Having The (Healthcare Decision) Talk
Difficult conversations—they go hand-in-hand with parenting, like skinned knees and training wheels. When we’re younger, those tough talks may center around Is the Tooth Fairy real? Where do babies come from? or When can I be ungrounded?
As important as those conversations may have seemed at the time, as we age, the topics between a parent and a now-adult child often shift, and those topics can be even more difficult to discuss, especially when it comes to talking about health care decisions.
Discussing health care decisions with our loved ones, as it turns out, is something at which many of us are not very good: according to an article by the National Institutes of Health (NIH), the rate with which caregivers can accurately discuss the health care wishes of their loved ones is around 68%. With grades like that, we would all be grounded.
Why is it so difficult for adults to discuss health care issues with their elderly relatives? Take your pick from worries about privacy or losing control, to actively denying the deterioration of a loved one, or fear of passing away or losing a loved one. The difficulty of the conversation increases with emotional intensity. The NIH report, however, makes it very apparent that "understanding care-seekers' preferences is never more critical than when care-seekers are incapacitated, especially when life-or-death decisions about medical interventions are required." In other words, it is crucial to know exactly what your loved one would want in any health care circumstance, especially when they are unable to make decisions for themselves. Thus, whether it's painful or not, it may be time to have The Talk with your parents—again, and, hopefully, before a crisis arises. Thankfully, there are a number of very helpful tips and resources available to help ease the conversation:
- Be prepared to listen when you begin having ‘The Talk’. The most important question, and the first one you should ask a loved one, is “How involved do you want me to be in your health care during this time?” Do they want you to speak with their medical professionals, therapists, or insurance providers? If so, then under what conditions? Only if they are completely incapable? Just in times of need? Asking your loved one how they would like to be helped and how much would be helpful rather than just stepping in without their permission or even an invitation can be a much more reassuring approach for family members. Your loved one may already be at a stage in life where they are beginning to feel a real sense of loss of independence and control.
- Help your loved one understand the importance of preparing for the future from a legal There are several ways of doing this including completing forms available surrounding direction in the case of an emergency (EMS/DNR forms). Another is establishing a medical power of attorney or advance directive. A power of attorney for health care permits the person you designate as your agent to make decisions on your behalf regarding your health care, but it does not specify what those wishes may be. This is where an advance directive differs from a power of attorney for health care. According to the Medicare Rights Center's website, it is crucial that you discuss the creation of a health care proxy and/or power of attorney with your loved one. They can designate someone they trust in these legal documents to handle their finances and health care if they are unable to do it themselves. If your loved one has designated you as their health care proxy, you will have the ability to access nearly all their information and records and make medical choices on their behalf if they become incompetent. In many states, you will be restricted in the treatment decisions you can make if you lack legal authority. The amount of information you can obtain may also be restricted; doctors are not compelled to speak with you but may do so if they believe it is in the patient's best interest. You can take care of all or part of your loved one's financial affairs if you have power of attorney. Financial matters include things like Medicare and nursing facility bills. The advance directive, like the medical power of attorney, enables a person to make provisions for health care decisions in the event that, in the future, he or she is unable to do so. However, unlike the power of attorney, which merely grants an agent the legal authority to make decisions on a loved one's behalf, the advance directive is wholly dependent on the wishes of the loved one expressed therein, making it a more popular choice for many families.
- Get ready for more than just ‘The Talk’—probably a series of talks. Having several briefer, easier-to-digest conversations rather than one lengthy "Sit down, we need to talk" marathon session may be preferable since, for the majority of us, thinking about, let alone discussing, a serious illness or death that will affect us or someone we care about is difficult.
Thankfully, it gets easier the more we talk openly, honestly, supportively, and compassionately about the future and prepare for it. This makes it easier to accept and honor our loved ones' wishes when they are no longer able to communicate them for themselves. Even though it might be uncomfortable, getting that result is worth struggling through a few awkward conversations to get.
Need advice on more ways to get in-home care and help for your aging loved one, call our office at (212) 614-8057. We would love to help your family.