As 2014 comes to a close, from California to Maine, multiple generations will gather around holiday tables. These events may present ideal opportunities to initiate conversations with loved ones -- young and old -- about sensitive issues like aging and end-of-life wishes.
Charlie and his four siblings, all in their 50s, gathered at the family home for a holiday dinner with their 88-year-old father, a widower who lived independently -- much to the family's growing concerns. Before dinner, the siblings held whispered conversations about their father's rapidly failing physical and mental powers. Just that morning, he'd backed his car out of the garage and right into the neighbor's prized purple azalea bush after he'd promised to stop driving. When questioned, the father's explanation was simple: "They need to trim that bush!"
"We have to intervene, do something," the worried siblings agreed. "Let me handle this," offered Charlie, the eldest son.
Halfway through the feast, Charlie stood up and tapped his glass with a fork, as though to make a toast. Trying to maintain a jocular tone, Charlie said, "Dad, pass me the peas -- and give me your keys." Silence reigned.
"Well, that's enough of that!" his father declared loudly as he helped himself to a second serving of turkey. Charlie's well-intentioned, if clumsy, approach ended all possibility of having a conversation that day and for many weeks to follow.
By the time Christmas arrived, Charlie had devised a plan and strengthened his backbone. Clearly, the moment had come to deal with reality, to acknowledge the family patriarch's growing physical and mental limitations and to converse with a fiercely independent senior who would not yield readily to discussing his present and future needs.
When Charlie broached the subject again, his father rebuffed him with a growl, "I'm not dying! Why the hell do you keep talking to me as though I am? Turn on the ball game."
Respectful but persistent, Charlie refused to be offended by his father's crusty resistance.
"We are all going to die, Dad," Charlie said gently. "It's really not an option. Every adult needs to think ahead. We need to know what your wishes are if you become ill and can't make your own decisions." Charlie shared how he and his wife had been getting their own affairs in order, even though were in their 50s and in good health.
This time there was no angry rebuttal, so Charlie took another step.
"You've always been there for us, Dad. Now I need your help. I'd rather that we have these conversations now, in the comfort of your living room, rather than at two o'clock in the morning in the emergency room."
And then, an amazing event took place. Charlie's father dropped his head to his chest and lowered his voice. "I thought if I didn't talk about these things they would never happen to me." He raised his eyes. "Silly, huh?"
Charlie sighed with relief as the most challenging and rewarding conversation he'd ever had with his father finally got underway.
Like Charlie, you may have an elderly parent who maintains a wall of silent resistance to issues dealing with the pain of loss over physical and mental abilities. Knowing that adult children are acting out of love and concern often softens such resistance.
Ideally, these conversations about the inevitable loss of vital abilities like safe driving or making decisions about end-of-life issues begin early and continue over time as the life cycle unfolds. In reality, such ongoing open communication rarely happens. Research shows that 60% of people say that assuring that their family is not burdened by tough decisions is "extremely important" while 56% of people have not communicated their end-of-life care wishes.
How to begin? Seize the moment. The illness or death of a family member or friend, or a news story, TV program or movie can lead to a conversation. (This article can spark a discussion; leave a copy on the kitchen table or with the bathroom reading material.)
After attending the funeral of an uncle who had been unconscious for several months following a massive stroke, one woman turned to her husband and said, "I'd never want to live like my uncle, unable to move or recognize anyone and kept alive by a feeding tube." That comment opened the way to other conversations that led to a discussion and documentation of their end-of-life wishes.
With time, patience and persistence, almost everyone can plan and prepare for excellent end-of-life care by discussing wishes with loved ones and documenting choices in an advance directive (a document completed in "advance" to "direct" people how to treat us if we are unable to speak on our own behalf). Advance care planning can decrease pain and suffering at the end of life, increase quality of life, lower medical costs and improve satisfaction for patients, families and healthcare providers. (For more information about advance care planning, visit the National Hospice and Palliative Care Organization website at caringinfo.org and also see theconversationproject.org and engagewithgrace.org.)
When you raise your glass and make a toast this holiday season, include a wish for health and happiness, lives lived well and a future well planned for.