You can leave your family desperately trying to make arrangements — or peacefully executing your desires. Here’s what you need to understand about life-end planning, whether it’s happening in months, years, or decades.
They want their family to avoid the hallway huddle
You could learn a lot by telling a health care professional about the issues that families face 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.”
They have these two health-related documents
As for the technical details of end-of-life planning, there are two documents that every adult should have from the health perspective. The first is the Advanced Directive, also known as the living will, which sets out wishes as to what medical care you don’t want (“no feeding tubes, please”), what you 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 in preparing for death is to pick up your long-term health attorney, also called a healthcare proxy or agent, who is the person you want to speak for yourself 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 can help you file these health records, there are other choices, says Radulovic. Every state has its own forms (some states incorporate them into one document), and you can get a copy of yourself by going to sites like NHPCO’s CaringInfo.org, selecting your state, and downloading the file.
Another option is to log on to AgingWithDignity.org to buy a copy of the Five Wishes document, which utilizes a more neutral tone to explain end-of-life planning and help you express additional wishes, such as whether you want music played or a massage. But if these official documents are intimidating, Radulovic recommends simply sitting on the computer and writing your wishes 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.
They cover estate planning basics
With the support of an online resource, such as LegacyWriter or LegalZoom (which may also include the Health Advance Directive and proxy), a simple will may be produced for young people without many assets.
Nevertheless, more complex arrangements for preparing for death, including naming guardians for young children, establishing trusts, and multi-generational planning, need to be made with the estate planning attorney, says Pamela Sandy, CFP, 2016 President of the Financial Planning Association. In either way, experts believe that anyone over the age of 18 should have at least a basic understanding 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 take place well before it is absolutely needed. “I tell my clients to review their estate plan when major life events happen, such as marriage or cohabitation, the birth of a child, or divorce,” says Sandy.
Nevertheless, she adds, there are many other times to update your death plan, such as after legislative changes, the death or illness of someone you named as a beneficiary or executor, or a sudden influx of money, such as your own inheritance.
“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 prepare is immediately after a serious medical diagnosis, particularly 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 be helping unless you pass them on 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 fact, choose a regular meeting, such as a reunion or a holiday, to give your family a ten-minute clarification on your plans if anything has changed throughout the year, he adds.
But they don’t overshare
The presence of too many family members 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 let your executor know that certain end-of-life planning documents are in place and who to inform if something happens, not even that person needs to see what’s in those documents. “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 while planning 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 50-year-old husband who died of a heart attack while planning for his anniversary celebration. Since getting married, he had not revised his estate plan, which still listed his sisters as beneficiaries, even though his wife had expensive health problems.
“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 most important things Sandy notices people forget about 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 changed usernames and passwords all over the place?” says Sandy, who advises 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 variety of online platforms; for example, Sandy includes Everplans — which helps store digital files to be accessed at the right time by a loved one— among its customer services.
They’re creative about end-of-life planning
With logistics in place, experts are encouraging people to be brave and creative about end-of-life planning. Radulovic sees a lively series of events and excursions among patients approaching their final days, such as Honor Flights for veterans who want to see a Washington D.C. memorial, a horse brought to the hospice for a final goodbye, and an informal wedding held at the 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. “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
Organizing your service ahead of time 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.”
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 main misconceptions he sees at the moment 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.”
They delegate their wishes
When you have several grown children, delegating duties according to their professions and interests will help them prevent conflict and work together to cope 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 that the next generations know who the last generations were. One easy step is to 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 just as essential to collect memories and stories. Arrington suggests a program called Have a Lifetime Talk, which contains a deck of 50 conversation cards that encourage people to share their most treasured 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.”
They say four things
At the end of life, the most meaningful discussions and regrets are not about careers or finances, but about relationships. “Often baggage is carried to 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 notes that one way to limit these 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.
They’re a role model
And when facing your final days, you have the chance to set an example for your children. “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.'”
