In America, we don’t like talking about mortality. Nor do we like planning for it. About 60 percent of us die without a will.
This is a tragedy. Lack of planning can lead to all kinds of problems as the end of life approaches. If you’re not clear about your elder’s wishes, their final days may be plagued by uncertainty and conflict. A will is just the beginning. You and your family should also consider other kinds of planning such as advance directives for healthcare, power of attorney, and so on.
It’s easy to say, “Take action!” It’s much more challenging to do something. Ideally, we’d set these systems with our elders before they start to have problems. Alas, that rarely happens. There’s no magic way to get financial, health, and legal issues in hand.
Start first by trying to get your elder’s cooperation. Explain what worries you. Gently share examples of the kinds of things that you and other family members find concerning. Assure the patient that you want to make sure they’re safe. Try to enlist the help of other family members or friends.
Sometimes, if the elder resists, it helps to point out that if they accept a little help now, it will avoid the possibility of losing all their decision-making rights sooner than necessary. Explain that if you set up systems for their healthcare now, they won’t have to worry about how decisions will be made when they can no longer do so. If they make plans for their estate currently, they can be sure their wishes will be honored.
If you wait until a person no longer had decision-making capacity, it is too late to make plans. In that case, your elder and your family will have many fewer options.
If you’re lucky enough to be having these conversations while your elder still has the capacity, be sure to set up systems that can respond to many different situations. Are there family and friends who can help? Who will be in charge of finances? Who will make medical decisions? Who will manage the day-to-day running of the household and the checkbook? When the patient loses capacity, who or what will manage the patient’s affairs?
Always try to separate your interests from the interests of your elder. Sometimes these can be very different. If your elder can no longer express their wishes, you should try to make decisions based upon the elder’s beliefs, preferences, and needs.
Whole shelves of books have been written about end-of-life and estate planning. There’s far too much to be addressed in a blog post. Here are some things you should be discussing with your elder and your family:
- Power of Attorney: This is a legal document that allows a person to appoint someone else to act on their behalf. It is usually used for specific situations, determined by the elder, and lasts for a limited time.
- Durable Power of Attorney: This works like plain vanilla power of attorney but is “durable.” That is, it remains in effect if a person becomes incapacitated.
- Guardianship or Conservatorship: When a person becomes unable to care for himself, it may become necessary to appoint a person to care for his affairs. This situation may be called a “guardianship” or a “conservatorship.”
- Trust: A trust is a document in which one person transfers money or property to another person to benefit a third party. It’s also possible for a legal owner to trust property without transferring that property to anyone else.
- Will: As everyone knows, this is a document that spells out where a person wants their belongings to go after they’re gone.
- Advance Healthcare Directive: This is a generic term. This document may also be called a “living will,” a “personal directive,” an “advance directive,” or “advance decision.” It is intended to be written instructions outlining what the patient wants to be done medically if they become unable to make decisions due to illness or incapacity.
You can find more information about these planning tools at Elderconsult.com. Be sure to consult an attorney or estate planner as you go through this process.
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Elizabeth (Dr Liz) has over twenty years of experience in providing medical care to the elders. She is board-certified in Internal Medicine, Geriatric Medicine and Palliative Care Medicine. Dr Landsverk founded ElderConsult Geriatric Medicine, a house calls practice, to address the challenging medical and behavioral issues often facing older patients and their families.