How to Have Successful Conversations About Care Decisions

Older adults often face hard questions about their end-of-life care: Should my doctors take extraordinary measures to keep me alive? Who should decide what care I receive if I’m not able to speak for myself? Where do I want to spend my last days? And how can I make my wishes known?

Nobody likes to think about end-of-life care, but it’s something most of us know we should discuss. One survey found that 95% of Americans would be willing to discuss their wishes. Unfortunately, the same survey found that just 32% have had the conversation.

If you’re not part of that 32%, we understand. We know that meaningful care conversations don’t just happen; they take planning and hard work. To help you get started, we’ve put together tips for caregivers and older adults alike.

Tips for Caregivers

Let’s start with caregivers.

As an adult child or other caregiver, you can help your loved one think through the issues and make the best decisions possible. You may also be better able to do things like finding an elder care attorney or getting all your siblings together to talk. That’s especially true when your loved one is in the hospital or is dealing with chronic health problems.

Here’s our advice for caregivers:

Start early. It’s hard to make good decisions in a crisis. Don’t wait until an emergency arises to start talking about what-ifs. Instead, start having conversations as early as possible. This could be as simple as saying, “Next time we get together, I’d like to talk about living wills.”

Start small. Don’t jump right into a big conversation that nobody is ready for. Instead, start small: Talk about your own plans. Ask your loved one what worries them. Share an article you’ve read about end-of-life care. (The Conversation Project website is a great place to start.)

Have several conversations. Don’t expect to have a plan in place after your first conversation. That puts too much pressure on everyone to reach a decision on the spot. Instead, raise the subject and then come back to it as often as you need to.

Choose the right setting. For big conversations, find a quiet, comfortable setting without a lot of distractions. Needless to say, a hospital room doesn’t qualify! And put away your mobile devices; nothing is as important as this conversation.

Involve everyone. Involve other adult family members in care conversations, including those who live out of town and don’t provide regular care. Close friends and religious leaders may also have good ideas. When you hear lots of perspectives, you’ll be better able to come to the right decisions.

Do your homework. Before you have a serious conversation, do some serious homework. Research advance care planning. Learn the difference between palliative care and hospice care. Find local elder care attorneys. Then, do more homework before you talk again.

Use your ears before your mouth. Listen to your loved one’s concerns. Their voice is important, and they may have a completely different perspective. Try to understand where they’re coming from.

Use your eyes, too. When you have care conversations in person, you can watch your loved one’s body language. That may clue you into unspoken concerns or areas of confusion.

Remember your role. Unless your loved one has cognitive impairment that affects their ability to make an informed decision, your job is to support them, not to tell them what to do — or to make an executive decision. Try to avoid slipping into a parenting role.

Cherish the moment. Know that you’re helping your loved one find peace of mind now and in the future.

Tips for Older Adults

Now, let’s switch gears and look at the older adult’s role. If your caregiver is handling most of the logistics of having care conversations, there’s not much left for you to do, right? Wrong! You have the most important job of all: deciding what your wishes are.

That can be difficult. Like we said at the outset, nobody likes to think about death and dying. But if you don’t make the hard decisions now, someone else will end up making them later. You’ve probably heard stories of family members squabbling in hospital rooms because they disagreed about a loved one’s end-of-life care. Don’t put your family members in that situation.

The Conversation Project (a nonprofit organization) has put together a great, free conversation starter guide, which we encourage you to download and complete. One of the most important parts lets you decide where you stand on 10 questions, like whether you want to have a say in every healthcare decision. By completing the guide before you have a care conversation, you’ll be much better prepared to talk.

Five Wishes, meanwhile, offers a fill-in-the-blank advance directive form that's valid in most states. It's available in both paper and digital formats in English and Spanish.

Many of our centers have additional local resources and documents to help with these conversations. When in doubt, ask!

One Last Tip for Everyone

Whether you’re an older adult or a caregiver, we have one last tip: just get started. The most important part of any care conversation is when someone says, “Could we talk?” or “I need your help with something.”