As I drove in the car around Thanksgiving, I caught an interesting story on National Public Radio: This Thanksgiving, Carve Out Time To Talk About End-Of-Life Wishes. As co-owner of SYNERGY HomeCare in Boston, that caught my attention. Peter and I know that when families gather together for the holidays, discussions of care for loved ones often come up. Since families are spread far and wide these days, it might be when families are able to see each other after quite some time. Signs of aging become apparent, and while Mom seemed strong and capable last spring, she might seem unsteady on her feet or more forgetful now. We receive many more calls about our services right after the holidays. The caller usually says something like, “My siblings and I talked about Dad’s increased need for help, and I volunteered to look around for services.”
This piece on the radio, by Jonel Aleccia, explores the importance of actually planning to have conversations about care--especially end of life care--when the family does come together. One might think that these discussions don’t belong in a festive, holiday atmosphere, but think about the warmth and love that we strive to share at these times. An honest and open discussion about serious things can reflect that love and the desire to care. It also shows respect and honor for the elder’s wishes.
I’m going to share some highlights from the piece, and while they are specific to end of life planning, I think the concepts apply to any discussion of care needs.
Aleccia cited two resources that can help a family get the most out of these conversations. One was the Five Wishes living will template, made available through the agency Aging with Dignity. President Paul Malley notices a surge of requests for this document during the holidays, so it is a discussion that many families are choosing to have, after the last bite of pie and the dishes are cleared. The five wishes address the pragmatic details of end of life, such as who should make the care decisions and what kind of care is wanted or not wanted. They also address more personal concerns, which could open up meaningful conversations as a family: values about whether to have prayer or to stay at home and how to be remembered at the memorial. These may be hard conversations to start, but sincerity and gentleness can bring tender and deep feeling to these topics. They might be the catalyst to some of the closest moments with family!
Another resource mentioned was The Conversation Project, which provides kits to help start the discussion of end-of-life plans. There is even a humorous video that shows a number of family members in front of the mirror, trying out different ways to broach the subject. After their awkward and funny attempts, they each become sincere and honest. Their tenderness and deep feeling are apparent. That’s when the conversation can become real and poignant and beautiful.
Most people agree that end-of-life discussions are important to have with loved ones, but a 2013 Conversation Project survey found that less than 30 percent have actually had “The Conversation”. There are many reasons that people hold back; they don’t want to appear insensitive or to bring up a sad but inevitable stage of life. They are busy with more immediate things and think they can get to The Conversation later. After all, there’s no imminent need, right? That’s the best time, however, to discuss these things, while the elder is still in good enough health to speak for him or herself and to express desires and preferences. In reality, there will never be a perfect time, so it’s better to be proactive and put it in the family schedule: this Christmas, we will talk!
And there are many positives that can come from having The Conversation. Rather than feel insulted, the elder will appreciate being heard, that his or her preferences are truly understood and acknowledged. It’s been shown that advance care planning, including the use of written documents like The Five Wishes or the Vial of Life, increases the chances that a person’s end-of-life wishes will be followed. And a conversation with all the adult family members who love and care for the elder gives him or her assurance and peace about what will happen in those last stages of life. The advanced directive can be sitting in the butter compartment of the fridge, but a real, in-person conversation assures that the family is aware and in agreement. Also, family members will have peace knowing that actions near and after their loved one’s death were planned and agreed upon. They don’t have to feel guilty or unsure about decisions made because they know the loved one’s wishes are being honored.
While the holidays are a good time to have “The Conversation,” it is also a good time to discuss more immediate care needs. When the family is together, it’s the easiest time to sit down over a cup of coffee and talk about how best to provide for aging parents or other loved ones. Are they able to manage activities of daily living (ADLs) like showering and dressing or preparing a meal? Do they remember to take their medications? Can they drive to appointments and out for shopping, or do they need transportation? The person who needs the care might also begin this conversation, making his or her needs known to the family and asking their assistance in finding solutions.
These conversations can take a cue from the end of life talks outlined above. What kind of care does the loved one need and want? What kind of care don’t they want? Where do they want to receive the care? What kind of caregiver would be the best fit? The goal is that the family coordinates to ensure that this person has the best and most independent quality of life possible, receiving the care that can help him or her achieve that.
SYNERGY HomeCare of Boston is prepared to meet with you at any time, to listen to your concerns and help you think through the possibilities. Our non-medical homecare services, whether provided in the client’s home or in a facility, enable the client to stay as active as possible. While helping with ADLs, offering companionship, and providing transportation and light housekeeping, our caregivers keep the client safe and engaged. This is the greatest gift you could give to your loved one!