“Because I’m a Dad”

Recently a friend sent me a link to this blog that was posted on the site of The Conversation Project website.

For years, as a physician and public advocate for better care, I’ve talked about the importance of having conversations about what matters most to people in life-threatening situations and completing advance directives. As a principle of clinical ethics and practice, I believe that clarifying people’s values, preferences and priorities, and striving to act in accordance with them are fundamental to quality care.
But when it comes to my own care, my reasons for advance care planning are, well, personal. I have an advance directive, not because I am a doctor, but because I have a family.

It is an important reminder that planning for a major medical tragedy is not just for those getting up in years. Every adult, even if they are just 18, needs to have an Advanced Medical Directive and a Health Power of Attorney. Dr. Ira Byock, MD made a very strong case for his daughters to complete these while they were in college, and it is worth a read for any parent.

During phone calls with each of my two daughters that spring, the subject of Father’s Day came up. One asked, “Hey Dad, is there anything you’d like for Father’s Day this year?” There was. “I’d really like you to complete an advance directive.” There was silence and so I continued, “The worst thing I can imagine is for you or your sister to be seriously injured or ill. But even worse than that would be having to deal with a court or state legislature or, heaven forbid, the U.S. Congress in order to make decisions about your care.”

Read the entire article here.

Resume vs. Eulogy

“I’ve been thinking a lot about the difference between resume virtues and eulogy virtues.”
— David Brooks

So opens a TED talk featuring the author, commentator, and current columnist for The New York Times.

Within each of us are two selves, suggests David Brooks in this meditative short talk: the self who craves success, who builds a résumé, and the self who seeks connection, community, love -- the values that make for a great eulogy. (Joseph Soloveitchik has called these selves "Adam I" and "Adam II.") Brooks asks: Can we balance these two selves?
TED Ideas worth spreading

I have been thinking a great deal about legacy in the years since I retired from my full time career, and as I have focused more on helping families take a more explicit approach to planning for end of life, I find that how we want to be remembered becomes something we think about the older we get. The list of what matters most to you changes. It is more focused on relationships, what you have done to make a difference, what you can still do to be a better person. 

Once one has achieved success, the law of diminishing returns begins to apply…the incremental money we earn has a smaller impact on our lives than it would have earlier in our career. 

As that happens, it seems to me that the side of us that also seeks meaning begins to come into our consciousness with greater weight as we cross into our 50’s, and grows in importance as the years go by. Though it's interesting to note that for all the flack given to millennials, that generation seems to be seeking meaning even earlier in life.

Are you leaning more now to your Adam II?

Before I Die…

A powerful art project, turned into a wonderful book:

After los­ing some­one she loved, artist Candy Chang painted the side of an aban­doned house in her neigh­bor­hood in New Or­leans with chalk­board paint and sten­ciled the sen­tence, “Be­fore I die I want to _____.” Within a day of the wall’s com­ple­tion, it was cov­ered in col­or­ful chalk dreams as neigh­bors stopped and re­flected on their lives. Since then, more than 1,000 Be­fore I Die walls have been cre­ated in over 70 coun­tries and sten­ciled in over 35 lan­guages by pas­sion­ate peo­ple all over the world. This full-color hard­cover book is an in­spir­ing cel­e­bra­tion of these pub­lic walls and the sto­ries be­hind them. Filled with hope, fear, humor, and heart­break, Be­fore I Die pre­sents an in­ti­mate por­trait of the dreams within our com­mu­ni­ties and a chance to pon­der life’s ul­ti­mate ques­tion with the peo­ple around us. The Be­fore I Die book is a re­cip­i­ent of a 2014 Amer­i­can Li­brary As­so­ci­a­tion award and Pub­lish­ers Weekly calls it, “a pow­er­ful and valu­able re­minder that life is for the liv­ing, and it’s never too late, or too early, to join the party.”

Go to Before I Die to see boards from around the world.  Better yet, make your own!

The Difficult, Delicate Untangling of Our Parents’ Financial Lives

Excerpt from a moving article in the Wall Street Journal: 

When my in-laws became too incapacitated to handle their own affairs, my wife and I took over. A year and a half later, we’re still trying to figure it all out.
By WILLIAM POWER
Updated March 27, 2016
“No, no, no, don’t transfer me to her again,” pleads my wife.
It is a typically frustrating moment in our family crisis, one that many grown children will have to face, ready or not: We are people in our 50s who are unraveling the finances of parents who can no longer do it themselves.
My wife, Julie, is on the phone with the company where her 82-year-old dad had once worked, trying to change the direct deposit of his pension checks to a bank closer to the assisted-living home where he and his wife now live, which is near us in Pennsylvania. Again and again, she is transferred to the person in charge, “Rose.” And every time, the same recording: “This number has been disconnected.”
In the room next to her, I see our once-usable sofa, covered with her parents’ financial papers from the 1960s to now. On the floor sit a metal tub and plastic cups of coins that we had hauled from the parents’ third-floor walk-up in Queens, New York—a small (but heavy) part of their lifetime of earning and saving, nearly all of it offline.
These are the kinds of elder-care issues that people talk about, but until you have lived it, you don’t truly realize all that is involved—not even someone like me who has spent decades as a financial reporter.” 

So begins William Power’s, and his wife Julia’s, long, exhausting, frustrating journey trying to help her aging parents handle their financial, medical and personal lives when her father is hospitalized. There is no central record of their various financial accounts, so it takes months to begin to piece this together, as her parents memories are vague. Virtually everything is on pieces of paper, with records going back to the early days of their marriage in the 60’s. Over many months, they wait for the mail to determine what bills her parents’ owe, and pore over the monthly credit cards, as many charges are on auto bill, for services her parents don’t remember signing up for. You can read the full article here.

With more than 10,000 Baby Boomers turning 70 every day, this is becoming a much more common occurrence. Which is why adult children of aging parents need to begin to have these discussions by the time their parents are in their 60’s, and don’t feel as threatened by this conversation. 

There are resources out there to help families. Don’t put it off. 

Giving Things Away in Your Lifetime

As we move beyond building our careers and families, and into that stage of life where we fully understand that our relationships mean so much more to us than our material possessions, many begin to give away some of those favorite possessions that are also loved by dear friends and family.

My sister did this when she was first diagnosed with stage IV ovarian cancer. She fought it, and went through all the treatments, and we were lucky to have her with us for another four years.

She was blessed with so many friends, and began to give some of her most loved possessions to many of them, while she was still living, and could see the joy they got from the gift. That process reflected love and joy back to her, knowing they would remember her each time they saw or used or wore their gift from her.

Three Unexpected Things That Can Happen Following a Major Illness or Death

Given my interest in this subject, from time to time friends will relay a story of what unexpected things happened following a major illness or death. Here are a few you should look into to see if you can easily remedy.

1. Credit Cards: 

Issue: Cards that are issued to one spouse, with the other listed as an additional cardholder, will often be automatically cancelled on the death of the spouse. Say, for example, you have an American Express Gold card, which was taken out in your husband’s name, and you are the additional cardholder. He dies, and it is noted in a local paper in the obituaries. Services who look for this information pass it on to credit card companies, leading the card company to cancel the card, even though it has two cardholders. If you are not sure who is the named cardholder, look at the bill:  that person is the named cardholder. 

Remedy: Each of you would be well advised to have a card in your own name, or perhaps 2-3, depending on how much you use them. Over time, when they are paid off promptly, and your credit rating stays strong, the spending limit will gradually rise, giving you each room in later years to be covered in the event that a joint card is cancelled. (It is always a good idea to discuss this with the card company, as their disclosure statements governing accounts change over time.)

2. Joint Bank Accounts

Issue: Banks, when they are notified that an individual has died, will put a freeze on the account, until they have the documents that show who has authority to access the funds. This takes time, at a time when you will need access to ready cash for immediate expenses. 

Remedy: Have a separate account in each of your names, with a way to transfer funds from your own investment account to replenish cash in your checking account. This can be done easily if you have a Living Family Trust estate plan. Discuss this with your attorney, and once you have that set up, then change the title to each of your accounts to the title of your share of the Trust. As you do this, you will be working with your banker, and they can help to ensure that it is done correctly.

3. Health Insurance While Traveling outside of The United States

Issue: You are traveling in Europe, and suddenly your spouse suffers a heart attack. He is taken to the local hospital and stabilized.

Remedy: There are really two questions to resolve in this situation, with a suggested remedy for each: 

i. Does your insurance take care of medical expenses when you are outside the country? You need to check with your primary insurer as well as your supplemental insurer, as often those expenses are not covered. You can purchase additional insurance just for this purpose.

ii. What if you feel your spouse would get better care at a hospital and with a doctor back in the United States? This involves medical evacuation, which is very expensive. But there are policies that can be purchased as insurance in case this happens, and you could ask your insurance agent what the options are. Some organizations offer this for a small annual amount for their members, so look into that, as well.

In all cases, check into your options well before you take a trip out of the country, especially if one or both spouses have had health issues. You would be surprised how often this happens, and it is a mess scrambling to find solutions when you are up against a short time frame. It can also be very expensive, if you have not planned ahead.

Photo by NASA

Grief Manifests Itself both Emotionally and Physically

We understand that there is an emotional response when we grieve. What is less expected for those just beginning the process is the physical toll of grieving.

Recently I was catching up with a friend who lost her husband to pancreatic cancer. He had fought a long battle, one they both thought he was winning, until there was a sudden and final clarity that he would not survive much longer.

We all understand, or at least we think we do, what someone goes through when they grieve…the sadness, the anger, the regrets, the loneliness, the difficulty in dealing with the permanence of death.

But my friend discovered that there were genuine physical changes, as well. She had so much to deal with, as her husband had a thriving business, they were very involved in the art community, and they had a growing family of grandchildren. He had handled all of the business, and all of the investments and financial side of their life together. He had left estate plans well in place, but had not written down where everything was, who should run the business, what his passwords were to their accounts, etc.

In dealing with all of this, she was still in deep mourning for the loss of her husband and best friend. She found that she ached all over, had stomach pain, and could not eat. 

On the mental and emotional front, she would cry unexpectedly, and had trouble making decisions. And would get anxiety attacks all of a sudden. This smart woman would find, to her dismay, she could not add up the simplest amounts when she was out to eat, or figure out the tip.

My friend mentioned that her doctor gave her a list after her husband passed away, explaining physical changes she would likely experience. On the website “Hello Grief” they have a list of physical and emotional responses to grief, which would be helpful to anyone going through this.

Another idea for someone going through this, and wondering if they are going crazy, I recommend Joan Didion’s wonderful book about her life in the year following her husband’s sudden death, while at the same time dealing with her daughter’s serious illness: The Year of Magical Thinking. It can be a thoughtful way to let someone know you perhaps understand what they are going through.

Photo by Volkan Olmez

Talking to Your Parents About End of Life Planning

We've talked about how important it is to be a full partner with your partner, and we've offered some advice on when is the right time to discuss your end-of-life plans with your children.

Now for the flipside: How can adult children think about raising this topic with their parents? Here are some thoughts based on my own experience.

Discovering New Things About People We Love

We recently visited with some of our customers, and filmed them sharing their stories. We also took this opportunity to have my mom share more of the Gracious Exit story. As she talked, she shared this wonderful story about discovering a set of plaques given to my grandfather, hidden away in the basement. It's a great reminder that there is always room to discover new things about the people we love, and how important it is to have these conversations.

We're excited to share more videos with you soon!