| Tue, Jun 18, 2013 @ 09:00 AM

Caregiver Corner: Necessary Conversations Part 2

Posted by Medicare Made Clear

end-of-lifeThe second in a 3-part series by Dr. Jamie Huysman, Vice President, UnitedHealthcare

No one is truly prepared to hear that a loved one is going to die. Although it is part of life, most of us still don’t want to accept death let alone prepare for it. In fact, a loved one’s serious diagnosis, impending death or sudden death can send an unprepared family into confusion and chaos.

In the best case scenario, the person transitioning or who has passed prepared for the end well before the need arose. It may not be a pleasant task, but it’s important to discuss and plan for health and legal needs and wishes for the end of life.

Advance end-of-life planning can help ease worry when the time comes. It can allow the individual and loved ones to focus on what’s most important to them at the time, rather than on putting affairs in order. Completing this task ahead of time may also be source of a comfort during life.

For families facing a serious diagnosis unprepared, it’s possible to embrace the situation as a gift of time. Helping a loved one identify their wishes can be a very intimate and loving experience. In some cases, it may help transform fear, anxiety and confusion into a sense of peace and serenity for all involved.

How to Talk About the End of Life

As with any sensitive conversation, choosing an appropriate time and setting is very important. Try to find a time and place when you and your loved one are relaxed, comfortable and can speak in private. Approach the topic delicately, first asking your loved one for permission. You might say for example, “I’m afraid that I won’t know what kind of care you would want if you ever got really sick. Can we talk about this now?”

Your loved one may or may not be ready to discuss their wishes when you first ask. It’s important to respect their readiness and go at their pace. You may have to bring the topic up several times. Keep trying, and remember that you are doing it because you care about your loved one and want to honor their wishes.

Once the conversation starts, be patient and listen. You may want to repeat what you hear and ask clarifying questions to make sure that you understand. Questions you may want to ask include:

  • If you were diagnosed with a life-limiting illness, what kind of treatment would you want to receive?

  • Who would you want to make decisions on your behalf if you became unable to do so?

  • Do you have a will? Who knows where it is?

  • How would you like to be honored at the end of life?

  • What can I do to best support you and your choices?

Documenting End-of-Life Wishes

End-of-life planning is a vast and sensitive topic with many variables. What I hope to do here is to highlight a few key things to think about when creating a plan for yourself or a loved one. It’s a good idea for each of us to have the following documents and information filed in a safe place. You can then review your decisions and choices periodically, and make changes as needed.

  • Create a living will to tell doctors how you want to be treated if you are dying, permanently unconscious or otherwise unable to communicate your wishes.

  • Create a durable power of attorney for health care to name a healthcare proxy who can make decisions for you if you are unable to make them for yourself. Your proxy can help ensure that the wishes of your living will are carried out.

  • Write a will and name an executor who can manage settling your estate. Your will can also define your funeral, burial or cremation wishes.

  • Make a file of all financial and insurance account numbers, passwords and safety deposit box locations. Make sure your executor knows where this file is and how to access your accounts.

If You Need Help Now

For families currently facing an end-of-life experience, the clinician in me strongly suggests that you seek help. Professionals, such as geriatric care managers or licensed clinical social workers, are skilled sounding boards. They are trained in matters of death and dying and how to help manage emotional family triggers that may arise. The family lawyer and clergyman may also be welcome advisers during this time.

Professional support is available through healthcare organizations, community groups designed just for this purpose and other sources. There may or may not be a cost. Your doctor or your local hospital can help you locate resources in your area.

And finally, if you are a caregiver, make sure you create a self-care plan. You can do a great deal to get in touch with your own feelings while laying the groundwork for grieving later. Be kind to yourself. Do the best you can, and make sure to “take your oxygen first.”

Look for part 3 of the “Necessary Conversations” series next month when we will discuss conversations caregivers may need to have for their own well-being.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.


Care and Planning for End-of-Life: Watch this video to learn more about legal and financial preparations.

AgingWithDignity.org: Learn about advance directives and create your own.

Medicare.gov: Visit the official U.S. government site for Medicare.


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