Facing the reality of a loved one’s aging or approaching the end of life is never easy. These conversations are often avoided because they feel uncomfortable, overwhelming, or simply too painful.
But, according to Kristin Scheeler, MSSW, CAPSW, and Certified Advanced Practice Social Worker and Primary Independent Patient Advocate with Madison Care Management, having open discussions early on is one of the greatest gifts families can give each other. Here, she offers helpful advice for those who are facing this scenario.
Planning Your Conversation
When preparing for these conversations, Scheeler suggests thinking in terms of three main categories:
- Health and Medical Care. Families should discuss diagnoses, likely disease progression, treatment preferences, and, most importantly, values around quality versus quantity of life. Assigning a healthcare proxy through a power of attorney is essential so someone is designated to make decisions if the person cannot.
- Funeral and Memorial Plans. Pre-planning can include choosing readings, music, or even prepaying for services. “It gives families some level of certainty when there’s no certainty about life,” Scheeler notes.
- Personal and Estate Matters. Wills, estate plans, and the designation of who will receive meaningful items such as jewelry or antiques can help prevent conflicts down the road.
Setting the Stage for Conversations
Scheeler acknowledges that it’s not easy to begin. “There’s a running joke in my professional circles that you bring this up at Thanksgiving,” she shares. “But really, it’s about planning a time and setting the stage and the intention. The other thing is to make sure that everybody who might be interested in this discussion is there at the same time. Whether that has to be done by phone or video to include everybody you want to include, I would always suggest everybody hears the same message from the loved one at the same time.”
Having everyone involved at once ensures the message is consistent and prevents confusion or misinterpretation later. Also, no family can prepare for every possible medical scenario. Instead, Scheeler emphasizes the importance of focusing on values.
“What has always been important to you in your life? What’s important to you now, and what do you think will be most important to you as you near the end of your life?” These guiding principles help loved ones make decisions when situations are unclear.
The Four Things That Matter Most
Scheeler often draws on the work of palliative care physician Dr. Ira Byock, who identified four statements people most want to say or hear before the end of life:
- Please forgive me.
- I forgive you.
- Thank you.
- I love you.
These simple statements hold enormous power. Most things people want to express can be distilled into one of them, and they bring comfort and peace in life’s most difficult moments.
Worth Mentioning: Why Funeral Planning Helps
While discussing funerals may feel uncomfortable, making decisions ahead of time can ease a tremendous burden. Families are often faced with hundreds of choices in the immediate aftermath of a death, all while grieving. Written plans reduce stress, prevent disagreements, and ensure the service reflects the loved one’s wishes. “It’s truly a gift you can give your family,” Scheeler says.
Keep the Conversation Going
Above all, Scheeler encourages families to treat end-of-life discussions as ongoing, not one-time events. Perspectives shift as people age or face new circumstances. Revisiting wishes ensures decisions reflect what matters most in the present. “Continuing the conversation is the most important thing to keep in mind when you’re having discussions about anything serious,” Scheeler emphasizes.
To learn more about patient advocacy and care management resources, visit madisoncaremanagement.com.
