How to Talk to Aging Parents About End-of-Life Planning

Talking about death matters.

Death is the universal human experience and it touches us all at one point or another. Despite this, the topic is often brushed aside or given as little attention as possible.

There’s a strange kind of paradox here, roughly 92% of people think that discussing end-of-life care and death is important. Yet, less than a third actually have these conversations. There’s something about the topic that makes us shy away, even when we know how crucial it is.

Yet, conversations about death don’t need to be morbid.

They can be surprisingly empowering, helping people to face the unknown with less fear and more peace. Such conversations also provide the space for end-of-life planning, which is what we’re looking at today.

The Basics of End-of-Life Planning

End-of-life planning is exactly what the name suggests – making plans and decisions for the end of your life. These plans can relate to many areas, including healthcare, finances, estate, and your legacy.

The best practice is to make the plans well in advance, then update them regularly. This means there’s less pressure and stress if you’re ill, and there’s always information there in case of an accident. Of course, not everyone manages this and that’s okay. In the end, whenever you do advance planning is better than not doing it at all.

For today, we’re specifically interested in advance care planning.

This specifically relates to decisions about future healthcare. It not only covers conversations on the topic, but also the legal paperwork, like Living Wills and Power of Attorney.

This type of planning is powerful, because health status can change suddenly, yet the required paperwork takes time and attention to complete.

There are also many cases where a person isn’t conscious or mentally competent at the end of their life, so they can’t make the necessary decisions themselves. So, it’s crucial to get the paperwork in place early – and to have conversations about end-of-life wishes.

Many adult children end up trying to support a dying senior who hasn’t planned for their death. Doing so can be incredibly confusing and stressful, especially if you’re in the position of making healthcare decisions for them, but don’t know what their wishes are.

As such, end-of-life planning is crucial.

So, how do you have the conversations?

How To Have the End-of-Life Conversations

Allow Space for Emotions

Difficult topics should always be approached with care. This is particularly true for end-of-life, as there are many complex emotions at play – affecting everyone involved.

Douglas Stone, Bruce Patton, and Sheila Heen talk about this in their book Difficult Conversations. Here, they highlight three types of conversations: What Happened, Feelings, and Identity.

Considering conversations in this way makes it easier to account for emotional and identity challenges, instead of expecting people to jump straight to the rational side of the argument.

Some areas to consider include the following:

• Fear of making the wrong decision or saying the wrong thing.
• Fear of the unknown.
• Concern that appearing weak may put them at risk. This is especially true for seniors who still live in their homes and do not want to move into assisted living of any form.
• Stress, strife or conflict within the family.
• Denial.
• The presence of secrets that they do not wish to share.
• Simply not being used to talking about emotions and/or having no interest in doing so.
• Not knowing who to trust. This can be particularly significant for anyone who has had their trust broken in the past.

Allowing space for emotions may mean that you start the conversations gently, stop when they get too much, and come back later. You might also talk through some of the fears first, affirming that you understand the topic is difficult and scary. 

Broach The Conversation Gently

End-of-life conversations aren’t just about what you say. They’re also about how you say it.

The site Dying Matters also highlights valuable ways that you can broach the topics, as well as how you can respond. Some key takeaways from their piece are the following:

• Be respectful. You don’t have to agree with what the other person wants to do and their wishes may not even be feasible. But, you still need to be respectful and understand that this is ultimately about their desires, not yours.
• Be calm and collected. As much as possible, try to retain a level head. End-of-life topics are challenging and can be immensely emotional. But, you need to be the one to guide the conversation, which may sometimes mean not giving in to your emotions.
• Focus on leading questions. End-of-life is a large and complex topic. The idea of simply talking about it often won’t be enough, the senior simply won’t know where to begin. Leading questions are a powerful way to guide the conversation without being overwhelming.
• Stay engaged. Use conversational tools like eye contact and body language to ensure that the senior knows you are interested and are listening to what they have to say.
• Provide comfort. Comfort can come in many forms and the best approach may vary depending on your family member. But, short comforting statements (like ‘I’m here for you’) and the touch of a hand are powerful approaches that can make the process much easier.
• Stop when needed. You may need to have multiple conversations, so the senior has time to process their thoughts and emotions. Ideally, conversations should be stopped before they feel overwhelming.

Follow Their Lead

Denial is common as people reach the end of their lives, but it isn’t always a bad thing. In fact, denial can have helpful elements, like helping people process information in a manageable way.

And, even if your parent isn’t in denial, they may have their own way of processing information.

Notably, people deal with end-of-life in different ways and with their own timing. It’s important to respect this, instead of trying to force the senior into a conversation before they’re ready.

Because of this, you may sometimes need to step back entirely.

Doing so can be tough, especially if there isn’t much time, but you may not even have much of a choice. You may need to introduce the topic, then wait for the senior to be ready and willing to talk about it.

After all, you can’t force someone to talk about something. Attempting to do so could easily make the senior more resistant.

Talk About Why

It may be helpful to explain why it’s so important to talk about end-of-life issues.

This includes bringing up the idea of advance planning and the need for official paperwork about end-of-life wishes. Some seniors may not realize that their wishes need to be recorded in a specific way for them to be followed.

This is also a chance to explain how conversations help family members.

In particular, knowing the parent’s wishes and having the correct paperwork completed can give the family peace of mind. This also makes advocating for the senior’s wishes easier and a lot less stressful.

Far too many family members have found themselves trying to make care decisions, without knowing what the senior would have wanted. This creates a guilt-laden situation, as the family can never be certain they’re doing the right thing.

Rely on Tools and Guides

You don’t have to have these conversations based on your instincts alone. There are plenty of products and services out there that can step you through the process.

For example, some guides will highlight key questions that you can ask and areas that need to be talked about. They might even give you lead in questions and ideas about how to broach a particularly difficult topic.

Two powerful examples are The Conversation Project and PREPARE.

Both are designed to make end-of-life conversations easy, especially for people who don’t know where to begin.

The Conversation Project also features a Conversation Starter Kit, which can be viewed online or printed. This kit provides a step-by-step approach for addressing this complex topic, along with places for you to write down information as you go.

Many of the sections are easy to fill in, asking for answers on a scale of 1 to 4. This helps to make the topic much less overwhelming and easier to follow.

Even if you don’t plan on using a formal guide, we recommend checking out the kit. It may give you ideas about how to tackle the topics and the angles you can consider.

When it comes to stepping through planning, Five Wishes is an excellent tool. The Five Wishes booklet is an easy-to-understand version of advance planning paperwork, one that’s legal in most states. In contrast, many other advance planning forms can be challenging to follow and understand.

Consider Spiritual Support

End-of-life is often the time when people start to ask questions and want to learn more about faith. It’s important to provide support here and to facilitate whatever concerns your family member may have.

This could involve getting a local pastor involved. A chaplain in a hospital or palliative care environment will often have the ability to contact people from other faiths and provide support.

Of course, not everyone will want spiritual support. You need to find the balance that works best for the person in your life, based on their wants and needs (not your own).

Final Thoughts

End-of-life conversations are hard. It doesn’t matter how prepared you are; the process can be draining and often frustrating.

You may also be fighting an uphill battle, especially if your family member is uncomfortable talking about the topic. This could even mean you never get the answers that you want.

And honestly, that’s okay. At the end of the day, this area is all about the senior and their wishes. If their wishes are mostly not to think and talk about end-of-life, then that may simply be how things have to go.