2008/02/21 00:00:00
Understandably, most people are uncomfortable bringing up topics such as illness, infirmity, and death with their aging parents. However, initiating these discussions before the need arises allows for frank, open interaction about parents' wishes and everyone's expectations.
Advanced care planning entails looking at several aspects of the aging process and making contingency plans for managing transitions and possible crises. Let's look at the most important areas.
- Housing. Early on, you should discuss with your parents where they would like to live if they become unable to live in their own home. Options include your home, a sibling's home, an assisted-living facility, a nursing home, or subsidized senior apartments. Carefully review the pros and cons of each setting and put plans in place to make your parents' choice a reality - if and when the time comes.
- Finances. There might come a time where your parents no longer are able to handle their personal finances because of physical or mental infirmity. Before that happens, discuss with them whom they would like designated as their financial power of attorney. This also is a good time to draft a will for distribution of property and assets (if one has not already been created). Hiring an elder-care attorney is money well spent because all the necessary documents can be completed and registered in one meeting. Your parents' financial planning also might include the distribution of assets to "spend down" their estate or building up assets to pay for future medical and health care expenses. A certified financial planner can assist with setting up trust accounts, certificates of deposit, and annuities.
- Health. Statistically, seniors are at greater risk for stroke, heart attack, fractures, dementia, and complications from chronic illness. It's a good idea to become knowledgeable about the aging process and the problems common to seniors. Before health problems arise, discuss with your parents the possibility of a life-threatening event and their wishes regarding care and treatment. A living will and/or advance directive spells out how they want to handle resuscitation (CPR), mechanical ventilation (respirator or breathing machine), a feeding tube, artificial hydration, dialysis, and other specific treatments. An elder-care attorney can draft these documents or, in some states, your parents can complete them themselves using standardized forms, which then are notarized and registered with the state. It's best to make these decisions when your parents are in good health and can share their wishes with you. Documents can always be changed as needed.
- Death. One of the most difficult transitions in life is the loss of a loved one. Planning ahead for the ceremony and rituals surrounding death allows families to concentrate on grieving rather than the mundane details of the funeral, memorial, and burial. Death is never easy to discuss, but broaching the subject as part of your other discussions can open the door to planning. Emphasize that arrangements are your parents' choice and you wish to honor their decisions. You also might want to set up an appointment with a local funeral home to discuss pre-need plans and options. It might seem that there is never a good time to initiate these discussions, but you need to make time. Approaching the subject in a relaxed setting and during familiar routines always is helpful. If you have siblings, involve them in the process. Be prepared for arguments, disagreements, and dissent among family members, and don't hesitate to bring in an unbiased third party to keep the discussion focused if you fear that emotions might run high.
The following resources can help you with planning:
www.agingwithdignity.org
www.myhealthdirective.com
www.parentswish.com
Nanette Lavoie-Vaughan is an adult nurse practitioner and professional consultant. She is a featured speaker at national professional conferences and writes about geriatrics for multiple publications. If you'd like to send Nanette a comment, question, or suggestion for a future column, please e-mail rolereversal@moaa.org.