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End-of-life planning: three tips for a tough conversation

Whether your loved one has just experienced a major health event or they’re simply getting older, end-of-life conversations are a necessary step in being ready when the time comes. Although a dreaded conversation, there are ways to ensure it goes as smoothly as possible. 

Tryon Medical Partners internal medicine specialist Dr. Althea Cunningham weighs in with three tips to tackle this conversation. 

It’s never too early to start the conversation. 

Dr. Cunningham emphasizes that there is no right or wrong time to start the conversation with your loved one – every family is different so their approach will be unique. 

“Ideally, you begin the conversation before you hit the stage where you need to, especially if your loved one is open to discussing it,” says Dr. Cunningham,“This can take some of the urgency out of the conversation.”

It’s also a good idea to keep the dialogue going. Circumstances may change and with it, their thoughts and opinions on what they want the end of life to look like. It’s important to provide them an ongoing opportunity to share specific wishes. An annual wellness visit is a good time to discuss end-of-life planning, when it may naturally come up.

Cover your bases so you’re not caught off guard. 

Dr. Cunningham recommends covering a few key topics when you discuss end-of-life planning with your loved ones. 

There are a few necessary documents for managing end-of life-arrangements, including: 

  • DNR (do not resuscitate) and DNI (do not intubate) orders. DNR and DNI orders tell clinicians not to attempt CPR or resuscitation measures. 
  • A living will. This is a specific type of advanced directive in which your loved one will clarify the medical treatments, procedures and medications they do or don’t want to receive to keep them alive.
  • A healthcare power of attorney. A healthcare power of attorney appoints someone to make decisions for you if you are unable. 

Outside of the necessary documents, Dr. Cunningham recommends discussing their living situation and any additional healthcare support they may need. 

  • Living situation. This may look like a conversation on how they can safely keep living independently (for instance, with a home health aid or a familial caregiver) or a discussion around assisted living. Dr. Cunningham points out, “If you think they may need assisted living, start to talk about that as early as possible and have a place in mind already. This will make the transition much smoother when it does need to occur.” 
  • Healthcare and wellness support. Depending on the situation, it may also be helpful to talk about their overall wellness, including food, medications and their home environment. Especially if they are living alone, making sure they can continue to eat a healthy diet and socialize with others is critical. This could mean finding a senior center to maintain community, picking up their medication or coming with them to doctor’s visits. 

Lean on support and resources. 

You don’t have to, and shouldn’t, do it alone. “Taking care of an elderly loved one is a marathon and not a sprint. Make sure to take care of yourself, too,” Dr. Cunningham notes. “This may mean letting go of certain tasks and getting outside help, like an aid. This is especially true for long, drawn out, painful processes like dementia.” 

Asking and accepting help from others in caring for your loved one is critical in ensuring they, and you, remain safe and healthy. This may look like communicating with other family members so they are in the loop and can help out when possible. 

Dr. Cunningham also points out the power of support groups and grief counselors for caregivers of those with conditions like dementia or those in palliative care and hospice. These resources can provide support and guidance before and after a loved one passes away. 

For additional guidance in starting the conversation, check out the Tryon Medical Partners Caregiver’s guide or reach out to Tryon today to meet with a clinician about next steps.