Friday, August 28, 2009

Empowering aging parents with advance planning

While many enjoy the benefits that modern health care offers, such as enhanced quality of life and extended life expectancies, many other Americans find themselves moving into unfamiliar territory -- caring for their aging parents. Conversations that once revolved around children, pediatrician recommendations and schools are turning to discussions about geriatricians and assisted living residences.

To better care for and empower aging loved ones, MGH Geriatric Medicine Unit Coordinator of Social Work, Barbara Moscowitz, MSW, LICSW, encourages all adults to consider advance planning -- for themselves and their aging parents.

"Our parents are now living much longer," Moscowitz says. "Often they do quite well through their 70s and 80s. Then suddenly or gradually, we begin to notice problems and deficits, and their lives and our lives change. Often we are not prepared to effectively or emotionally deal with the transition to caring for our aging parents. But there are several important steps we can take to ensure the comfort, care and dignity of our elderly family members."

Having the Conversation

One of the first and most important steps to caring for aging parents is to start preparing for times of potential crisis. This starts with having open and honest conversations about what the parents would like their children or spouse to do if they are faced with illness or frailty.

"These are critical conversations," says Moscowitz. "In this day and age, retirement can be as long as 40 years, and families ideally should start planning for and with their elderly parents just as they think about planning for a child attending college. This involves more than just thinking about saving money. It involves being forthright in sharing preferences related to choices surrounding medical care, living arrangements and advance directives if the parent is faced with illness or frailty."

Moscowitz explains that these discussions can help equip both the caregivers and elderly adults with appropriate resources, support systems and information, and help both parties emotionally prepare for a potential crisis.

Advance Directives

If the time comes -- due to illness, frailty or accident -- when loved ones can no longer make their own decisions about medical care, it is important to have in place a set of advance
directives, preferably in writing, so that their wishes are specific, clear and available. Some of the types of advance directives are the following:

Health Care Proxy: Under the Massachusetts Health Care Proxy Act, individuals have the right to appoint another person to make decisions about their health care in the event they cannot do so themselves. This person becomes the health care agent or health care proxy, and he or she can act as such with a completed Health Care Proxy Form. This form is available at most hospitals and can be found at

Living Will: This document details a person's preferences about life-sustaining treatment in the event of terminal illness. Legal immunity is given to caregivers who comply with an appropriately drafted living will. The U.S. Living Will Registry electronically stores all types of advance directives and makes them available to hospitals across the country through an automated system. The system is free and confidential at

Durable Power of Attorney: Similar to the Health Care Proxy Form but for finances and business affairs, this document allows individuals to designate a surrogate decision-maker, such as a friend or relative, to manage their business matters and make medical decisions if the individual can no longer do so. Individuals should discuss with the surrogate ahead of time the details of their personal business affairs.

Medical Directive: Those who prepare their medical directive have in writing their wishes regarding various types of medical treatment in several representative medical situations.

Moscowitz encourages individuals, whether they are children of elderly parents or aging themselves, to begin the process of planning in advance for future health care decisions. It is important to note that these decisions can evolve and change as life situations change. Nothing is permanent, and the person who is designating a surrogate and discussing preferences for care is in charge as long as his or her capacity to make decisions is intact. Only a physician can decide when someone is unable to make his or her own decisions.

"Making advance decisions about one's medical care is a right," she says. "People may be afraid to bring it up; the topic can seem depressing. But talking through these types of decisions ahead of time is an opportunity to offer your loved one a real gift. With advance planning, a lot of pain can be avoided. If a time of crisis arises, the caregiver can make decisions that they know their loved one has made and agreed with themselves. Preparing for our aging loved one's health with advance directives is a type of security blanket for both the caregiver and the older adult."

For more information visit the Senior Health Unit website or the Patient and Family Learning Center

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