Families ‘talk turkey’ to discuss advanced care planning | SteamboatToday.com

Families ‘talk turkey’ to discuss advanced care planning

Holiday gatherings provide relaxed time to plan ahead for seniors

The Ladd family, here with son Matt Ladd and parents Alice and Dave Ladd, talked in advance for several years about advance care options. The Ladd parents now live in Casey’s Pond near their son and daughter-in-law in Steamboat Springs.
Casey’s Pond/Courtesy photo

Sitting around the family Thanksgiving table or chatting on a holiday Zoom call can be great times to catch up with loved ones. This time also can provide a less stressful opportunity to start conversations early about how older or perhaps ill family members would prefer to have family support as they age.

“A lot of times, at Thanksgiving, we think about people we’ve lost, and we’re reminiscing. So, it can be a time we can be more open to intimate and meaningful conversations,” said Peggy Budai, a nurse practitioner and clinical nurse specialist in older adult and palliative care for UCHealth. “Hopefully, this will get some people ‘talking turkey.’”

“Talking turkey” is one way to say families can start conversions about how their older loved ones would like to plan in advance for their later years. The benefits to these important but sometimes difficult conversations are numerous, such as bringing siblings together on the same page about honoring their parents’ wishes, planning ahead for aging-in-place home safety upgrades or care support, reducing family disagreements or stress when traumatic health issues arise, and increasing piece of mind for the whole family.

“It’s better to have this conversation over pumpkin pie and coffee at the dinner table surrounded by your family and friends rather than at the bedside at ICU or after you have called 911,” said Budai, who has cared for older adults for 30 years. “So many of us are still not having the conversation, and then the surviving family members can be left feeling guilty, depressed and unsure if they did the right thing for their loved one.”

A variety of helpful conversation-starter resources are available online or through games, such as Go Wish cards from the nonprofit Coda Alliance or the conversation game Hello. The website TheConversationProject.org, a program of the nonprofit Institute for Healthcare Improvement, wants to help every person’s desires for end-of-life care to be expressed and respected. Families can download for free the print or audio version of “Your Conversation Starter Guide” that outlines “how to talk about what matters to you and have a say in your health care.”

Help for ‘talking turkey’

The Conversation Project: TheConversationProject.org — includes videos and conversation starter guides in English and Spanish.

The Go Wish Game: GoWish.org — includes a free online, interactive version or link to purchase the card game.

Advanced care forms: UCHealth.org/services/palliative-care/advance-directives — provides forms in English and Spanish to complete a living will, advance directive or medical proxy.

The nurse specialist said these conversations may be challenging or awkward to have, so family dynamics of past conversations should guide individuals as to how to bring up the topic. Family members can share an explanatory online video or use a variety of empathetic techniques.

“It is normal for people to struggle with or be resistant to these conversations and for people to think it’s too early since no one is chronically or seriously ill,” Budai said. She noted a mantra in the elder care planning world is, “It’s always too early until it’s too late.”

Adult children can introduce the topic by noting, “talking about it can bring peace of mind right now and bring us all comfort, and we want to know what you want,” Budai said.

The most important part of talking turkey is for family members to listen to the older individuals about what the seniors want so that the right decisions can be made later.

The Go Wish card game, also available online in a free interactive version, is one way to help start holiday conversations for family members to learn the advanced care desires and wishes of seniors.
Coda Alliance/Courtesy photo

Budai said she might advise, for example, siblings in their late 50s who are thinking ahead about their parents in their 80s, “At the first meeting talking turkey, open up the door to conversation and ask them what matters to them at the end of life, ask them what are their priorities and share some of your priorities.”

As conversations continue through time, a variety of topics can be addressed, ranging from selecting a health care proxy, establishing a living will and advance directive, and determining where older adults would prefer to spend their last days. Aging adults may have already made end-of-life plans that they have not shared with their children, so the older individuals can fill out a “my gift of information” booklet or “peace of mind planner” with key information for their children or relatives.

Another advantage of having such conversations early can be that families identify resources available in the community that can help, such as transportation, house cleaning or meal services.

“People don’t tap into all the resources that are available because they don’t think about it until they already need it,” Budai said.

Budai said although the desire to age in place at home is a growing trend, the COVID-19 pandemic heightened the desire for seniors to be able to stay at home safely as long as possible. Investigating senior care services ahead of time makes aging in place a more feasible plan, she said.

“Using home care-based resources certainly is a trend that we are hearing people talk a lot more about,” Budai said. “Over the last decade, there has been a push to help people understand if they plan ahead, they have a greater opportunity to potentially age in place in their homes.”

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