Dear Attorney Tully: Dad’s physical health is failing rapidly. He is already in a wheelchair and I suspect it’s probably time for him to go into a nursing home for long-term care. But, I’m worried because there is so much COVID-19 in the nursing homes and Dad has not done any of the things you have suggested over the years in your column regarding estate planning and asset protection. Can you suggest ways for me to bring these things up to him?
ANSWER: Certainly. Communicating end of life wishes will provide clarity and reduce anxiety for your dad and family. It’s important that you have “The Talk.”
“The talk” involves a frank discussion with your dad about financial and health care arrangements for the end of life. The discussion should include where the he wants to live, how he wants to be cared for, how he wants his money managed and what kinds of burial or funeral arrangements he would prefer.
Seniors and their families often ask our law firm how they can get their parents to talk about their long-term care, finances and final arrangements. These and other delicate aging issues often go unaddressed because of an individual’s discomfort with these issues. We are also often asked when these discussions should occur.
There are a few benchmarks that our firm uses to initiate discussion on difficult aging subjects. If the adult child is over 40 and the parent is over 70, it is time to have ‘the talk’. We call this the 40-70 rule. Aging is inevitable and by this age ‘the talk’ is necessary.
Let’s face it, talking to our loved ones about aging, money and death are not the easiest topics in the world. The hard part about talking with aging parents, is that they’re used to being in charge, instead of getting advice from their children. Probably the most important aspect of having “the talk” is to at least start a dialogue and break the ice.
Dr. Atul Gawande, in his excellent book, On Being Mortal writes about a 1991 study in La Crosse, Wisconsin.
Local medical leaders headed a systematic campaign to get medical people and patients to discuss end-of-life wishes. Within a few years, it became routine for all patients admitted to the hospital, nursing home or assisted living facility to sit down with someone experienced in these conversations and complete a multiple-choice form that boiled down to four crucial questions. At this moment in your life, the form asked:
Do you want to be resuscitated if your heart stops?
Do you want aggressive treatments such as intubation and medical ventilation?
Do you want antibiotics?
Do you want tube or intravenous feeding if you can’t eat on your own?
By 1996, 85 percent of La Crosse residents who died had a written advanced directive like this, up from 15 percent, and doctors virtually always knew of the instructions and followed them.
How can an independent, trained professional assist with “the talk”? Often when a senior hears information from a professional, non-family member, it resonates more than when the information is coming from a family member.
When “the talk” begins in an elder law attorney’s office, it is easier for all to speak on issues, such as finances, health and end-of-life.