Communicating with an older adult about their wishes
Caregivers who want to help a person create legal documents for end-of-life and estate planning must be able to find out what their wishes are. This article explains some tips for having those conversations and then describes the kinds of topics that need to be discussed for the main end-of-life and estate-planning legal documents.
How do you start and continue the conversation?
Caregivers who want to help a person create legal documents for end-of-life and estate planning need to be able to find out what their wishes are, and then help guide them to the legal documents that will make their wishes clear and legally binding.
Studies show that 92% of older adults want to talk about their end-of-life wishes, but only 32% have done it. More than half of older adults would like their family members to start the conversation.1
To do this, family members or caregivers need to start the discussion gently and gracefully; make it clear that the goal is to understand and honor a person’s wishes; ask open-ended questions, listen well, and let the person take the lead; be patient and understanding; and let the person know how they can make their wishes clear and legally binding.
Start the conversation gently and gracefully
If you feel a person would react badly to a direct approach, you can start the conversation by sharing your own challenges in making these kinds of decisions. You could also ask the person about their general feelings and views about a subject, instead of what they personally would do. For example, you could say you read about people being put on ventilators during COVID and ask what they think about being kept alive artificially.
As a person’s caregiver, you will probably have a good sense of whether it’s best to be direct or indirect in starting this kind of conversation.
Make it clear that the goal is to understand and honor the person’s wishes.
To keep a person from feeling defensive or suspicious, let them know that you are having these discussions to help them lead the best life they can and have their wishes followed. You can use phrases such as, “I want to be sure that the doctors and I know what to do if you are ever in this situation.”
Ask open-ended questions, listen well, and let the person take the lead
Telling a person the “right” way to think or act will probably not help you learn what their wishes are. Instead, ask them about their thoughts, feelings, values, and beliefs about end-of-life topics, and listen to their answers with genuine interest.
Be patient and understanding
Conversations about end-of-life and estate planning can be frightening even at the best of times. Older adults who are facing their own mortality or who may already be losing some control over their mind or body could be feeling scared. Don’t be surprised if they respond by getting angry, defensive, or dismissive. Think about how you would feel in their situation, and stay gentle and supportive.
Let the person know to make their wishes clear and legally binding
When a person has told you their views about the topic, mention that there are documents they can create to give instructions about their wishes and make them legally binding. Most of these documents do not require a lawyer, and there are inexpensive online services that can help the person complete the forms.
It is important to make sure the person knows that without these documents, doctors and lawyers will have to use state law as their guide. For example, if they don’t make a will, their money and property will automatically go to their spouse (or registered domestic partner) and blood offspring.2 If they don’t create advance directives, doctors and emergency medics are required by law to try every reasonable kind of treatment to keep them alive.
What questions need to be answered?
In order to help guide a person to the right legal documents, several questions must be answered. These include how a person feels about medical treatments; who the person wants to make medical, legal, and financial decisions for them if they become unable to make the decisions themselves; who will receive what assets and under what conditions; and who will be in charge of carrying out the will and testament.
How does the person feel about medical treatments?
You must find out how a person feels about medical treatments. For example, do they want to receive heavy painkillers, undergo chemotherapy, undergo emergency surgery, or be kept alive artificially? This conversation is needed for the following documents:
- Living will
- Do Not Resuscitate/Do Not Intubate order
- Portable Medical Orders (POLST) documents.
Each of these documents contain legally binding instructions about a person’s wishes regarding medical treatment if they become incapacitated (in other words, unable to make or communicate decisions for themselves). For example, they may or may not like the idea of being put on a ventilator if they stop being able to breathe on their own or being given cardiopulmonary resuscitation (CPR) if their heart stops beating.
Who does the person want to make medical decisions?
If a person becomes unable to make or communicate decisions for themselves, who do they want making medical decisions for them? This conversation is needed to create the medical power of attorney (MPOA) document. The MPOA names a person who will make all decisions about medical treatment and care if a person stops being able to do so for themselves.
Who does the person want to make legal and financial decisions?
If a person can no longer act for themselves, who do they want making legal and financial decisions for them? This information is needed to create the financial power of attorney document, which names a person who will carry out legal and financial actions for a person if they become incapacitated.
Who will receive what assets, and under what conditions?
Discussing who a person wants to give their money, property, mementos, and other assets to is necessary for creating the following documents:
- Will and testament
- Transfer on Death deeds
Each of these legal documents names beneficiaries of the person’s estate. Some also say what conditions the beneficiaries need to meet in order to receive the assets, such as being a certain age or getting a college degree.
Who will be in charge of carrying out the will and testament?
The person will need to select someone to handle the estate, the terms of the will, and the probate process after they die. This person is called the executor of the will, and they should be someone who has good organizational skills and the time to manage this lengthy and often difficult process.
The person planning to make the will needs to make sure the potential executor is willing and able to do it. They also need to name at least one alternative person in case the first choice can’t do it when the time comes.
Creating legal documents
Decisions related to aging and end of life
Durable power of attorney
Engaging an attorney
Financial plans versus estate plans
Medical power of attorney
Overview of estate plans
Overview of legal documents
Overview of trusts
Using an online service
Will and testament
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