Tough Talk

Getting past the discomfort of intimate topics is vital for late-in-life and end-of-life discussions

When we are children, our parents have “the talk” with us. Then, when we’re middle aged, we have “the talk” with them. The first one is, of course, about the birds and the bees. It’s awkward and uncomfortable for everyone involved, but no one wants his or her kids to learn about things the hard way, or the wrong way, from misinformed kids on the bus.

The second talk is about end-of-life planning and preparations, and it’s just as important as the first one. At some point we need to broach the subject to make sure things are in order and that we know what our parents’ wishes are so that we can help achieve them. Having the right plan and making some decisions early can save the entire family distress down the road.

Healthcare Directives

“You tend to think that the ones who are closest to you understand how you think, but that’s not always the case,” says Bill Mundt, an attorney with Madison law firm of Murphy Desmond.

Children may not always know what parents who are in a coma or otherwise incapacitated would want. Siblings might disagree on the appropriate course of action for Mom or Dad. Or Mom may be so distressed over Dad’s sudden illness that she can’t make any decisions, and she asks one of her three children to handle things—and it turns out that it wasn’t the child who expected to be in that position.

Those are just a few of the scenarios that can cause additional tension among family members during an already stressful time. Yet individuals and couples can avoid those situations by having the right legal documents in place.

An advance healthcare directive, sometimes called a living will, spells out what kinds of medical interventions an individual would want under certain conditions; doctors refer to these directives when a patient is no longer capable of making decisions about his or her immediate healthcare. Some directives also specify a certain kind of power of attorney or healthcare proxy by which another individual is charged with making healthcare decisions if there are any gray areas in the document.

These are invaluable for families, says Tom Moreland, president and CEO of St. Jude Hospice, and he encourages individuals to look into the documents sooner rather than later. “It is never too early for end-of-life planning. It doesn’t matter how old you are,” he says. “I’m thirty-four years old and I have a healthcare proxy and a living will. You never know when the end will come, and you don’t want to do that type of planning when you’re in a crisis situation. That’s so much harder to do.”

For example, some individuals or couples wait until one of them is diagnosed with a terminal cancer. Some never wrestle with the decisions ahead of time at all. Yet young parents die in freak auto accidents and middle-aged parents can die of freak heart attacks. Sometimes we have enough warning to get our affairs in order, but not always.

“We ask our patients at the time of admission if they have a living will, and most of the time the answer is ‘No,’” Moreland says. “It’s something that is hard to talk about, but it is important because it is inevitable. We never know when that time will come, so plan now, when you’re healthy and can make your wishes known, so there will be no question later of what you want.”

Moreland says it is not safe to assume that everyone in the family will agree on end-of-life healthcare decisions. He has encountered families in which half the siblings think hospice is appropriate and the other half do not. Other times one child is certain that a parent would want to make one decision, while the other child is certain that the parent would make a different one. 

“With planning, siblings don’t have to take on these hard choices because they already know Mom’s and Dad’s wishes,” Moreland says. “That is really the heartbreaking thing of end-of-life care, when we see families struggling to decide. That is why it is best to do it way before that crisis so that emotions aren’t involved.”

Sometimes parents do not recognize the potential problems of not having healthcare directives in place. Other times children simply do not know what or how much planning parents have done and what their general wishes are. That is why Mundt encourages open and frank communication among his clients. “I’ve seen more arguments simply because the family has not communicated for one reason or another,” he says.

While asking outright is often the best approach, not every family has that dynamic. Mundt says those who anticipate uncomfortable conversations should be sure to take advantage of any natural opportunities that present themselves. “You should just ask, but it can be easier to focus on a catalyst,” Mundt says. “A health crisis is a catalyst. A death of a parent’s close friend of the same age is a catalyst.”

Finances

Of course, health is not the only issue at hand. Baby Boomers with elderly parents will want to make sure that the folks have their finances in order as well. Yet talking about money can be even harder than discussing health. Children worry that their parents will misinterpret their interest as greed, while parents may not feel it is anyone’s business where the money is or where it will go.

Matthew Ruppe, director of investment services for UW Credit Union, says it is important for both parents and children to at least be aware of what planning has been done and where important documents and information is kept. “People need to be proactive, so stress the concerns,” he says. “Make sure they know you’re not going to share all this information with the world and remind them that it’s important to be ready.”

It could be as simple as telling kids where the files are or who the attorney is, and it could be as detailed as going through documents to make sure they are still current and still reflect parents’ wishes. For example, a beneficiary on a life insurance policy may have died, or a beloved daughter-in-law named in a will might no longer be married to that son.

Ruppe also notes that some accounts and resources can be kept out of probate by adding payable-upon-death language. That is usually available at most financial institutions at no cost. It is an example of an easy step that parents can take to simplify the probate process down the road. “It costs you nothing and it gets the funds exactly where you want them to go,” Ruppe says.

That is why Mundt believes it almost never hurts to have open discussions about the contents of the will and other estate plans. He says he can usually identify all the assets even if parents never shared the information and even if they died without a will. But the talks still give parents the opportunity to make improvements, if they wish, based on developments in financial instruments or the law. Children get the opportunity to ask questions to understand why parents made the choices they did or to make recommendations for improvements.

Some of these conversations can also alleviate or prevent strained familial relationships. For example, kids may want to know who the executor of the will is, and parents could then explain that the middle child was chosen in place of the eldest because she has a law degree and lives around the block and not across the country. Parents can also use the discussions to gauge interest in family heirlooms so that belongings end up in the best and most appropriate hands.

“Parents can be really helpful in these situations,” Mundt says. “They can determine what is really important. That communication is the key thing…and I’ve seen it work quite well.”

Other things to consider include preparing a durable power of attorney, by which the parents choose an agent to handle their financial affairs should they become incapacitated. These decisions are as important as those governed by the healthcare directive. Someone needs to pay the mortgage and the utilities or file the taxes if Mom is in a nursing home and incapacitated.

Also, the sooner the talks happen, the more options parents will have for their plans. For example, Ruppe points out that insurance is affordable for the young and healthy. That is why it is important to consider both life insurance and long-term care insurance before advanced age or illness. “When you are planning, it is nice to have those tools available,” Ruppe says. “A lot of times you lose those choices when you wait too long.”

Another thing children can address, Ruppe says, is future funeral expense. While it might sound morbid to discuss it ahead of time, the reality is that funerals can easily cost between $12,000 and $15,000. That is a big price tag at an emotional time, and bereaved spouses and children might struggle with making the right choices to honor their loved ones.

Ruppe urges clients to consider a funeral trust and even advanced funeral planning to make some of those decisions in a rational, not an emotional, way. Also, any assets in that trust are protected from creditors and from the state with respect to Medicaid considerations, so funeral arrangements would still be covered even if other monies have been spent down. “I see more and more people doing this lately,” Ruppe says. “Funeral arrangements can be very trying.”

Senior Housing

Another difficult decision that some individuals face involves when to give up the family home. While some people live in their homes until they pass away, others move into different housing as they age to minimize maintenance hassles and expenses. Some need the care or companionship available in certain senior residential communities.

“Usually it is time to move out of your current situation when [you] cannot maintain it financially or physically,” says Whitney England, property manager of Monona Meadows, a senior apartment complex. “When maintaining a mortgage payment, household maintenance, or yard upkeep becomes more of a burden than a luxury, then it is time to start thinking of a change and the future.”

England encourages individuals to start considering and even looking at senior housing before a crisis. “Do not wait until the last minute,” she says. “Chances are that the one housing option you plan on signing up for already has a waiting list.”

She recommends starting the process about a year before a desired move. “That will give you ample time to really do your research, find the right fit, and mentally and physically prepare yourself for the new chapter in life.”

Betty Fischer, community relations coordinator for the assisted, enhance assisted and memory care community with Heritage Monona independent living community, says senior apartments and independent living have both evolved dramatically in the past twenty years. They are more inviting and tend to offer social programming to help engage residents.

Fischer recognizes that the transition can be scary at first, especially for those seniors who were reluctant to give up their homes or their perceived independence. “I think we sometimes need to give those reassurances that we’re not trying to take away anything,” she says. “We’re trying to enhance
their living.”

Cost is a factor for most seniors, so prospective tenants and their families should be prepared to disclose finances to residential communities. England says Monona Meadows is a Section 8 building, a designation which limits the amount seniors have to pay in rent. England also notes that other programs can help cover living expenses if finances are tight. Fischer adds that long-term care insurance can be a helpful factor, and says there are some government assistance programs for veterans and other individuals.

The important part, Fischer says, is to make sure all involved family members are fully informed of the prospective resident’s financial situation so that all viable options are explored and considered. “If you don’t know where the finances are and Mom and Dad aren’t willing to share, it makes it extremely difficult,” she says. “If we don’t know what their finances, wants and needs are, we can’t help them get what they want.”

-Jennifer Garrett

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