End-of-Life Planning for Families and Seniors: How to Start the Conversation

by Bestow Team | November 14, 2018

End-of-life planning is a difficult topic for many families to discuss.

Millennial parents may be hesitant to have the conversation with their loved ones, because it’s hard to envision a life without them or they’re not sure how they will react to a serious conversation about their health.

For aging seniors, it can be equally difficult to broach the topic to their children. For instance, they may have noticed a gradual decline in their health, but don’t want to burden their children with sorting out long-term care options. It’s also possible that they’re waiting on a physician to initiate the conversation for them.

Wherever you are in life, end-of-life conversations aren’t easy — but they’re necessary. Like many things, successful end of life planning is all about communication. To make the topic less stressful, here’s a guide to help both parents and seniors when they finally decide to initiate the conversation.

Table of Contents

Starting the Conversation

Discussing end-of-life planning can be a prickly topic for millennials and seniors. According to a recent study, 80 million American families reported that they haven’t discussed any end-of-life issues together, and 70% of end-of-life conversations are prompted by a health crisis or emergency event.

Whatever the reasons may be, older millennials and their aging baby boomer parents find it difficult to broach end-of-life discussions, but this is a topic that shouldn’t be put-off. End-of-life preparations need to be carefully planned. Otherwise, families are rushed to make expensive financial decisions without having time to think them through.

So, when is it the appropriate time to think about starting the conversation? Experts recommend the 40/70 rule, which suggests that adult children should bring up the topic as they approach the age of 40, or when their parents near 70 years of age.

When and how you discuss end-of-life issues is ultimately up to you, but here are some ways families can tactfully approach the topic.

How Millennials Can Talk to Their Aging Parents

One of the best ways to approach an end-of-life discussion with your mom, dad, or loved one is to be proactive about addressing the same issues in your own life first.

For example, if you plan on discussing something such as life insurance with your parents, first take the time to educate yourself about what types of plans are realistic for you and your family. You may even want to invest in your own life insurance policy before bringing it up with your parents.

Once you have a solid understanding of the subject, you can tell your parents that you’ve been considering taking out a life insurance policy, and ask them if they’ve thought of doing the same. This creates a natural opportunity for you to lead into other end-of-life discussions.

Remember, you’re leading this conversation. Here is a list of questions and talking points to help guide you:

  • “If something happened to you, I’d want to make sure your last wishes were honored. Have you thought about writing a will?”
  • “If you were diagnosed with a terminal illness today, what kind of medical treatment would you like?”
  • “Say you were no longer capable of making medical decisions for yourself.  Who would you trust to make those choices for you?”
  • “Have you given any thought to future long-term care? If so, what are your preferences?”
  • “Have you considered who you would want to take care of your finances in the event that something happened to you?”

You should frame these questions in a way that gives your parent or loved one as much independence and respect as possible. This will make the conversation more amicable and help you both work through the questions together.

How Seniors Can Talk to Their Children

As a senior parent, you should bear in mind that it’s best to have end-of-life discussions with your children while you’re still able. That said, the most beneficial discussions often occur at home or sprinkled into the routine life events.

However, discussing these topics is not always easy to do. Seniors avoid discussing their health complications for fear of becoming powerless or weak in the eyes of their loved ones. Ultimately, they don’t want to become a physical or financial burden on their families.

Seniors should be proactive about end-of-life matters, as this is the best way to prepare for the difficulties ahead. What should you discuss with your children when you finally decide to have the conversation? Here are some talking points to move you in the right direction:

  • Clearly state your preferences for end-of-life medical treatment. If you haven’t thought of a writing a living will yet, now is a good time to discuss it.
  • Tell your children or loved ones who you will entrust with the power to make medical decisions for you if you are unable to.
  • Discuss who you will entrust with your finances if or when you are no longer capable of managing them yourself.
  • If you’re comfortable, discuss your last will and testament and how you would like your estate to be divided up.
  • Make your last wishes clear regarding funeral preparations and any final expenses.

Be prepared to explain your reasoning behind your decisions if need be, and make sure to keep family and loved ones updated on any changes you might make to your last wishes. With that said, each of these talking points can be difficult to work through if you haven’t done the research yourself. That’s why it’s crucial to look into important end-of-life documents sooner than later.

Important End-of-Life Documents

Important end-of-life documents include items such as a last will and testament, power of attorney, and advance healthcare directives, among others. It’s crucial to discuss these matters sooner rather than later, especially since some items may require legal assistance depending on state laws.

Below is a list of the most pressing documents to address together.

Last Will and Testament

A will, also known as a last will and testament, is simply a document that states someone’s last wishes. After the time of death, a probate court sees to it that these wishes are carried out. So, what information should a will contain?

At a minimum, it should do the following:

  1. Name an executor, or a personal representative. This is a person or institution appointed to ensure that all wishes are carried out as written.
  2. Name beneficiaries to receive property. A will should specify who receives specific “gifts of property,” or specific bequests, which include real estate, cash, and personal property. Typical beneficiaries are family, close friends, business partners, or even charities and businesses.
  3. Specify what personal properties should be divided. Assets that are to be divided among beneficiaries need to be detailed in a will.
  4. Allocate business assets. Business assets are often separated from personal assets, and business owners often have specific instructions regarding them in a will.
  5. Address all debts, expenses, and taxes. It’s helpful to include how final expenses are to be handled, such as funeral costs or inheritance and estate tax.
  6. Mention any special instructions. This can range from how one’s home should be maintained and cared for to arranging a caretaker for pets.

How to Talk About It with Your Parents

Ask your parent or loved one if they’ve begun their estate planning yet. If they have, you should discuss who all they will involve in the process. For example, who will be appointed executor, and how will the estate be divided? It’s also worth asking if their will has been kept up to date.

By addressing these questions early on, you can prevent any potential family feuds or fallouts that could have occurred otherwise. You will also spare your parent or loved one’s estate from being tied up in a probate court, deducting the cost of court proceedings directly from the estate.

Lastly, it’s wise to consult an attorney or legal advisor if you have questions regarding the legality of the terms within the will. In most states, a will is considered legally binding if it contains the testator’s signature (the author of the will) and the personal signatures of two witnesses. If you want to do this easily online, a company called Tomorrow worked with 52 attorneys across the country to create a free legal will that you can complete in under 10 minutes.

Power of Attorney

Power of attorney (POA) is a document that authorizes an appointed agent to act in someone’s stead regarding their legal, personal, medical, or business matters. There are different types of POAs, each of which grants the authorized person, or “attorney-in-fact,” specific powers.

When appointing an agent, it’s important to select a trusted person in the event that you or your loved one is incapacitated or simply can’t be present for one reason or another.

There are four types of POA to be aware of:

1. General Power of Attorney

A general POA is comprehensive in that it gives the attorney-in-fact the power and right to act on the individual’s behalf. The agent can sign documents, pay bills, and even make financial transactions on you or your loved one’s behalf. The general POA terminates when the individual  dies unless it’s rescinded beforehand.

2. “Special” or Limited Power of Attorney

A limited POA is designed for very specific purposes like giving someone the power to sign a document on a specific day or time. Limited power of attorney is usually terminated at a specified time.

3. “Healthcare” or Springing Power of Attorney

This type of POA grants the attorney-in-fact the power to act in someone else’s stead only if they are incapacitated or unable to make decisions on their own. For this reason, it’s crucial to clarify what determines incapacitation in the document.

4. Durable Power of Attorney

Durable POAs only come into effect if you or your loved one is incapacitated, and the powers are specified by the grantor, or person authorizing the POA. Usually, a durable POA grants the agent the powers to handle finances or to make medical decisions.

How to Talk About It with Your Parents

When discussing POA, first discuss potential candidates for the primary agent role. Remember, this person needs to be someone you trust. It’s also important to go over the medical and financial state of affairs in order to provide the designated individual all of the necessary information.

Advance Healthcare Directives

Advance healthcare directives are specific medical instructions that specify how a person would like to be cared for if or when they are no longer able to make those decisions themselves.

It’s important that the person’s preferred healthcare proxy be included as well. A healthcare proxy, also known as a healthcare agent or durable power of attorney for healthcare, makes important medical decisions for an individual once their doctor determines they are incapable to make medical decisions.

Living Will

A living will is an advance healthcare document that provides someone’s personal preferences for medical treatment when they are terminally ill or shortly before death. Should they require life-sustaining medical treatment to survive both family members and a physician can refer to their living will to determine if that is what they would want.

How to Talk About It with Your Parents

If you’ve noticed any concerning changes in your parent or loved one’s condition, it’s time to discuss their living will and advance healthcare directives. A living will can make difficult medical calls much simpler if your loved one has provided their preferences regarding their treatment.

A good way to approach this discussion is to ask your parent or loved one if they’ve thought about what things they want at the end of their life. This simple question will often trigger them to mention specifically what they have in mind.

HIPAA Waiver of Authorization

A Health Insurance Portability and Accountability Act (HIPAA) waiver of authorization is a legal document permitting someone’s health information to be shared with other third parties, such as doctors, attorneys, researchers, and other family members.

Protected health information (PHI) is only accessible to “covered entities,” like a designated healthcare provider, to ensure privacy. By obtaining a HIPAA, third parties are granted permission to access this information for research or legal purposes.

The main reason a family would want a HIPAA waiver is to make sure that the appointed agent under their parent or loved one’s medical power of attorney has the power to discuss important matters regarding their health with a doctor, and to review their medical records if need be.

How to Talk About It with Your Parents

It’s best to bring this up once your parent or loved one has appointed a medical power of attorney. Overall, you want to make sure that you, or whomever is given the medical POA, has complete access to your loved one’s protected health information.

Authorized User on Investment and Bank Accounts

You or your loved one may need access to a family member’s banking and investment accounts to cover medical and funeral costs in the event that they are incapacitated or pass away unexpectedly. Authorizing another person to use an account varies depending on the bank and the type of account. Contact the respective bank or institution to determine how to proceed.

It’s crucial to finalize these details before it’s too late. If you don’t, the matter of distributing these funds must be handled in a probate court. Any legal fees that arise are taken out of the estate property, which would otherwise pass on to family members or beneficiaries.

How to Talk About It with Your Parents

If you’ve noticed that your parent or loved one is having money management issues or is forgetting to make payments on time, you should discuss their finances with them. Simply ask them how their finances are in general to get the conversation started.

End-of-Life Housing

End-of-life housing is worth considering if your parents can no longer take care of everyday tasks or routines without assistance. There are five types of end-of-life housing, each of which offers different amounts of care depending on the individual’s condition.

1. Assisted Living Facility

Assisted living facilities typically provide a small apartment designed to accommodate one person, but sometimes two, depending on the facility. These rooms come with a bathroom or a small kitchen and are furnished in some cases. Doctors and nurses are available at all times to assist with basic everyday tasks like cooking, cleaning, or administering medication.

2. In-Home Care

Commonly referred to as “aging in place,” in-home care is the most popular choice among seniors. This is an ideal option if your parents require assistance with daily tasks but don’t want to be admitted to an assisted living facility.

Although in-home care might seem like the best option, it can be quite expensive depending on the extent of home modifications. Possible general modifications include:

  • Widen doorways
  • Install railings on stairs
  • Install ramps and/or lifts
  • Buy a hospital bed for the bedroom
  • Install railings in the shower, among others

Your family must also consider the costs of paying for an in-home caregiver. There are two types: Home care aides (HCA) and Home Health Aides (HHA).

Home Care Aides

Home care aides help with general housework, like laundry, grocery shopping, and cooking. They are also expected to talk to and comfort your loved one.

Home Health Aides

Home health aides are usually certified nursing assistants that provide medical services like monitoring blood pressure and administering medications.

3. Nursing Home

A nursing home is ideal if your require constant assistance. They are similar to assisted living communities in that doctors and nurses must be present at all times in case of an emergency. This certified staff provides services like meals, transportation, on-site physical therapy, entertainment, and recreational activities in addition to assisting with tasks like bathing, walking, and administering medication.

Nursing homes are expensive, averaging at about $6,000 a month. Federal benefits like Medicare will cover a short-term stay, or if your family qualifies, Medicaid will cover most of the cost.

4. Hospice Care

Hospice care is end-of-life care designed to provide comfort to an individual during the last weeks of life. Hospice focuses on relieving pain through medication and assistance administered by caregivers. Typical services also include providing psychological support for families of the patient.

5. Palliative Care

Palliative care is similar to hospice in that it’s chief aim is to alleviate the patient’s pain. However, palliative care is available at any point during the patient’s illness, whereas hospice is only offered in the final months, weeks, or days of someone’s life.

How to Talk About It with Your Parents

Once you’ve observed that your parents or loved one has trouble with daily tasks, you should find the right time and place to bring the matter up to them. Tell them you’ve noticed they struggle with everyday tasks, and that they should consider long-term care options.

When it’s time to discuss your parent or loved one’s future living situation, it’s important to discern what their wishes are first. Do they prefer in-home care, or would they rather be moved into an assisted living community? Once you’ve figured out their desires, you should also discuss plans to cover the costs.

Discussing Life Insurance

Life insurance is something both young parents and seniors alike should consider. In addition to a will, life insurance is a great way to ensure that you and your loved ones have the funds to cover funeral costs and other final expenses.

The two most common types of life insurance are whole life insurance and term life insurance.

Whole Life Insurance

Whole life insurance is a permanent life insurance option, and it is usually taken out by high-income individuals. Whole life insurance comes with higher premiums that go toward a death benefit and an overall cash value that accumulates over time. As the policy matures, more of the premium goes toward the cash value, which can be invested in a retirement fund, taken out as a loan, or withdrawn should the policy be canceled.

Term Life Insurance

Term life insurance is available in set terms, such as 10, 15, 20, 25, and 30-year terms, and comes with cheaper premiums than whole life insurance. It’s more affordable and usually comes with level payments, meaning the price is consistent throughout the life of the policy.

How to Talk About It with Your Parents

A good way to introduce this topic is to simply ask if they’ve considered either whole life or term insurance. As mentioned earlier, it helps if you tell your parent what kind of research you’ve done on the behalf of you and your family. This makes it easier to discuss available options with your parent.

Additional Resources

Here is a list of resources to help you and your loved one prepare for end-of-life planning.

End-of-Life Discussion Games

There are many ways to have end-of-life conversations. These fun, interactive conversation starter games make it easier to begin talking about end-of-life issues together.