Surveys show that 90 percent of people say that talking with their loved ones about end-of-life care is important, but only 27 percent have actually done it. Similarly, 82 percent of people say it’s important to put their wishes in writing, but only 23 percent have actually done that. It’s not easy to talk about end-of-life planning. The Conversation Project, sponsored by the Institute for Healthcare Improvement offers Your Conversation Starter Kit: When it comes to end-of-life care, talking matters. The kit is available at

In three steps, the kit guides you in collecting your thoughts and then having a conversation with your loved ones. The first step is “Get Ready.” It poses two questions to help you get started: What do you need to think about or do before you feel ready to have the conversation? Do you have any particular concerns that you want to be sure to talk about? For example, are your finances in order; or will a particular family member be taken care of?

Step two is “Get Set.” What is most important to you as you think about how you want to live at the end of your life? What do you value most? It uses a series of statements to ascertain what you think or feel about specific aspects of end-of-life care. What are the most important things that you want your friends, family, and/or doctors to understand about your wishes and preferences for end-of-life care? Step three is “Go.” When you’re ready to have the conversation, whom do you want to talk to? When? What do you want to be sure to say?

End-of-life care planning documents include a Living Will/Advance Directive and a Durable Power of Attorney. A Living Will, also called a directive to physicians or advance directive, is a document that states a person’s wishes for end-of-life medical care if they become unable to communicate their decisions. For example, the will may direct that palliative care – care to decrease pain and suffering – can be administered, but that “extraordinary measures,” such as CPR, should not be used in certain circumstances. Without such a document, family members and doctors are left to guess what a seriously ill person would prefer in terms of treatment. They may even end up in a painful dispute, which occasionally makes it all the way to a courtroom.

A Durable Power of Attorney (DPOA) appoints someone to carry out the wishes about end-of-life treatment that are written down in a Living Will. The person named is called the “agent,” “healthcare proxy,” or “attorney-in-fact” of the person who makes out the DPOA.

Some people pay a lawyer to prepare a Living Will. However, most people can create one without a lawyer by downloading forms available on the internet. WellSpan Health’s hospitals and doctors provide a booklet, Advance Directives, and a standard Living Will and Durable Power of Attorney. Note that beginning the first of this year, Medicare will pay a physician, nurse practitioner, or physician assistant for a consultation about end-of-life care planning as a separate service.

Often the most difficult step in end-of-life care planning is having a conversation with loved ones. But as the late comedian Red Skelton used to say, “Don’t take life too seriously, you don’t come out of it alive anyway.”

Mark Berg is a member of the Pennsylvania Council on Aging, and chairman of the Adams County Office for Aging’s Citizens Advisory Council.

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