Almost no one wants to talk about death, whether their own or a loved one’s passing. But Maureen Kures welcomes the discussion. Kures is the Seattle-based founder of Radiant Mourning, a service to help families discuss and plan for death. “We don’t want to talk about death in our culture because of that fear of the unknown, that someday we’re going to be gone,” Kures says. “Many people don’t even want to think about it.”

Years ago, when she started working at her first nursing job in an oncology unit, Kures felt scared. But over time, fears fell away. “It’s always sad when someone dies that we love. We miss them,” she says. “But death can be a beautiful journey.”

Only 40% of Americans have planned for their deaths in any way, Kures says, preferring to ignore or postpone the topic. But adult children between the ages of 45-65 tend to start getting anxious about juggling the needs of aging parents and growing teens or young adults. It’s the perfect time to initially — and very gently — bring up conversations around end-of-life, funeral and burial, and after-death plans. In other cases, it’s the parent’s job to introduce the complex topic.

There’s an inherent tension as parents age, says Scott Schill, attorney and director of Longevity Law and Planning (which includes elder law and estate planning) at S.R. Schill & Associates. Adult children tend to be motivated by concern for safety, while older adults value autonomy.

It’s almost a reversal of the teen-parent relationship, although most adults can make better decisions about independence and risk trade-offs than teenagers, he notes. With the right balance and open communication, everyone can be accommodated.

Initiating final conversations

Adult children might use a celebrity, friend or family member to initially broach the topic, Kures says. An example: “Olivia Newton-John just died but was diagnosed with breast cancer 30 years ago. What would you want if put in that position? Aunt Mary’s stroke paralyzed her on one side — what would you want us to do for you in that situation?”

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Don’t be surprised if a parent doesn’t want to discuss death. Step back and try again at another time — don’t push. But frame it as a way to honor and respect a parent’s wishes and reduce future familial conflict.

As a nurse, Kures often saw families fracture over misunderstandings and disagreements when a dying parent’s wishes weren’t documented and discussed in advance. Perhaps one adult child was left in charge of health care decisions — but no one else knew — or no one was left in charge, and kids bickered.

Some parents call a family meeting after completing legal or other planning work with an attorney. This can start with simply saying, “I want you to hear from me what I want if anything happens and I can’t make my own decisions, and why.” You can discuss whether you want a funeral, wake, or memorial and any estate planning documents.

No matter who initiates, bring the entire family to the table to avoid gossip and rumors. Reactions may differ, and that’s OK, Kures says. If the conversation gets heated, consider a talking stone or stick so that only one person speaks as others listen. If it’s too emotional, it’s fine to step back and try again later.

Set the table, have a glass of wine, and with luck, at the end of the family meeting, everyone walks away feeling good. “It’s a chance for generations to exchange promises,” Schill says. Children want to know that parents will understand the courage required when asking a parent to get help. Parents want to know that their children will advocate for their ability to return home if in the hospital.

Practicalities

An elder law attorney like Schill helps aging parents chart a path that avoids big fears, whether the nursing home, family conflict, outliving the nest egg or becoming a burden. The end goal? “To simplify, dignify and unify,” he says, by leaving a manual of instructions, so no one is left making regrettable or difficult-to-impossible decisions.

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Schill suggests a “suite of documents,” including the will, health care and financial power of attorney, living will, HIPPA authorization documents and a remains-handling directive, among others.

Providing direction for remains gives the family “a rite, something to do for closure,” Schill says, and describes any prepaid funeral expenses. Prepaying offers many advantages, he says, including removing one more to-do and cost from the kids’ list. Decision-making during grief is a vulnerability, he says, sometimes leading to susceptibility to pitches for extravagant funeral expenses.

In addition, a “What about me document” outlines your tastes. “If I’m in the hospital, what do I want on the TV? MSNBC versus Fox News?” If you don’t want the last thing you hear to be the voice of Sean Hannity or Rachel Maddow, you might consider letting others know. 

Review your health care and legacy once a year and discuss any changes with your family. Talk about hospice, too, Kures suggests. While most don’t call hospice until the end, the resource can step in with a prognosis of 6-month life expectancy or less. “You can have two people with the same diagnosis, but the person on hospice will live weeks to months longer, with a better quality of life,” Kures says. 

Beyond practicalities

Conduct a parent-child “life review” by peppering conversations with everyday questions, Kures suggests. “What was your favorite ice cream? Who was your favorite teacher?” And more revealing questions, too, such as “What was the hardest challenge you’ve faced in life?”

Many parents want to feel they’ve made a difference and had a purpose in life. Final discussions also involve discussing regrets, asking for forgiveness and forgiving others. “If you talk it out, you may not find it’s not a regret at all, but simply require looking at a memory from a new perspective,” Kures says. “But talking is essential.”

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Both the dying and family members often experience “anticipatory grief,” she says. Discussing memories, laughing and crying together and sharing special last moments can help with eventual acceptance and healing. 

“If we don’t have these conversations and lean into the grief, it’s often harder to deal with after,” she says. “Conversations may be awkward at first, but the richness that comes from it is so important and profound and gives you a gift to help with your grief.”

Discussing a parent’s “bucket list” can help provide advance closure. As physical mobility becomes increasingly limited, the list may change. Ask a parent, “What brings you joy in your day? What’s something you’d like to do again, someone you’d like to see, a place you’d like to return to?” The responses could range from driving up the Oregon coast to see an old friend or visiting Edmonds to watch ferries set sail into the sunset.

Kures’s mother is turning 86 and said she hoped to revisit New England in the fall. Although she’s in perfect health, Kures and her mother will be going in a few weeks. It’s never too early to check off bucket list must-dos.

Resources

A geriatric care manager can help the family navigate quality of life issues, Schill points out, especially regarding health care systems and default pushes toward institutional versus at-home aging. Find out more at Aging Life Care (aginglifecare.org).

Kures says those with a terminal or life-limiting diagnosis can opt to hire a death doula, who can assist with bereavement, bedside vigils or education and planning. The Gentle Passage Doula Collective’s (gentlepassagedoulacollective.com) hosts a once-monthly online Death Cafe for your death-related questions. 

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Card games make revealing, vulnerable conversation a little easier — and perhaps even fun — including The Death Deck and the Hello Game.

Honoring Choices Pacific Northwest (honoringchoicespnw.org) offers thoughtful conversation starters and advance directive and health care agent forms.

The Conversation Project (theconversationproject.org) also offers tips for having end-of-life conversations and insights for caregivers, including a guide for dementia.