When thinking about planning, I typically see a maze of legal twists and turns, forms to complete, conversations to conduct — an obstacle course with no finish line. But if I “de-construct” planning, it becomes more doable and less overwhelming. Here’s how I approach it:

Advance Care Planning

I start with my advance care directive comprising my living will and health care power of attorney (POA) or proxy.  These inform my loved ones and medical professionals how I wish to be treated if I have a life threatening illness or accident. The health care POA designates who should make health care decisions for me should I lack capacity to do so. Also included are a list of my doctors, prescription medicines, and other medical information.  

Of course, none of these documents are really operational without a conversation with those to whom I entrust my care. Advance care planning can extend to care-giving, whether provided by loved ones or hired aides. I also include a “dementia-directive”* which sets out my preferred levels of care should I lack capacity to make health care decisions for myself.

Financial Planning

This portion of the planning process addresses distribution of my assets, be they real, personal, and/or accounts with financial institutions.  These include my will or estate plan, or both. Crucial to completing this phase of the process is – again – a conversation with my loved ones about the terms of any asset distribution, who is my will’s executor, and where to find a signed copy of my will. 

End of Life Planning

How I wish to die is critical information for family members and my medical professionals. Writing out those instructions is only half the task.  Talking about my death, is key to my loved ones’ understanding my final wishes. In addition, I may decide to transmit in writing my ethical or spiritual values, write my obituary, and design my funeral or memorial service. Handling these tasks myself will save my family possibly agonizing moments as they try to divine how I’d like to be remembered.  Now that Death with Dignity (aka physician-assisted suicide) is gaining support, I will prescribe under what conditions I would prefer this mode of dying. **

Digital Legacy Planning

This element refers to whether and how I want to preserve or eliminate my digital presence. The larger my digital “footprint,” the larger my digital presence. How do I “get off of” Facebook, LinkedIn, Instagram, etc.? Or do I want to remain there in perpetuity? (One shocking statistic suggests that in 100 years, there will be billion dead people on Facebook). What about my passwords, photos, emails, texts, business information that live on after I pass on? Those, too, are part of this process.

Planning doesn’t have to be onerous if we approach it as a step-by-step process.  

*A dementia directive states how much medical care I would want if I had Alzheimer’s Disease or another form of dementia. See: www.demential-directive.org.

**Nine jurisdictions, including mine, the District of Columbia, permit physician-assisted suicide. California, Colorado, District of Columbia, Maine, Hawaii, New Jersey. Oregon, Vermont, and Washington.

Earlier I discussed how important medical advocacy is when a loved one or friend is hospitalized. As someone’s medical advocate, you want to ensure the hospital staff is serving her as well as possible. Especially at discharge. No one should ever be discharged from a hospital without an advocate, or at least a friend or caregiver, present to hear a discharge nurse’s instructions and review the paperwork that most discharged patients rarely have the capacity to absorb.

Following her hospital discharge your loved one (who has Medicare) may require skilled nursing care (SNC). She qualifies for SNC if: 

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A friend recently arranged to have his will prepared.  He told me he planned to bequeath his one piece of real property in three equal measures to his brother and his two sons.  In other words, three persons would become co-owners of one property. 

I asked whether he planned to discuss with them the terms (not the value) of his bequest.  He replied that they refused to discuss the matter. He said their unwillingness to discuss the bequest almost guaranteed a dispute over the distribution of the property after his death.  He acknowledged that from past experience he was powerless to avert this outcome. Discussions about death or money were out of the question. 

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Trust

Parents need to know their adult children will, to the best of their ability, ensure they receive appropriate care in a hospital, assisted living, or skilled nursing residence. They hope their kids will look out for their safety without diminishing their autonomy and independence, but enough to keep them safe.

Transparency

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A friend recently had spine surgery that took 5+ hours. After regaining consciousness, she found herself in the recovery unit…for the next 26 hours! Groggy from the anesthetic and not knowing whom to talk to, she languished there until a friend arrived and raised hell. She subsequently learned that private rooms were available throughout the 26 hours, but somehow the Recovery Unit staff wasn’t aware of any. When they finally wheeled her to a private room, she waited another hour for the room to be cleaned.

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Like many of you, I have an Advanced Care Directive comprising a Living Will and Health Care Proxy (or Power of Attorney) to make decisions for me if I lose my capacity to do so. I live in a jurisdiction (the District of Columbia) that permits physician-assisted death. My family and I have discussed my health care values and preferences. If I ever have a mind crippling illness and had earlier told my family and physician my preference not to continue living in that situation, my family and doctor know what to do. Right? Wrong!

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My last blog listed types of listeners. From the ‘pouncer’ to the ‘monopolizer.’ Now, on a more positive note, this post suggests ways to enhance conversation. The first (and for me) most challenging step calls on us to become empathic listeners. I came across this term in an article by Dr. Tammy Lenski* who attributed it to author Steven Covey. For Covey “empathic listening is listening from the other person’s frame of reference. Only empathic listening comes from a desire and commitment to listen without an agenda (emphasis added).”

Developing the “mental muscle” to listen empathically takes practice. Give it a shot the next time you’re engaged in dialogue. In addition, consider these techniques to enrich your exchanges:

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One of the topics Carolyn and I discuss in our presentations about our new book Love’s Way involves Listening.  Most of us don’t listen well. And even when we think we are listening, we sometimes fall into one of the following categories:

The Pouncer: This non-listener is waiting for the other speaker to pause just long enough to inject his point into the conversation.   The speaker may be in the middle of conveying a thought, but hesitated to take a breath or sip some water. That’s the moment the pouncer has been waiting for: to take charge of the conversation.

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Talking with your doctor (provider) is not just about what ails you. It’s more.  Lot’s more. Let us count the ways:

First, a patient should know his or her health goals, or seek help in defining them, especially as she or he advances in years.  For example, if you became severely ill, even mortally ill, how much ‘heroic effort’ would you want your doctor to provide?  You should understand your medical options in case a health crisis occurs.  Bottom line: What quality of life would you want were you severely ill with questionable chances of recovery?  

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