“The Talk”: How to Have Difficult End of Life Conversations with Your Parents
Updated: Dec 8, 2022
Our relationships with family members have some of the most meaningful impacts on our lives. Admittedly, the relational dynamics of any given family are incredibly complex and sometimes messy. That being said, when the end is near for a loved one, hopefully, the majority of the details have already been taken care of, and you can focus on fond memories and celebrating a life well-lived. Here are a few tips to help you have productive, respectful end of life conversations with your parents.
1. It’s a Process – Take Your Time and Tread Lightly
End of life conversations are multi-faceted and may require a few different discussions to harmonize all the details. When we think about “the end,” it encompasses quite a bit more than just the death bed. It may be helpful to group these conversations into two broader categories: 1) day-to-day care and maintenance and 2) near-death decisions.
The day-to-day care and maintenance category centers around how your parents live their lives in their old age. Specific items to discuss would include what’s important to them as they age, fears they may have, the people involved in their care (i.e., their care team), and their preferences regarding staying in their home, moving in with a relative, live-in care, and assisted living facilities.
The near-death decisions are often handled through various estate planning documents such as a general power of attorney and medical directives with a power of attorney (sometimes called a health care proxy). These medical decisions and the documents that help articulate them are usually centered around life support or life-sustaining measures, pain relief regimens, and organ donation.
These conversations will prompt your parents to consider their mortality, so they may be hesitant to engage. This is normal. For you, you may be concerned that your parents could think you’re trying to pry into their lives or get a peek at what you may stand to inherit from them.
One way to counteract your parents’ hesitation and your own concerns is to focus on proactively ensuring that when the time comes, your parents’ wishes will be respected, and they will receive compassionate care and the best quality of life.
2. Discover What Your Parents Value
When engaging with parents, a bit of humility will serve you well. It may be tempting to think that you know what’s best for them, especially if their health has been declining, but these conversations will be most productive if you focus on listening to them and truly understanding their wishes. Take good notes and ask questions whenever the slightest detail is unclear – this will help you be more effective in fulfilling your parents’ wishes.
For you, these conversations are an opportunity to be of service to your parents. For your parents, these conversations are an opportunity to explain what they value. Try to be particularly sensitive to what they’re trying to convey and why it matters to them. If you dig deep enough to discover the rationale for why they feel a certain way, it will help you be a more vigorous advocate for them. Even if there are details that may be unimportant to you, if your parents spend the time to bring them up during these conversations, try not to brush those details aside.
Take the time to talk to them about what brings them joy. If a parent will experience a somewhat controlled or “expected” passing, you may be able to surround them with elements that bring them joy in those final moments. Some of those small joys could include classical music, artwork, flowers, or even the aroma of freshly baked bread.
It may seem odd to work through now, but in that moment of passing, odds are you’ll want to make your parents as comfortable as possible. At the very least, you may reacquaint yourself with a few of your parents’ favorite things, which could help you build an even deeper bond while they’re still with you.
3. Help Your Parents Understand Each Other
Your parents are most likely each responsible for the other’s care. Although you may initiate the end of life conversations to understand your role, it is also critical that your parents understand each other’s wishes. They may have different values, different interests, varying perspectives, and different preferences.
Discussing everything as a group will allow for more robust planning, identification of the nuances in your parents’ wishes, and shed light on potential hurdles to overcome.
4. Be Thorough, Be Detailed, and Ask Questions
Your parents may already have existing medical directives or other estate planning documents that attempt to address their wishes. These legal documents can be a good entry point into starting the conversation. For instance, if you are named as the person who will make medical decisions (i.e., you have been given power of attorney and can act as your parents’ agent), you might have questions about what this role will entail.
In addition to having these conversations, it is essential to review the existing documents to ensure that your parents’ wishes are accurately reflected in the documents. This document review is necessary even for individuals who may not be the agent who is named first (i.e., successor agents should understand they may have a role to fill).
Medical directives and documents regarding care decisions are not the easiest to understand, so talking through them with your parents can be incredibly helpful. There will likely be several “what if” questions that arise during the initial conversation. If these questions are not able to be fully addressed, jot them down for further discussion.
As family legacy planners, we are always happy to assess issues and brainstorm possible solutions with clients (for instance, assessing the feasibility of long-term care facilities). As an additional resource, the attorney who drafted any existing estate planning documents may also be able to provide insight.
5. Don’t Put This Off
When scheduling time to talk, the sooner, the better. You should have these conversations ahead of time in case your parents lose capacity or begin suffering from dementia, Alzheimer’s, or other diseases.
According to a survey by The Conversation Project (a national campaign dedicated to helping people talk about their wishes for end-of-life care)[i], 92% of Americans think it’s important to discuss their end of life care wishes; however, only 32% have actually shared those wishes.[ii] Moreover, 53% of Americans would be relieved if a loved one started the conversation.[iii]
It is much easier to have these conversations and devise a plan when all is calm, rather than creating a plan amidst the chaos when the need arises, which can happen suddenly.
Simply coming to grips with the unfortunate fact that sudden, debilitating medical conditions (such as strokes or heart attacks) are a real possibility can aid you in being prepared.
Often, people can be very particular about what they expect, how they want to be treated, where they will live, and who will provide care. Keep in mind that in the event of a sudden, catastrophic medical event, your parent may not be able to communicate afterward. Recognizing this possibility, the more in-depth and detailed your conversations are, the better. This is especially true when facing palliative care or a terminal illness.
6. Be Forward-Thinking
The exact time of a loved one’s passing is impossible to predict. Considering that reality, after having these conversations with your parents and understanding their wishes and your role, you should proactively engage in a follow-up discussion if circumstances change.
As a simple example, imagine that you planned to have your parents move into a guest house (ADU) on your property. However, you later end up having to move, or your parents have medical care needs that are more hands-on than expected. Having a follow-up conversation about revising the plan would be critical.
Similarly, suppose there are deaths in the family such that no one named in the existing estate planning documents is left/willing to serve in the roles identified. In that case, it will be imperative to take a close look at the documents and update them as needed.
While these conversations can be delicate, they can also be enlightening regarding your own legacy. As family legacy planners, we build plans which combine comprehensive estate, investment, insurance, and tax strategies. Our insight can be helpful as you navigate the ways in which your parents’ plans intertwine with your own. If you’re thinking about having a conversation with your parents, or if you’ve already had one but would like to receive some additional guidance, we are happy to assist. Schedule a complimentary meeting to discuss your legacy planning needs today.
Disclosures: This information should not be construed as investment, tax, or legal advice.
[i] The Conversation Project was founded in 2010 by Pulitzer Prize winner, Ellen Goodman.
[ii] “The Conversation Project - About Us.” The Conversation Project. Accessed November 29, 2021. https://theconversationproject.org/about/.
[iii] “Most Americans ‘Relieved’ to Talk about End-of-Life Care.” The Conversation Project, April 10, 2018. The Conversation Project. https://theconversationproject.org/wp-content/uploads/2018/07/Final-2018-Kelton-Findings-Press-Release.pdf.