I recently attended an End-of-Life Expo. Organized by Washington, DC-based IONA Senior Services, a highly respected nonprofit dedicated to improving the lives of aging persons, its notice about the expo tweaked my interest: “When you express how you want to die, you reveal how you want to live.”

The day-long expo offered 12 sessions from dementia planning and organ and body donations to writing your own obituary and DC’s Death With Dignity Act. (In 2016 the District of Columbia joined seven other jurisdictions* and enacted a Death with Dignity law that enables terminally ill DC residents to take their own lives with two doctors’ approvals and after meeting a host of other requirements.) More on this below.

The meeting spaces were filled to capacity and late registrants were wait-listed. Attendance at most sessions was standing room only. The speakers were well-prepared and engaging. 

My first session focused on writing one’s own obituary. What a great idea! Instead of having your relatives hurriedly piece together a summary of your life, why not do it yourself before you die? It takes a weight off your loved ones who may be absorbed with de-cluttering your home or coping with unanticipated financial complications. I didn’t know that (at least in Washington, DC) one has to pay a line-by-line charge for their obituary notice to appear in The Washington Post. By writing my own obit, it will contain what I want included.

Another session dealt with starting and talking about life and death matters. Drawing on “The Conversation Project,” a project of writer Ellen Goodman, the speaker offered suggestions for initiating and engaging loved ones in learning one’s end-of-life wishes: Do I want doctors to take heroic measures to extend my terminally ill life for a few weeks, or do I want to die without tubes and wires sprouting from my body — all working to add a few days or weeks to my diminishing time on earth?

The Death with Dignity session was the most attended. People need clarity on what the Act permits. For example, one has to be terminally ill and in the last six months of their lives to qualify for lawfully taking their own life. A person with dementia cannot take her own life. Only persons with “the ability to make and communicate health care decisions to health care providers” qualify for this program. Other provisions call for the terminally ill to submit a written and witnessed request to his attending physician before a “covered medication” can be prescribed; that the cause of death is the illness the patient suffered from NOT suicide; and the terminally ill person must ingest the lethal medication by him or herself without assistance from a medical professional.

Clearly many people are hungry for this information. They want to know how to die, not just when they’ll expire. Professionals in the aging arena should not underestimate people’s desire to learn more about what to expect as illness takes its toll and the need to prepare for death looms larger on the horizon.

Congratulations to IONA Senior Services for coming up with this remarkable program. It’s time comparable organizations and government agencies begin preparing us for the final season of our lives.

* Vermont, Colorado, California, New Jersey, Oregon, Hawaii, and Maine

I’ve given up resolving to lose ten pounds (now it should be fifteen) and exercise more. I still hope to do those things, but know I can’t count on enough self-discipline to accomplish either.

So this year I kept it simple. Two discrete goals, time-limited. And a continuation of my jagged trajectory in the bigger sphere of spiritual growth. 

A beloved baby grand piano takes up a quarter of my living room but sits unplayed. I love music. I want to play it. But something else always seems more urgent. One day Jim asked, “Could you just practice thirty minutes a day?” So I made a resolution to do that. I didn’t tell him, but I just sat down and played (badly) on New Year’s Day.

That afternoon our condo book club got together for drinks and snacks to celebrate the New Year. We went around a circle, describing something meaningful we experienced over the holidays or during 2019. When it came to Jim, he said, “My wife played the piano for me.” 

I didn’t know such a simple thing would mean so much to him. So this is one I’m going to try to keep. 

My other resolution was only for a month. I’m writing a third book and I promised myself (and my agent) to have a complete book proposal in her hands by January 31. Will I do it? I’m making progress. I believe I can do it, which helps. 

The spiritual practices I want to continue (I won’t call them resolutions) are two. One is writing in a daily gratitude journal, in which I list up to five things for which I’m thankful. This practice keeps me grounded. It reminds me, even when life is painful, that something in my life – a warm home, a loving companion, enough money, good doctors, a supportive faith community – is a sign of God’s continuing grace.  

The second is to carve out at least thirty minutes a day for silence. I may walk or journal or meditate or pray or read Scripture or other inspirational writing – or just sit quietly and listen for the “still, small voice” within.

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.dementia-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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When my husband Jim turned 82 recently (my age), one of our kids gave him a birthday card. It showed a back view of a naked white-haired guy running into the ocean. The word “Yippee!” in the shape of swim trunks was pasted across his buns. The card said, “Getting old is AWESOME!” 

But inside it read “ … said no one ever. Anyway, Happy Birthday!”

Not LOL. 

I for one do say old age is awesome! I’m not as spry as I used to be, but the freedom makes up for it. Here are some AWESOME things I couldn’t do when I was younger:

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Helicopter parents hover over their children, trying to protect them from every possible danger or scheduling every minute to insure a child succeeds
at whatever the parent holds dear, whether it’s sports or music or straight
A’s. Sometimes helicopter parents morph into “helicopter grownup children” as their own parents age. In their 50s or 60s, they may begin to parent their parents. What’s meant as caring can feel like control.

Signs You’re a Helicopter Kid

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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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