It’s Time to Have “The Conversation”


by Michael Bloom~
The most awkward conversation that we can have is not about sex. It is about death and dying, especially with our aging family members. You see, most of us, especially Americans, do not like to discuss this topic even though we know that death and taxes are inevitable.

If you or those you love do not want to talk about dying, you are not alone. This was the case with my parents. I was very fortunate for all of my caregiving responsibilities from a legal perspective. My father realized the importance of consulting with an elder law and estate planning attorney after his retirement. All important documents such as a will, trust, durable powers of attorney, and health care proxies were in place. My father did not hesitate to plan in-depth for his passing as he wanted to make sure that things would transition smoothly for my mother and me should he pre-decease us. He did extremely well with his research and preparation and even purchased pre-planned funerals, which again were a great comfort when the time came to execute those plans.

Unfortunately, my father ended up with vascular dementia as a result of a catastrophic heart failure event. Even though my mother and I were named as his health care proxies, he never had a discussion with us about what types of specific interventions or measures he would like taken during his last months of life. The health care proxy document appointed the people to make decisions on his behalf but provided no information as to what his treatment wishes were. I also learned that my parents never discussed their end-of-life care wishes with one another. In fact, my mother avoided discussing death or dying at all so she ended up deferring all decisions related to my father’s treatment to me.

My family was like most families in this respect.

60% of people say that making sure their family is not burdened by tough decisions is “extremely important”

56% have not communicated their end-of-life wishes

Source: Survey of Californians by the California HealthCare Foundation (2012)

70% of people say they prefer to die at home

70% die in a hospital, nursing home, or long-term care facility

Source: Centers for Disease Control (2005)

82% of people say it’s important to put their wishes in writing

23% have actually done it

Source: Survey of Californians by the California HealthCare Foundation (2012)

After traversing the heart-wrenching road of supporting my father through his end-of-life journey, I attempted to have “the conversation” a few additional times with my mother. At the conclusion of my final attempt to discuss the topic of care wishes, my mother stated that she did not ever want to talk about the topic again. She told me, “Michael, I trust whatever you decide to do at the time.” On the one hand, this was very affirming and flattering as to her faith in my caregiving skills and decision-making. On the other hand, it left me with the feeling of an extra burden. I made decisions for her treatment while I supported her at home with hospice based upon my gut feelings rather than deep understanding as to her desires.

Believe me, this is not a preferred pathway. The good news is that I was an only child so I did not have siblings to argue with over my treatment decisions. Given my work with clients and friends, I know that treatment decisions often elicit much conflict and sadness for larger families. To minimize the risk of anger and hardship among our loved ones, it is vital for all of us to have “the conversation” with those who may care for us. If we become incapacitated and unable to make decisions for ourselves, we must have someone legally appointed (usually via completion of a simple form in front of a few witnesses). It will better serve everyone if we provide clear guidelines or a roadmap for our appointed person(s) to follow. This will do much to reduce uncertainty during some of the most stressful situations families ever face.

How do we start “the conversation” with our aging family members who may be resistant to such a discussion? I recommend not singling them out with the need or responsibility to have “the conversation” and to coerce them to fill out paperwork such as a health care proxy or directive. After all, anyone who reaches the age of 18 really can benefit from having such documentation in place. Once we reach the age of majority, a parent cannot step in to automatically make a decision. None of us are guaranteed a fully functioning body and mind until our elder years. People of any age can be involved in an accident or suddenly struck by a catastrophic illness.

One of the most beneficial activities a family can complete is to have every adult member of every generation have “the conversation” and complete necessary documents that meet state and local requirements. How do you find such information? One of the best free websites that I recommend to my clients who wish to engage in this discussion is The Conversation Project located at The site has a free starter kit to help facilitate your wishes and how to have the conversation with loved ones and your doctor. For further resources, I highly recommend the Centers for Disease Control’s Guide “Advance Care Planning –Selected Resources for the Public.” This resource guide can be accessed at I have used the site myself and have facilitated a number of conversations with clients that quickly get the documents in place. Feel free to reach out to me if you need support at

Once you gather information and reflect, choose to have “the conversation” with your trusted family members and friends as soon as possible. This is one of the best activities that can be done in service not just for your aging family members, but for all family members – especially those who will serve in a caregiving role. So, take a deep breath, arrange a family meeting, and do it!


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About Michael Bloom

Since 2011, Certified Professional Coach and Caregiving Without Regret™ Expert A. Michael Bloom has helped to revitalize the careers of hundreds of family and professional caregivers with practical, tactical soul-saving coping strategies and support them in saving lives. With a wealth of practical expertise as both a family and professional caregiver, Michael serves as a welcome and sought-after catalyst to guide caregivers and health and human services leaders to stay energized and committed to work that has never been more important or vital than it is today. Great information and resources are available at

6 thoughts on “It’s Time to Have “The Conversation”

  1. Terri

    As a professional caregiver myself I agree that this is such an important conversation to have. Another important thing is to be sure that whomever you or your loved ones choose as their medical POA or end of life decision maker will be able to abide by their wishes. One other big point….living wills don’t belong in a safety deposit box. Your loved one, their medical POA, and their doctor should all have a copy. If going to the hospital have a copy with you so that your care decisions are made known.

  2. Sheila Brennan

    Great article, Michael. Reading the statistics were reassuring to me. I had been told that my mother opted out of the talk because she’s Irish and that’s how the Irish are! I’m glad to see that I’m not alone as a child who has a parent who hesitates to share her wishes for the end of life! I am from a massive Irish, Catholic family and making decisions, especially without benefit of her guidance, will be difficult and most likely questioned. It’s always good to know that you’re not alone.

  3. Charles D. Stark

    I agree with your emphasis on the importance on the family conversation. Sadly, families often do not have these difficult conversations throughout the development of the family on many issues, so there is no experience or pattern to follow when the time come to discuss elder care. One distinction I make with my clients is that the documents that delegate elder care decision making are legal documents, not medical or social documents, yet they are implemented in those settings. This ages the file conversation all that much more important, and as you say more important when there are multiple siblings geographically, and possibly emotionally divided.


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