually just chatted about them when I was visiting at their home or when we were out at doctor appointments. I did read at AARP about an interesting trend among many of us baby boomers – Discussing End-of-Life Issues Over Dinner.

Whether you decide to go with a dinner format or a more casual chat in the living room, there are some excellent resources online to help us with these discussions and with preparing and planning for a positive and proactive “end-of-life.”

  • The National Institute on Aging has some excellent information to help with this topic including a free PDF booklet – End-of-Life: Helping With Comfort and Care – and another free PDF – Getting Your Affairs in Order. Be sure to scroll all the way to the bottom as you should see links to even more useful pages and booklets.
  • AARP has another good article, Beginning the Conversation About the End of Life with suggestions for questions to ask and links to more resources.
  • The National Hospice and Palliative Care Organization has some excellent links and resources at Learn About End-of-Life Care. They cover the topics of hospice and palliative care as well as Advance DIrectives and Living Wills, including state-specific Advance Directives for you to download.
  • Alzheimer’s Disease diagnoses are growing and this health issue definitely has some extra challenges. has a good section on Planning for Your Future including Legal and Financial Planning, Building a Care Plan and End of Life Planning.
  • Kiplinger’s is always a favorite resource of mine including their article, 4 Key End-of-Life Documents to Get in Order which lists the four vital forms along with the reminder that many banks and other companies have their own forms as well, something my family has run into many times! So be sure to check with all your banks and financial institutions to ask whether they will accept what you have or need another form from them.

All of these combined are an excellent starting point for what is usually a long season of preparation and implementation for elderly parents and those who will be helping them address this topic. It’s not an easy time but it can be the beginning of a new kind of closeness with each other as you come alongside to help one another. It’s also a wonderful opportunity to set an example for the next generation. And as time-consuming as all this paperwork can seem, in the long run it will truly be a major time and stress-saver.

How about you? Have you or your elderly parents already had this “end of life” discussion? Do you have any thoughts or suggestions for resources to add to our list. We’d love to hear them in the comments below.

Written by senior living writer Kaye Swain

Medicare Costs at End-of-Life Driven Largely by Daily Functioning

Researchers from the Mount Sinai School of Medicine in New York and the University of California in Los Angeles released the results of a study examining factors that influence the costs of end-of-life care on February 15, 2011. The study, “Determinants of Medical Expenditures in the Last 6 Months of Life,” led by Dr. Amy Kelley of the Mount Sinai School of Medicine, found that costs associated with end-of-life care rely more heavily on individual patient characteristics than geographic region, which was previously believed to be the primary driving factor behind end-of-life costs.  Frequent hospital stays mean higher end-of-life costs

In prior research, Medicare costs during the last six months of life were strongly correlated with a patient’s geographic location. Previous research didn’t account for individual patient characteristics, such as impairment, a decreased ability to perform one’s activities of daily living (ADLs) and a patient’s support systems. This current study examined 2,400 older adults across the United States and took individual circumstances into account, as well as the characteristics of local health systems.

A person’s level of impairment and ability to perform ADLs was found to be a stronger predictor of higher Medicare costs than the person’s medical condition. Dr. Catherine Sarkisisan of UCLA says (as quoted on, “Having a caregiver available may help people avoid undesired hospital stays,” indicating that higher costs in the last six months of life could be attributed to more frequent hospital stays among older adults who lack sufficient support systems and don’t reside in a communal setting, such as assisted living or a nursing home, where caregivers and licensed staff are available to help residents 24 hours per day with their ADLs and other needs.

The study also found that advance care planning had no impact on Medicare costs near end-of-life, but having family nearby and dementia were associated with lower expenditures. A few chronic diseases, such as diabetes, were associated with higher end-of-life costs.

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Advance Care Planning Now Possible Under Medicare

Effective January 1, 2011, seniors will have the option of voluntary advance care planning under the Medicare benefit. This same benefit was initially included in the original health care overhaul, but opponents successfully abolished it from the initial reform bill with a public outry labeling the practice “death panels” and calling it “government-sponsored euthanasia,” according to End-of-life discussions

Some say that opponents of the reform bill merely took the opportunity to turn the public against health care reform. Others say that encouraging and funding end-of-life discussions may lead seniors to forego life-sustaining or life-extending treatments they may otherwise have opted to receive.

Encouraging end-of-life talk is not new in the healthcare industry. In the past decade, pioneers have stressed the importance of educating the public about their options when it comes to end-of-life treatments and encouraging them to make their own choices about the treatments they choose to receive. It’s standard practice in many assisted living facilities and nursing homes for social workers to aid residents in end-of-life planning.

Any adult can legally elect to receive — or not — different types of life-sustaining treatments in the event of terminal illness or catastrophic injury. These documents are referred to as advance directives, living wills, or “Do Not Resuscitate” orders. Laws on these documents vary from state to state, as do the specific meanings of the terms.

In some instances, a “Do Not Resuscitate” order simply indicates a person does not wish to receive cardiopulmonary resuscitation (CPR) or advanced cardiac life support if the heart stops beating, while an advance directive or living will — in most cases — details the different circumstances under which an individual wishes to receive a variety of life-sustaining treatments, such as intubation (feeding tube) or being placed on a ventilator.

The new regulation will enable seniors to (at their own choosing) consult with a physician and receive assistance filling out end-of-life forms. The question at the center of this debate is whether or not such discussions will cause seniors to feel pressure to opt out of treatments they actually want.

What are your thoughts on the subject? Do end-of-life discussions discourage seniors from receiving life sustaining treatments or serve as a means to educate on the options and empower seniors to make their own decisions?

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