planning for the later years

Sunday, August 13, 2017

NFL training camps mark the career beginnings of new stars but also the end of the road for veterans whose desire to play has waned or whose bodies have failed them. Sometimes, the signals marking the end are recognized by the player but for some, the end is marked by a call from the coach asking for a meeting that includes a reminder to bring the playbook.

Life transitions mimic sports timelines in many ways. Decisions that affect how the later years of life are spent often are neglected and delayed, until one day, the choice is no longer that of the person. Instead, circumstances force others to choose where a person might live, how much care they get and ultimately whether treatment should be offered at all.

Everybody gets the concept of financial planning for their later years, but many people fail to get the rest of the planning details. There is always another day to write a will and deal with who gets what, but a will just deals with stuff and there are other more important planning tools that need to be addressed. Living wills, advanced directives, end of life care plans are terms that evoke fear and sadness to the point people choose not to plan how they will be cared for in their old age or in times of medical crisis. Ignoring the paperwork might mean others, perhaps strangers, will try to guess what a person really wanted towards the end of life.

Advanced Directives

Advanced directives, or living wills, write down what type of medical care a person wants and how aggressive that care might be. It starts with the basics. If your heart stops, do you want CPR performed. If you stop breathing, do you want to be placed on a ventilator and have a machine breathe for you. Next questions may ask about aggressive care with surgery, intravenous antibiotics or whether the goal of care is not curative but rather comfort in nature. It’s important to remember that the decisions are fluid and not written in stone; they can be changed at any time and often re-adjusted. When a patient who wanted absolutely everything done, presents in crisis after a prolonged illness, there might be a change of heart. And the same can be said for somebody who wanted nothing done at all, but changes their mind when they became ill.

Power of Health Care

Sometimes people can’t speak for themselves, either because of the criticality of the situation or because their ability to understand has been robbed because of dementia or other illness. Hopefully, a power of health care has been designated by the patient, the person who understands what the thoughts and hopes of the patient were, to best decide what the patient wanted, and not what the designated decider wanted. The power of health care is different than the power of attorney or POA.  The POA deals with money decisions and does not get to decide how much or how little health care is wanted.

Living Arrangements

Perhaps the hardest part of planning has to do with where a person might live if they become too ill or too frail to care for themselves. Often, there has been little thought given on the part of the patient. Most people think that they will be able to care for themselves forever. Families also see people as frozen in time, always going to be as they are now. But one Thanksgiving, people might notice that a parent takes a bit longer to start their day, takes an extra nap and calls it an earlier evening than usual. Next Easter, the naps are longer and the days are shorter.

Family round tables need to talk about the future. Some may decide to care for their own as long as they can, depending upon finances and amount of care a person needs. Some families cannot because of a variety of reasons. Planning home health care, assisted living facilities or nursing homes take time and insight as to availability and finances, especially if the patient is aware and wants input into the decision making. There is nothing worse than having to decide living arrangements at 3am in the ER, where options are limited and decisions seem almost coerced by the situation.

Pro athletes are usually aware when their skills have eroded to the point where they can no longer play at an elite level. And yet, it may take a coach or another player to suggest that they voluntarily retire. If that hint isn’t taken, they may get the call to bring their playbook. In life, there are also hints that cannot be ignored, to allow quality years and dignity in living.


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