Simple Questions to Start an End-of-Life Conversation with an Elderly Loved One
Statistics show that when people talk about their healthcare wishes long before they reach the end of life, they receive less unnecessary and expensive care when they are dying. An excellent example of this fact is La Crosse, Wisconsin, where, as a result of a 20-year old initiative to talk about end-of-life planning, 96% of people who die have completed paperwork to specify their wishes for care. Because of this preparation the community spends less on end-of-life healthcare than any other place in the country. 1
We know that talking about death and dying helps people get the healthcare they want and avoid the care they don’t want, yet most people don’t have conversations about the end of life. According to a survey by The Conversation Project 90% of those surveyed think it’s important to have this conversation but only 27% have actually talked to someone else about what they want for themselves when they reach life’s end.2
This is one of the most difficult discussions we can have with a loved one. When I needed to bring up the subject with my own mother I struggled with how to begin. I didn’t want her to misinterpret my intentions or to be frightened about her health when I brought it up. I also sensed that if I “blew it” with my first attempt at talking about the end of life, I might not get another chance.
Eventually I thought of two questions that helped me broach the subject of death and dying with Mom and led us to a meaningful conversation:
“What was it like for you when Grandma and Grandpa died?”
Mom loved telling stories about the past and I found that she was eager to talk to me about the deaths of her parents. I learned that she felt guilty that Grandma had died in the hospital after her third heart attack. She had told Mom she never wanted to go to a hospital or be resuscitated again. Mom hadn’t been able to change the circumstances of her own mother’s death because there was no hospice in the community at that time and no awareness of advance directives.
Next she told me that Grandpa had died in the hospital all alone in the middle of the night while he awaited surgery the next morning. Again she felt guilty that no one was with Grandpa when he died and wondered what she could have done differently.
Both of these stories helped me explain to her how things are different now, and how hospices help people stay at home (if that is their wish) and advance directives help them avoid unwanted treatments. Families that are well-informed about their loved ones wishes can help make the best possible medical decisions when that person reaches the end of life. This led directly to my next question for Mom:
“What would you like to be different for you when your time comes?”
This seemed like a logical and natural question to ask when it followed the previous conversation. Mom wasn’t shocked or upset at all when I asked it. She actually seemed relieved to tell me some things she had thought.
She told me she was certain she did not want to die in a hospital or any other facility. She wanted, if possible, to die in her own home and in her own bed. She also wanted to have only minimal medical intervention during the rest of her life because she felt it was natural to grow older and die of old age. She didn’t want to be subjected to treatments that wouldn’t make a difference and would only “make her miserable.”
From there we discussed what she envisioned as a “perfect funeral,” where she wanted to be buried and how she wanted her possessions to be distributed to her family and friends. She told me she had wanted to talk about these issues but hadn’t known how to bring them up and she was grateful that I asked her those two simple questions.
If you are struggling to start a conversation with your elderly loved one think of your own simple questions that might open the subject in a non-threatening way—or feel free to borrow mine. Any amount of discussion that follows will be helpful and informative. I guarantee you will be glad you made the effort to have this talk and you might even be inspired to think about your own end of life wishes. It’s never too early to start the conversation and the process.