Midlifers seem to be guilty of wishful thinking when it comes to the possibility of a long, devastating illness.
In an AP-LifeGoesStrong poll conducted this spring, 64 percent of Americans born between 1946 and 1964 (and 70 percent of all U.S. adults) said they did not have a health-care proxy, living will, or advanced directive that spells out what care they would like to receive if they're unable to communicate with their doctors. Yikes.
So why do we put our heads in the sand? "We live in a youth-obsessed society," says family-care consultant Melissa Kahn, head of Kahn HealthCare Consulting in Chicago. "People are so focused on staying young and doing everything to avoid the inevitable. So I think it's just human nature to avoid certain topics."
Sickness and death are certainly among them. "Planning for aging is not something that's high on a priority list," she says.
To get motivated, we often need to witness a crisis. "Somebody has a family member who gets sick, or there's a fall, there's an accident, where all of a sudden people realize, 'I haven't thought about this,'" she says.
Proxies are forms that say, "If I am no longer able to make decisions for myself, I designate x, y, and z to be my agent," says Kahn.
WHERE THERE'S A WILL…
Living wills – which states like Illinois let us download from the internet — also let us specify exactly what we would like to happen if we're incapacitated.
Hospitals typically ask, "Do you have advance directives?" "Most people hear that, and they have no idea what this person is talking about," says Kahn. "That's not the right time to be signing that. You want to think about that before you go into the hospital."
Discuss wishes with family members. Often people say, "I want my spouse to be my healthcare proxy, my agent," says Kahn. "But they haven't really talked to that person about their wishes. Or they designate a child. The child has no clue what that person wants."
Even people in their 20s should start making plans. "If something happens to me, who do I want making decisions for me?" says Kahn. "And who is my backup if that person is unable or unwilling?"
TALK IT OUT
And that's a problem. "There can be family disputes when there hasn't been a discussion about end-of-life wishes and how to honor them," says Kahn. At all stages of life, discuss the "what if's" and legally document your wishes. Be specific. Think about, "If I were in an irreversible medical situation, what would I want for my end of life?" You can be as specific as you'd like. For example, say, "If my condition is irreversible, and there's no chance I would come out of it, not only do I not want to be put on a respirator, I don't want tube feeding or antibiotics — only comfort measures," says Kahn.
Sometimes people overreact because they think misinterpret what a living will means. They may think someone is going to unplug the machine if they're even an acute, temporarily incapacitated state, says Kahn. In this case, doctors would talk to family members to clarify the difference.
Plan ahead. And ideally, travel with the legal documents that specify your wishes. Your attorney, your doctor, and your designated family member or your proxy should keep copies, says Kahn.
Without knowing your wishes, hospitals by law must take every measure possible to keep you alive, says Kahn. "It really makes a difference to have those documents in order."
COMMUNICATE YOUR DESIRES
Tell your kids who will be your proxy. Otherwise, sibling rivalry may surface. "How come mom picked you and not me?" says Kahn. "It's important to think about who will be able to honor your wishes and be comfortable in that role." Perhaps a spouse suffers from memory problems and needs a backup.
Consider hiring an outside mediator who can make it easier to bring up uncomfortable issues. "We don't like to talk about the what-if's and end of life," says Kahn. She sends her clients a document that summarizes what they have agreed on – and encourages them to revisit the issues in a year or two, since feelings may change. "Living wills are not irrevocable," she says. "Life is a process."
The National Academy of Elder Law Attorneys advises thinking about changes after these five "D's": a new decade of life, a death in the family, a divorce, a diagnosis of significance, or a decline in condition.
For help writing wills, living wills, and proxies, check out the American Bar Association's "consumer's tool kit for health care advance planning.
For help finding an attorney, check with your local or state bar association or the National Academy of Elder Law Attorneys.
While you're at it, consider donating your organs after you die. See organdonor.gov. And don't forget to talk with your loved ones about where you'd like to rest after your death. More than a third of Americans who die today are burned in crematories.
For more stories about wills and related aging issues, read:
Why You Should Write (Or Re-Write) Your Will Now
How to Make Sure Your Aging Parents Are Healthy, Happy, and Prepared for the Future