If you live a long time and need help toward the end, who will help you? Where will you receive that care? If you cannot make decisions for yourself, who will you want to make your financial, legal, and medical decisions? Yes, these difficult questions may lead to uncomfortable conversations, but the result will be that you make important decisions for yourself. And just like other big decisions you have made, like getting married, buying a house, changing jobs, wouldn’t you prefer to make the decision yourself rather than letting someone else make it for you?
People age differently. Some are old in their 50s, and some are youthful into their 90s. And some of us still think we are 25! Regardless of your age, it is critical to ask these questions and have these conversations when things are going well instead of in crisis. When we are under stress, our brains often limit our thinking to simplify our choices. We may oversimplify things and see decisions as all or nothing. Here are some of the questions that you should consider when analyzing your end-of-life precautions:
When would you make a change to your housing situation?
Most people say they want to receive care at home. Think through what changes you may need to make to our home so that you can age in place there. Would your doorways and bathrooms need to be modified to fit a walker or a wheelchair? Would a stairlift need to be installed, or can you live on one level? Would you make a change to your living situation if long-time friends and neighbors moved or died? Loneliness has been linked to a higher risk for medical problems like heart disease and cognitive decline. Would you move to a retirement community if the cost of care were lower than the cost of care at home? In Birmingham, the average cost of a home health aide is $20 per hour. If you need more than 5 hours of help per day for an extended period, it may be less expensive to move to an assisted living facility. Of course, your financial situation, including whether you have long-term care insurance, will play a role in this decision.
How will you know when it is time to stop driving?
My sisters and I had to take the car keys away from my Dad, and that experience was worse than I imagined it would be. Dad was experiencing cognitive decline. In hindsight, we should have stopped him from driving well before we did, but we waited because we hated to take more independence from him. Will you depend on your doctor to make this decision for you? This resource from AARP may be helpful. Once you are no longer driving, how will you get to the people and places you want to go? Will you use ride-sharing services like Uber and Lyft? Maybe ask a family member or close friend to drive you? Or perhaps stopping driving is another reason you would consider moving to a retirement community?
How will your bills be paid if you have trouble remembering, making decisions, or concentrating?
It would be beneficial to have a power of attorney in place for someone to make legal and financial decisions for you, and that person may be the one who helps with your day-to-day money management. What steps could you take now to simplify your finances? Could you combine bank accounts and/or investment accounts? Could you close credit cards? If you need someone to pay your bills, you might want to check out the American Association of Daily Money Managers.
What quality of life is essential to you in the end?
Do you want to do whatever it takes to live? Or is there a time that you would transition to comfort care to manage pain? It would be best to have an advanced healthcare directive that appoints someone to make medical decisions for you. But it is important to share what you value at the end of life with this person so the right decisions for you can be made. The book, Being Mortal by Atul Gwande, is a worthwhile read when making these types of decisions, and so is the tool Five Wishes.
My Dad was 89 and physically healthy until several weeks before his death on February 5th, 2021. Even as he was declining, he was still my Dad. He reminded me to eat, to go home, to be with my family, and to go get some sleep. You can still parent to the end by making these difficult decisions for your family ahead of time.
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