Guest editorial: A conversation with loved ones can be important holiday gift
founder of Yarrow Hospice & Palliative Care
With the holiday season approaching, many people visit with family members they don’t see often during the year. While everyone anticipates a joyous reunion, for many it is also a time to look ahead and consider what support and change may be needed as parents and grandparents become more frail and in need of assistance. Some of those conversations may be difficult if for no other reason than acknowledging our collective mortality. Interestingly, reflecting on what really matters in your life as you approach death (which is true for all of us) gives rise to a much greater appreciation of each day.
It is important for parents and grandparents to consider that children and grandchildren deserve to know your wishes for the remainder of your life. What counts as a quality life for you? What is left on your bucket list that you wish to accomplish or experience? What medical intervention do you want or don’t want if you are not able to speak for yourself AND who should speak for you? Communicating your preferences to your family is critical because without that knowledge, there may be conflict within and between family members when time comes to make difficult decisions. “Disease may invade bodies of patients, but the experience of illness devastates all those around them. Suffering demands that others bear witness, and family members are assigned front-row seats.” Angelo E. Volandes, “The Conversation.”
Children and grandchildren – nudge your family to talk about what’s important to each of you in your life. Here are some suggestions:
- Plan for the conversation.
- Be sensitive to the fact that you will be discussing emotionally laden topics.
- Choose a place and time that are conducive to an open conversation.
- You may have to discuss the same topic on several separate occasions.
- Realize that family members may disagree and that the goal is to allow each person to have a say in the matters being discussed.
- Use “I” statements to get your view and feelings across.
- Do not use this time to discuss old wounds or bring up unresolved issues from the past.
- Be aware that initial decisions may change.
Planning is not only about the end of life choices, but as critical is the need to plan for caregiving that may be required long before the end of life. While most people prefer to remain in their home, doing so often requires assistance ranging from a couple of hours per day to 24-hour care. Long term care insurance can be essential in bridging the economic burden for care in the home or in a long term care facility. It is important to know that only short term rehabilitation is covered by insurance, including Medicare and all caregiving beyond that becomes a personal liability. Only once you have exhausted most personal assets, does Medicaid become a payor for caregiving.
While the issues to be considered may seem daunting, addressing them when there is not a crisis demanding an immediate decision, allows for improved, thoughtful choices going forward.
Consideration should be given to the following:
- What are the economic resources available for caregiving and/or what additional steps can be taken to improve those resources?
- What are the preferences of those family members most likely to be in need of caregiving?
- Are family members available, willing and able to assume some or all caregiving needs?
- What possible relocation may be necessary to ensure caregiving?
- What resources are available in the community where caregiving is likely to take place?
Start the conversation – let it be the gift you give each other this holiday season.
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