16 Things Smart People Do for End of Life Planning
You can leave your family scrambling to make arrangements—or calmly executing your wishes. Here's what you need to know about planning for the end of life, whether it's happening in months, years, or decades.
They want family to avoid the hallway huddle
You could learn a lot by asking a healthcare worker about the problems families run into when a loved one dies. "Time and again, hospice professionals see families in the hallway of the emergency room or ICU trying to figure out what Mom or Dad might have wanted, and that's a very tough time to think these things through," says Jon Radulovic, vice president of communications for the National Hospice and Palliative Care Organization (NHPCO). "People often put more thought into preparing for the family vacation—the transportation, the timing, the meals—than planning for the end-of-life experience we'll all have." Here's a fascinating look at how doctors choose to die.
They have these two health-related documents
As for the nuts and bolts of end-of-life planning, from a healthcare perspective there are two documents every adult should have. The first is the advance directive, also known as a living will, which spells out wishes regarding what medical care you don't want ("no feeding tubes, please"), what you do want ("give me every treatment known to man"), and organ donation. "With these documents in place, your medical professionals will know exactly what your intentions are," says Radulovic. The second step for preparing for death is picking your durable power of attorney for healthcare, also called a healthcare proxy or agent, which is the person you choose to speak for you if you can't speak for yourself. "Sometimes that's the person closest to you and sometimes not," says Paula McMenamin, MSW, a medical social worker at The Elizabeth Hospice. "I've had patients say, 'I know my husband would follow my wishes, but I don't want to put that pressure on him so I'm choosing my sister.'"
They try DIY planning
While an attorney could help you prepare these healthcare documents, there are other options, says Radulovic. Each state has their own forms (some states combine them into one document), and you can get a copy yourself by going to sites like the NHPCO's CaringInfo.org, selecting your state, and downloading the file. Another alternative is logging onto AgingWithDignity.org to purchase a copy of the Five Wishes document, which uses a more conversational tone to explain end-of-life planning and helps you express additional wishes, such as whether you want music played or a massage. But if such official documents feel overwhelming, Radulovic suggests simply sitting down at the computer and writing your wishes out yourself. "What your doctors want is some guidance, so even just a document you've typed on your own would be better than nothing at all," he says, adding that it's best to have your write-up witnessed and notarized. This choir sings to people who are dying and it's just beautiful.
They cover estate planning basics
For young people without many assets, a simple will could be created with the help of an online tool, such as LegacyWriter or LegalZoom (which could also include your healthcare advance directive and proxy). However, more complex arrangements for preparing for death that include naming guardians for young children, setting up trusts, and multi-generational planning need to be done with an estate planning attorney, says Pamela Sandy, CFP, 2016 president of the Financial Planning Association. Either way, experts agree that anyone over the age of 18 should have at least the basics of a death plan in place. "Think to yourself, if I don't wake up in the morning, can my family continue to operate without me?" says Bob Arrington, president of Arrington Funeral Directors in Jackson, Tennessee, and the immediate past president of the National Funeral Directors Association. "I've seen many situations where all the household finances were only in the head of one family member, then an unexpected death occurs and the next of kin is left trying to put a puzzle together."
They know when to make these arrangements
The best advance care and estate planning happens well before it's actually needed. "I tell my clients to review their estate plan when major life events happen, such as marriage or co-habitation, the birth of a child, or divorce," says Sandy. However, she adds, there are plenty of other times to make updates to your death plan, such as after changes in laws, the death or illness of someone you've named as a beneficiary or executor, or a sudden influx of money such as an inheritance of your own. "I see people forgetting what's in their estate plans all the time," says Sandy. "So every year, sit down with your financial planner to review your arrangements." Failing that, the next best time to plan is immediately following a serious medical diagnosis, especially in cases of cognitive impairment. "I've had families of patients with advanced dementia say, 'We're ready to do a power of attorney for healthcare,'" says McMenamin. "And we have to say it's too late because it can't be done by a family member, it has to be done by the person themselves."
They share wishes with loved ones
Even the best-laid plans won't help unless you relay them to family and healthcare providers. "A living will that's just locked in a safe deposit box won't do you any good," says Radulovic. "Discuss these plans with loved ones, medical professionals, a life partner—whoever is in your intimate network." In addition, choose a regular gathering, such as a reunion or holiday, to give your family a ten-minute update on your plans in case anything has changed during the year, he adds. Find out some things to say to comfort someone who is grieving.
But they don't overshare
Involving too many loved ones in your estate planning process could backfire. "I've seen parents with good intentions bring their adult children in to explain their plans, and it creates all this stress with the kids saying, 'I didn't know Mom had that much money,' or 'Why is she the executor,' and suddenly you're hearing about when they were teenagers sharing a bedroom—it gets crazy," says Sandy. While it makes sense to disclose to your executor that certain documents for end-of-life planning are in place and who to contact if something happens, not even that person needs to see what's in those files. "I remind my clients it's still your money; it's not their money yet, so think about whether disclosure is going to cause angst in the family."
Remember, beneficiaries override a will
The beneficiaries you name when preparing for death are more important than many people realize. "One thing people don't understand is that beneficiaries override anything in your will because the assets go directly to those named persons," says Sandy. "Quite frankly a lot of people could do simple estate planning just by naming the appropriate beneficiaries on their assets." She adds the example of a husband in his 50s who died of a heart attack while getting ready for his anniversary celebration. Since getting married, he hadn't updated his estate plan, which still named his sisters as beneficiaries, even though his wife had costly health issues. "A significant amount of insurance assets went to two sisters—it was an absolute mess, and some of those family members still don't speak to each other," says Sandy. "Everybody thinks they've got time, but sometimes we run out of time. So it's very important to make sure your beneficiaries, especially, are up to date."
They figure out their Facebook future
One of the top things Sandy sees people forget when preparing for death is that we live in a digital world. "You have to ask yourself, if I'm dead tomorrow, what do I want done with my Facebook page? What about my Twitter account? What about the fact that lots of my bills are electronic and I have changing usernames and passwords all over the place?" says Sandy, who urges clients to think about their online persona after they're gone. "I have a client whose husband's Facebook page is still up as a memorial, but I personally don't want my Facebook page out there." Such digital estate planning could be done through a number of online platforms; for example, Sandy includes Everplans—which helps store digital info to be accessed by a loved one at the appropriate time—among her services for clients. People also use social media as an outlet for life events, which comes with certain social media etiquette rules to remember.
They're creative about end-of-life planning
With the logistics in place, experts encourage people to be brave and creative about end-of-life planning. Radulovic sees a colorful range of activities and excursions among patients nearing their final days, such as Honor Flights for veterans wanting to see a Washington D.C. memorial, a horse being brought into hospice for a last goodbye, and an informal wedding celebrated at a patient's bedside. "I remember a local EMT team taking a man in a stretcher for a final 'walk' through a mountain range because he loved the outdoors," he says. And that creativity applies to funerals as well. "We had a woman who was killed last summer in a motorcycle accident, and the two daughters said they were going to miss their mother's Christmas because she put a tree in every room," says Arrington. "So we brought their Christmas trees into the funeral home and decorated them in July because that was an important part of her life."
They pre-plan their own funeral
Arranging your service in advance is a way to spare family members a lot of taxing decision making. "You can go to any funeral home in the country and say you want to start a file to pre-plan your funeral. Our home has two cabinets full of pre-planned files that include who will sing, who will read, what the flowers will be, and some folks already have the clothes they want to wear hanging in our closet," says Arrington, who adds that you don't have to pre-pay to make these arrangements. "We got a call at 1 this morning that a death had occurred, and the family didn't even have to walk in our door because all the planning had been done five years ago. Compare that to the family for whom nothing has been done, and they have to accept a death at 1 am, rush in here nine hours later and deal with the stress of trying to put this big puzzle of information together from scratch." If you're concerned about budget for a service, consider these money-saving tips from funeral directors.
They ask questions
"The last thing we want is for a family to say they wish they'd have known about a particular option two weeks after the funeral is over," says Arrington. "It's the funeral director's job to explain all the information, and it's the family's job to ask questions if you're not sure about something." He adds that the biggest misunderstandings he currently sees involve cremation. "A lot of people don't understand that cremation has nothing to do with memorialization. Even with cremation, you can still have the visitation and ceremony with the body that you would with a traditional funeral." Everyone should know these basic rules of funeral etiquette.
They delegate their wishes
If you have multiple grown children, delegating responsibilities according to their professions and interests could help them avoid conflict and work together to deal with your loss. "In my own case, I have a mom with five headstrong kids who each thinks they know best," says Radulovic. "So for example, one child could be put in charge of healthcare stuff, another could be in charge of financial stuff, and another could be in charge of the spiritual arrangements."
They build their family's legacy
Do your part for the family tree by making sure next generations know who past generations were. One simple step is labeling family photos. "I have a volunteer right now who's going through pictures with a patient and making photo boxes to give out to her family," says McMenamin. It's equally important to collect remembrances and stories. Arrington recommends a program called Have the Talk of a Lifetime, which includes a deck of 50 conversation cards that prompt people to share their most significant memories. "It's important to really know your family and pass those stories along," he says. "Otherwise once that generation is gone the second and third generations may not even know their great grandaddy's first name." Curious about your family tree? These professional ancestry trackers can teach us a thing or two.
They say four things
At the end of life, the most meaningful discussions and regrets aren't about careers or finances, but about relationships. "Sometimes baggage is carried into the last mile of the journey, such as reconciliation with loved ones," says Katrina Scott, a board-certified oncology chaplain at Massachusetts General Hospital, who adds that one way to minimize such regrets is to make sure you say these four things to the people closest to you: forgive me; I forgive you; thank you; I love you. "These sentiments are ideally expressed as part of daily life, but they become especially important as things come to an end," she says. Here's how happy couples express their love.
They're a role model
Even when facing your final days, you have the opportunity to set an example for your family. "Through the dying process, you can be a teacher to show loved ones it is possible to die without causing so much family friction that everyone will be afraid of their own death. That's a gift you can give to the people you love," says Scott. "Just tell them, 'Everyone will eventually die; this is my time, and I'm going to try to do this with love and grace.'" Next, read some lessons about life from people who spend time with the dying.