How to Talk to an Elderly Parent About End-of-Life Decisions

 In Advice

For those adult children who are providing care to their aging parents, talking about end-of-life issues can be a daunting prospect. The oldest members of our society have lived through a time when death was rarely discussed and planning for the end of life was not an option to be considered. They may never have thought about their own death and may be resistant to attempts to bring up the once-taboo subject.

But we know that having these difficult conversations in advance can lead to better quality of life and less family stress during the last days of life, not to mention decreased futile medical treatment and unwanted intervention. So the value of talking about end-of-life decisions with elderly parents cannot be overstated, even though it may present a challenge to children who take on this task.

Here are some suggestions for starting a conversation and making it valuable and worthwhile for everyone involved:

Don’t put it off

Discussions about end-of-life issues are best when conducted over time, with multiple opportunities to explore the options available and the emotions surrounding the subject. Those families that wait until a health crisis occurs end up making hasty decisions without really knowing their loved one’s preferences. Talking in advance allows everyone to process the fact that death is a normal part of life and should be planned for just like we plan ahead for college, marriage, retirement or other milestone events of life.

Beginning the conversation about the end of life while your loved one is still relatively far away from that event allows for a gradual step-wise approach to the subject that can proceed slowly over several months. Everyone will feel more comfortable talking about death if it seems to be more distant in the future.

Complete your own advance directive form first

By filling out your own living will in advance you will have experienced the challenge for yourself of thinking about your preferences for the end of life. The knowledge you gain will help you tune in to how your parent might feel about answering these questions and also prepare you for the difficulties in this process. In addition you’ll be able to start your conversation by talking about your own choices and why you felt you needed to complete an advance directive.

Do your homework

Spend some time researching options for end-of-life care such as hospice and palliative care and also find out what facilities and programs are available in your community. Eventually you will want to create a list of questions to consider with your loved one so that you can stay organized during your discussion and not leave out any important issues. The Starter Kit from The Conversation Project can be a helpful guide to get you started. Learn more about hospice care at http://caringinfo.org. You might also consult a local hospice to get more information from them about the services they offer.

Choose the right time and place

Some experts recommend starting end-of-life discussions during a special event, such as a holiday dinner, when a large number of family members are present. The advantage of this strategy is that you can communicate with many people at once. However it may feel too chaotic and too confronting to bring up a sensitive topic at a time of celebration. For some people it may be better to talk over a quiet lunch or while on a walk or drive together. If your parent has had a recent medical check-up or change in health status, that can also be a good time to bring up the discussion.

Plan a great introduction

You will feel more confident in initiating the discussion if you have already decided how to bring it up. You might remark that you recently completed your own living will or read an article or talked to your own doctor about end-of-life decisions. As mentioned previously you can begin by describing your own feelings about the process, why it was positive for you and how you feel it will benefit your loved ones to know your choices.

Another option is to ask your parent what it was like for them when their own parents died. Through the telling of those stories you can glean what went wrong (or right) at your grandparents’ end of life and then ask: “How would like it to be for you when it’s your time?”

You can also watch a film together like “The Bucket List” and use that as a conversation starter. Begin by talking about your own bucket lists and then move on from there to ask about wishes for healthcare at the end of life.

Proceed slowly and gradually

The advantage of talking about these issues far in advance is that you will have time to divide the conversation into shorter segments so you won’t have to address everything at once. Begin by talking about “bucket list” items as above, then move to healthcare choices, such as quality vs. quantity of life, care at home or in a facility, natural dying vs. prolonging life through artificial means, and finally, after-death considerations like funeral and burial options.

Take notes

During your discussion be sure to write down your parent’s most important wishes, then review your notes together to make sure they are accurate. These notes will come in handy when you need to share this information with other family members. Also in a moment of crisis your memory may be faulty so you will be grateful to have written documents that verify your conversation. Have your parent complete an advance directive form and be sure that they share it with medical providers, attorneys and clergy in addition to other loved ones.

Be persistent

This end-of-life conversation is one of the most important discussions you will have with your parent, so don’t be deterred. Even if you get rejected at first keep trying over time to introduce the topic in various ways. Watch for opportunities to talk further such as when a friend or relative dies or a tragedy is mentioned in the news; gather articles from magazines and newspapers; describe a funeral you’ve attended; talk about teaching your own children about grief. There are many different ways to approach this subject so be creative and don’t give up.

Ultimately everyone will benefit from the effort you make to talk to your parent about the end of life. Remember that 100 years ago death was a normal part of everyday life and took place in everyone’s home, so conversations about death happened naturally and of necessity. By fostering an end-of-life discussion in our homes we are restoring a tradition of the past that will bring greater balance and peace to us throughout the rest of our lives.

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