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Most Adults Still Avoid this Essential Step in End-of-Life Planning

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It’s something almost everyone agrees they need to do. So why do two-thirds of adults still fail to do it?

We’re talking about end-of-life planning, specifically the type of advance planning that tells both your family and your health care team exactly how you want to be treated when you’re close to death.  Generally called “advance directives,” these documents guide those caring for you when you’re no longer able to make your own decisions, something that can happen at any stage of life, not just old age. Here at AgingOptions, in counseling our clients and talking with radio listeners and seminar guests, we encounter story after story describing how difficult it is for loved ones when someone is facing the end of their life without ever having told their medical team or their own family exactly what they ought to do.

This recent article that appeared on the authoritative website Kaiser Health News puts the scope of this failure to communicate into perspective.  It qu0tes a recent study in which analysts reviewed more than 150 separate research projects in order to evaluate the state of end-of-life planning for more than 800,000 U.S. adults. Of this large group of people, only about one-third had some form of advance directive in place – either a “living will” to spell out their health care preferences or a health care power of attorney specifying who would have the power to make health care decisions on their behalf. Those older than 65 were a bit more likely than the rest to have one of these documents in place, but the total number of seniors – about 45 percent – still leaves more than half of older adults who are continuing to avoid end-of-life planning.

The irony is that things on the planning front should be getting better. The Kaiser Health News article points out that in 2016 Medicare began reimbursing doctors for time spent in counseling beneficiaries about their end-of-life preferences. It’s too early to tell if this step will have much of an impact on the number of people making these critical plans, but experts suggest people will still choose to steer clear of addressing their desires for their final days. So the question is why? If the need for planning is so clear, why do two-thirds of people insist on avoiding this topic altogether?

“There are many reasons that people are reluctant to sign a living will,” says the Kaiser report. While specific health care forms may vary from state to state, they all ask people to spell out what medical intervention they want under various medical circumstances: ventilators, feeding tubes, CPR and other emergency procedures. One medical instructor in analyzing the data observed, “Many people don’t sign advance directives because they worry they’re not going to get any care.” She added that in some people’s minds the directive “becomes this very scary document that says, ‘Let me die.’”  That’s the kind of fearful and unpleasant topic many people simply choose to avoid – but when they do, they’re not doing their families any favors.

Some people also may fear some unintended consequences when doctors need to act on an end-of-life directive. As one geriatrician put it, “People generally want to live as well as they can for as long as they can.” The Kaiser article adds, “If that means going on a ventilator for a few days in order to get over a bout of pneumonia, for example, many may want to do that. But if their living will says they don’t want to be put on a ventilator, medical staff may feel bound to honor their wishes. Or not.” This is where clear advance communication between the patient, the family and the medical team becomes essential. As the Kaiser article explains, living wills may be legal documents, but that doesn’t mean they’re not open to reinterpretation from medical staff and loved ones.

We do take issue with one particular quote from the Kaiser Health News article. It comes from a woman named Ellen Goodman, described as a Pulitzer Prize-winning writer and founder of something called The Conversation Project, designed to give people the tools to help them talk openly about end-of-life issues. Goodman says, “The most important thing is to have the conversation with the people that you love around the kitchen table and to have it early.” While we agree with the sentiment, we disagree with the method. In our experience, casual chats around the kitchen table, as charming as that may sound, can never take the place of serious planning guided by a trained, experienced legal professional. Time and time again we’ve heard horror stories about families fighting tooth and nail over the care of a beloved parent because Mom or Dad had failed to make their wishes unambiguously clear, and now each adult child has a different recollection of those “kitchen table conversations.”

What’s the answer? We strongly suggest that you contact us at AgingOptions and bring your loved ones together for a professionally guided family conference. This invaluable process will go far beyond end of life planning, and will result in a greater sense of clarity and peace of mind than you thought possible. Call us during the week and we’ll explain more.

We also highly recommend that you and your loved ones make plans now to attend a free AgingOptions LifePlanning Seminar. During this information-packed few hours we’ll cover a full range of retirement planning issues – medical, financial, housing, legal and family – and we’ll explain how these all work together harmoniously in the form of an AgingOptions LifePlan. It’s far and away the most comprehensive approach to retirement planning you’ve ever seen! Remember, the seminar is free, but you’ll need to pre-register for the event of your choice because space at these popular seminars is limited. Click here for dates, locations, and online registration, or contact us during the week for assistance. Don’t let another month go by without making the most important plan of your life! We’ll look forward to seeing soon you at an AgingOptions LifePlanning Seminar.

(originally reported at

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