Talking to your parents about aging, illness, and death is hard. It’s one of the hardest conversations you can have–but it’s also one of the most important. The feelings that might come up during the conversation, if uncomfortable, are better than the feelings that would otherwise come up when an emergency happens and there is no plan in place for taking care of them (or even a consensus among relatives on how to move forward). As we always say in our office: “it is better to have a plan and not need it than to need it and not have it.”
With that said, directly asking a loved one “hey, what would happen if you died today?” might not be the best way to start the conversation. So let’s consider some better alternatives to open the conversation about estate planning.
1. Tell your loved one what you’re doing for your own estate planning
Telling your loved one about your own estate plan, or your wishes to create your own estate plan, might make them consider making one themselves. Tell them what is in your Last Will and Testament, whether you have a Trust, and who you have chosen to act as your Power of Attorney. Hearing about your concerns for your own aging and death, and hearing how you’ve decided to navigate the future, will give them an idea of where to start, which is often the hardest part. Many people also struggle to decide on an estate planning attorney. It is important that the Nashville attorney they hire aligns with their needs. Hearing about your own process of hiring an attorney, and how you determined which one would be the right fit for you, can help them navigate the difficult world of hiring a Tennessee Wills and Estate Planning lawyer.
2. Talk about other situations that have happened that worried you or made you curious
Many of us know at least one person who has suffered the loss of a loved one and then had to endure the resulting feud among the family. These feuds happen so frequently that a significant number of fictional stories are based on them. Unfortunately, plenty of them could have been avoided if a clear plan had been put in place. And these feuds rarely start right after the death—many of them start much earlier, when the loved one’s health began to decline and someone had to step up to take care of them. Estate planning does not just mean deciding what happens after you die; it also means deciding what happens if your health begins to decline. If there is no plan in place for declining health, it will be up to the family to decide what happens. Even the closest of siblings can begin to resent one another if they feel that their parents’ care is not being handled properly.
Although it is fictional, the feud in This is Us between the siblings regarding their mother’s care is an accurate portrayal of what can happen in these situations. The siblings argued on what kind of medical treatment their mother should receive, and again on where she should live and who should look after her. Although all of the siblings had the best of intentions and loved each other and their mother, the feud nonetheless happened. The mother sensed the feud would escalate once her diagnosis advanced, and so she decided to name her daughter (her most level-headed child) as her healthcare power of attorney. Although the siblings still butted heads with one another, the daughter was able to carry out her mother’s wishes.
There are plenty of other examples in books and TV of families feuding over a loved one’s care or death. Talking about these hypothetical situations might make it easier to begin the conversation about aging and death.
3. Ask what would happen to their children, pets, and home if they were in a medical emergency
While discussions about aging and death might be intimidating, discussions about medical emergencies might be easier to handle. Medical emergencies can happen to anyone at any time. Our office even recommends that eighteen year olds get power of attorney documents in place, as it is important for them to have someone able to speak to medical professionals on their behalf in the event of an emergency. Since medical emergencies can happen to anyone, loved ones who do not like having their age pointed out might be more receptive to the conversation. If you know your loved one is anxious about having a stroke or falling down stairs, and tends to avoid or shut down conversation about either of those scenarios, it might be a good idea to use another medical emergency in your conversation (like a car accident, for example). While it is important for your loved one to confront their anxieties, it is not always our place to force them into a confrontation. Using a more neutral example (like the car accident) instead of one they constantly worry about might be a good way to ease them into the conversation.
4. Ask if they can show you where their estate planning documents are
After signing estate planning documents with our clients, we tell them to please let their family know their wishes and how to find the original documents. After all, the estate planning documents are only as good as the family’s ability to find them. In the event of a medical emergency or death, the signer of the documents will not be able to locate them. If no one else knows where they are or how to find them, the documents become effectively useless. It is therefore of the utmost importance that loved ones know where to locate the original documents. If you know or suspect that your loved one already has a plan in place, ask them where the documents are and how they plan to transfer the documents into the right hands in the event of an emergency or death.
For more information on how to talk to your loved ones about aging, illness, and death, we encourage you to check out The Conversation Project.
So you’ve been to your primary care provider and they’ve told you it’s time to see a specialist. Or maybe they’re changing practices or retiring! Or maybe you’re looking at our list of recommended doctors appointments and realizing you need to make some new appointments as you get older. Whatever the case, now you’re tasked with finding a new doctor – and it might feel daunting. We’ve got some tried and true recommendations to make this task just a little easier for you.
Don’t be afraid to ask for a recommendation!
Start with the doctor you trust – who do they recommend you visit? Maybe that’s a specialist within a greater healthcare system (Vanderbilt, St. Thomas, etc.) or maybe it’s someone who has expertise in your specific diagnosis. But don’t stop there! Next, if you’re comfortable, reach out to your family and friends to see if they have a provider whom they really like. Why do they like their doctor? If you trust their opinions, this might be a good resource for you.
If you’re able, consider the possibility of driving to get a good doctor. Sure, they’re on the other side of town, but if they come highly recommended and you’re only going 1-2 times a year, it might be worth the traffic!
Lastly, be sure to consider any deal breakers. This looks different for everyone, but it could include transportation factors, a specific focus in their practice, or you’re looking for a doctor of a specific gender (like a female OB/GYN). Take my example – my husband and I are child-free, so I was very pleased to find a gynecologist who doesn’t also help with childbirth. It means she is able to focus on what matters to me and isn’t away delivering a baby when my appointment time comes around.
Check out their internet presence.
Most offices these days have a website, listing their hours, providers, and even patient ratings of the physicians. Do you like what you read there? Or is there something that makes you think twice? If there are comments, take the time to read those, as they may give you a deeper understanding of the provider’s demeanor and care (rather than just a 5 star rating).
Additionally, use this website to confirm the doctor’s licensure. You can also view any disciplinary matters on your particular doctor in their Practitioner Profile on this website.
Contact the provider’s office.
The last thing you want is to show up and find they only accept a certain type of insurance coverage! Call the office and ask if they take your insurance; you can find your information on your insurance card. Keep in mind that the staff may need to look up the information, but “I don’t know” is not an acceptable answer here. If the person who answers isn’t sure, ask to speak to someone in the billing department to verify your coverage.
Don’t forget to also ask if you will need a referral to their office from your primary care provider. Some specialists will accept self-referrals, but your insurance company might think otherwise!
What about a copay?
Oftentimes, your insurance card will list a copay amount for various types of providers. If not, be sure to log in to your insurance company’s website and verify the copay, or call the number on your card to speak with a representative. Specialist visits typically have a higher copay amount than a regular PCP appointment; you will want to be prepared.
Remember: just because you see a doctor once doesn’t mean you have to continue seeing them. Just like any professional, you should find someone that you are comfortable with – which isn’t a reflection on the doctor or their skills, sometimes it’s something that you just have a gut feeling about and want to find a better fit. Feel free to tell the doctor this. If you can articulate what you want, tell them and ask if they have a recommendation. They probably know other doctors in their area!
You and your provider are a team, and by working together, you should be able to ensure you are taken care of for years to come! You have the ability to direct your healthcare and make decisions for your future; hooray for being proactive!
As a child, our parents are responsible for making sure we get our regular check ups and vaccinations, but as an adult- throw in figuring out health insurance- things get so much more complicated!
Scheduling doctor appointments is a necessary task that can come with a lot of headache and uncertainty. How often should we go? Where do you find a primary care physician????
Just like you get your car a check up before you go on a long trip, it’s important to regularly check in with appropriate medical professionals in order to prevent a bigger health crisis down the road. Which screenings do we need throughout our life and at what intervals? Let us help you relieve some of that stress by following these scheduling and screening tips!
Read on for a list of appointments you should make this year, and remember to ask if your insurance is in-network when you schedule! We’ve got a handy tool at the end of this article to help you keep track of your appointments.
Appointments for All Adults 18+
Primary care physician (PCP)
When: Annually
Who: Everyone. Seeing a PCP on a regular basis is the best way to monitor your wellness. Your PCP will be able to help you make an informed decision on what appointments you should add to your annual list.
Dentist
When: Every 6 months
Who: Everyone
Gynecologist
When: Annually or if pregnant/trying to conceive
Who: People with female reproductive systems. It is recommended that you begin annual gynecologist visits as a teenager or after you become sexually active. Regardless of sexual activity, it is recommended that your first visit be by age 21 at the latest. If you have a new sexual partner, an STI test is recommended. If you regularly have more than one sexual partner, it might be wise to have a STI and Pap test every 6 months.
Eye doctor
When: If you have healthy vision, schedule a visit once in your 20s, twice in your 30s, and once at age 40. Those with existing vision needs should follow their eye doctor’s recommendations on frequency of visits. If you develop any vision difficulty or eye problems, a check up is recommended.
Who: Everyone
Dermatologist
When: Annually
Who: Everyone, especially if you spend a lot of time in the sun, are fair-skinned, or have family history of skin cancer.
Vaccinations
When: As recommended. Your PCP should be able to help you decide when to get vaccinations or boosters. Vaccine recommendations frequently include:
Annual flu vaccine comes out around September
HPV vaccine and meningitis for young adults
Shingles
Covid 19 vaccine and appropriate boosters
Who: Everyone
It’s important to get regular appointments with your doctors so they will have a baseline for your health conditions in case things change.
Appointments for Adults ages 40 +
Gynecologist – Mammogram
When: Annually
Who: People with breasts
PCP – Rectal Exam/PSA blood test
When: Annually
Who: People with prostates
Gastroenterologist – Colonoscopy
When: Regular screenings are recommended for those between the ages of 45 and 75. If your colonoscopy shows no signs of cancer, you can typically wait 10 years before scheduling another one.
Who: Everyone
If you’re 50+, add this l screening to your list:
Lung Screening
When: Annually
Who: Adults who have smoked 1 pack of cigarettes per day for 20 years or 2 packs per day for 10 years and currently smoke, or adults who have quit smoking within the last 15 years.
If you’re 60+, add this screening to your list:
Osteoporosis Screening
When: Age 65 and up
Who: Cisgender women and People assigned female at birth
If you have a family history or risk factors of any particular diseases, talk with your PCP to decide if you need earlier, more regular, or other specific screenings. Remember, prevention is better (and cheaper) than the cure!
Extra tips:
Need a New Year’s Resolution? Schedule all of your doctor appointments before the end of January so that you can cross that task off your to-do list and feel good about prioritizing your wellness
The ACA covers 100% of preventative health care. Visit Healthcare.gov for more information.
Add travel time to your appointments in your calendar
Remember to wear short sleeves to doctors appointments so they can easily take your blood pressure
We know keeping up with all of these appointments and screenings can be overwhelming. If you’re a visual organizer like us, please use our fillable guide to make sure all of your appointments are scheduled. Hang the guide on your fridge or in your office so that you’ll never miss an appointment!
Cheers to taking care of ourselves and advocating for our health in 2023!
As we enter into the holiday season, I’ve invited my dear friend, Gabby Daikon, to share her experience with grief after losing her mother as a young adult. I met Gabby about a year ago through her grief journals and later joined her for virtual Yoga Nidra and “bad bitch” meditations. In a year that has been unpredictable, these practices have brought me comfort, and I hope her words will be a comfort to you.
Grief is all-consuming and yet different for every individual.
For me it felt like a fog, a fog that I knew was there but I couldn’t get to the other side of it. I hear that is what Seattle is like, I guess grief is like Seattle. I have never been but I hear it is beautiful but always cloudy. I think grief is similar in that it feels constantly dreary but also has a weird comfort and connection to the true essence of life. I am sorry if you live in Seattle and that offended you. I truthfully have no idea what Seattle is like.
Grief is a journey
My grief journey has been a bumpy ride, to say the least. I have struggled tremendously, found support, struggled again, learned to surrender and the ride keeps on going. I found that my biggest mistake was pretending to be OK. I held all of the burdens of my losses inside of myself and made myself sick. Truly sick.
Ride the waves
We run and hide from any negative emotions, but the more we tense and grip, the harder they hit. Instead, float on the tides. Let your emotions move you around without crashing over you; brutally. Wade into the fears, float with them, don’t judge yourself, and usually, you can come out without drowning.
Grief-positivity
My true healing began when I learned how to surrender to the pain, the grief, and all of the parts that make this life. It is so sad that grief is such a large part of life and yet rarely spoken about. I believe that when we begin to speak about it we can all heal and find the beauty in our journey.
Yoga Nidra provides a moment of reprieve
I found Yoga Nidra at a time when I truly needed it. I felt this constant pain of anxiety because I had this undercurrent of grief that I just could not truly access. Yoga Nidra was the first time I felt at peace for 45 minutes. I am not saying it healed me completely but it gave me a moment of reprieve and sometimes when we are deep in the grief journey that is all we can ask for. A moment of reprieve.
Yoga Nidra is a guided meditation
Yoga Nidra gives us the opportunity to float with the currents. During Yoga Nidra there are no moving postures, simply lie wherever you feel comfortable and allow yourself to feel supported. It is a guided meditation – you are not left alone with your thoughts, you are supported by the meditation. During this time you may be having trouble feeling rested, Yoga Nidra is equivalent to 3 ½ hours of deep REM sleep to the body. It also helps move energy through the subconscious mind and welcome what the mind needs to welcome without the tension and anxiety attached to it.
Yoga Nidra makes you an observer of the mind, an observer of grief, being able to welcome it without having it drown you. I invite you to just take a few deep breaths, allow what comes to come, and know that you can handle it.
Grief is personal
There are scientific benefits that I can list but the truth is that grief is not some scientific formula, we just have to do what we can to get through and for me, that was writing to my Mom and other loved ones when I truly needed her and Yoga Nidra. With the loss of a key family member there is so much more loss that people don’t speak about- like; the family dynamics, your personality, a self-identity, and so much more. So if you are deep in your grief all I can offer is my truest empathy and compassion because there are no magic words, it is just hard, and sometimes we just need people to understand how hard it is.
Use the promo code GALS to get a discount on one of Gabby’s services
Looking to reduce stress and anxiety? Improve your mental clarity? If so, consider adding Yoga Nidra to your wellness routine. Use the promo code “GALS” and you can get a discount on Gabby’s services.
For the month of November, we want to focus on caregivers. While family caregiving can be rewarding, it also takes a toll. Most family caregivers hope to add a professional service to their loved one’s support system, but figuring out how to do that is just one more thing to add to your already-full plate.
What types of care are there? Who provides these services? How much do they cost? What limits are there? How do I pick the right service for my family?
You’ve got the right questions, and Google is overwhelming. So we called in an expert. Our friend Perry Brown, President of our local Right at Home care team, was kind enough to provide us information about the types of care options available and the most common questions you may have. If you’d like to know more about Right at Home, we encourage you to check out their website here and sign up for their newsletter. If you are ready to talk to someone about in-home care, Perry and his team would be happy to help. You can reach them by phone at (615) 360-0006 or by email at info@rahnashville.net.
Let’s Look at Types of Care You May Want to Consider
When an older loved one or adult with a disability needs caring support at home, it can feel daunting to know which professional care services are best. Who can help with bathing and meals? Is a registered nurse needed for wound care? Can hospice care happen at home?
The Global Coalition on Aging and the Home Care Association of America state that almost 70% of Americans who turn age 65 will need assistance at some point to care for themselves. These senior care industry leaders also report that “already 40% of adults aged 65+ need assistance with daily living activities.” The fast-growing care needs of the country’s increasingly older population can leave care recipients and their families confused over in-home care options. The complexity of nonmedical and medical services available also may jeopardize a loved one from getting the timely and attentive care they need.
To help simplify the professional in-home care choices, Lorraine Grote Johnson, Director of Care Quality at Right at Home, a leading in-home care agency, notes that it is important to understand the differences between home care and home healthcare. Grote Johnson, a registered nurse for more than 35 years in both hospital and home settings, gives the following overview of common care services available in the home.
Home Care
In-home caregivers are the extra hand to provide personalized support to a loved one in their own familiar home surroundings. Home care can be part time, full time or live-in assistance ranging from light housekeeping and meal preparation to personal grooming and toileting. At-home caregivers can provide care services such as being a companion who helps write the grandchildren to driving the care client to medical appointments and to complete errands. Home care allows a loved one to stay safe and independent at home as long as possible. Grote Johnson points out that home care staff members are not legally allowed to take on skilled medical care such as dispensing medications and working with tube feedings. Most at-home caregiving services are covered through private pay.
Home Healthcare
Home healthcare is skilled nursing care that is prescribed and directed by a physician and supervised by a registered nurse. Home healthcare is suited for complex health issues that require a higher level of medical assistance, or when a loved one is recovering from an injury or recent illness. A professional skilled nursing team can accommodate a client’s numerous medical care situations such as monitoring vital signs, medication setup and management, dressing changes, and continence care.
“Generally, home healthcare is delivered by Medicare-certified companies and may include physical therapy, occupational therapy and speech therapy,” Grote Johnson said. “A registered nurse makes a care plan and supervises a home health aide who helps a client with activities of daily living such as bathing and dressing. The RN does supervisory visits in the home at least once every two weeks.”
Medicare and other health service providers that pay for home healthcare determine the number and length of nurse visits to the home. Private pay skilled nursing care has no limit on in-home service hours. Specialized palliative care and hospice care also fit within the realm of home healthcare.
Palliative Care
Palliative care is specialized support for people living with a serious illness or transitioning toward death. Palliative care focuses on pain relief, comfort and reduced stress for an ill loved one and balanced overall health for the patient and family members. Palliative care serves not only the dying but also those with chronic diseases such as cancer, congestive heart failure, kidney disease and Alzheimer’s. A specially trained palliative care team includes doctors, nurses, professional caregivers and other specialists who work together to improve the quality of life for the care client.
Hospice Care
Originating in Europe during the Middle Ages, hospice, which is derived from the Latin word for “hospitality,” is care that aids the critically ill and dying with medical, emotional and spiritual support. Hospice or end-of-life care is a type of palliative care, but the ailing person is no longer seeking curative treatment. The aim of hospice care is to extend comfort, peace and dignity to individuals in the dying process. Hospice programs also support a patient’s family with counseling and bereavement care. Hospice teams of doctors, nurses, social workers, chaplains and other caregivers provide care in patients’ homes or at a hospice center, hospital or in-patient care facility.
“Hospice typically serves a terminally ill person with a life expectancy of six months or less,” Grote Johnson explains. “In some cases, a hospice patient’s health improves to the point where the individual no longer needs the specialized care. Also, if a person starts to feel better, they may want to negate hospice and start receiving curative medical treatment again. At any point, a hospice client can change their mind about their care.”
Tips for Choosing At-Home Care
Because of the quickly expanding number of at-home services on the market today, Perry Brown, President Right at Home Nashville advises those in need of care and their families to consider the following tips for choosing at-home care:
Select services only from a professional, licensed agency. Make sure you see actual proof of certification and licensing for the agency.
Be certain that the caregiver who works with your loved one is insured and bonded.
Get a detailed care plan or treatment plan upfront. Ask about goals of the suggested services.
Review the caregiver’s qualifications, experience and amount of supervision on the job.
Discuss all financial costs and evaluate options for saving money on home care, including long-term care insurance, a reverse mortgage, Veterans Aid and Attendance benefits, etc. Reference Right at Home’s information on how to pay for home care.
For securing skilled nursing care and home healthcare, Grote Johnson offers additional suggestions. “Choose a company that knows and maintains federal and state regulations,” Grote Johnson advises. “Make sure the company does criminal background checks on their nurses and caregivers and verifies their licenses. Ask whether the nursing staff has gone through a thorough orientation and if they know infection control practices and what to do in emergencies. Also, make sure skilled nursing staff members have critical thinking skills and completed competency testing, and that home health nurses have the proper qualifications, because they are taking your loved one’s life into their hands in what could be life-or-death situations.”
Availability of qualified at-home services varies by locales across the country, so Brown recommends reviewing at-home agencies online, then visiting with the agencies in person. “Be sure to check references of the in-home agency candidates and their specific caregivers,” Brown explained. “Talk to others in the community who are familiar with the agencies and their reputations. In getting the best care possible for your loved one, every question and concern matters.” For additional information about choosing home care, home healthcare, palliative care or hospice care in your area, talk with local medical professionals for referrals, or contact the National Association for Home Care & Hospice, or use the U.S. Administration on Aging’s Eldercare Locator.
As we approach Halloween and Día de los Muertos, it seemed appropriate to get a little more matter-of-fact about deathcare resources. One end-of-life resource that we want to highlight is the option of engaging a “death doula” for those who are facing the end of their lives.
Our guest blogger this week is Ellen Abbott. We met Ellen in her role as Care Manager for Visionary Care Consultants but soon learned that we shared an interest in helping people through some of the most difficult transitions of life. Ellen completed her certification as a death doula in 2019, so we asked her to tell us more about what a death doula is and how they serve those at the end of their lives.
You may have heard recently about a “death doula” or an “end of life doula” and wondered who they are and what do they do? As a death doula myself, I’m happy to tell you!
What is a death doula?. We use midwives to educate and assist families to help bring babies into the world, why not have the same for those who are towards the end of their journey here?
There is a growing movement among end-of-life professionals in the United States to bring back the role of a non-medical person who stands in the gap between doctors, hospice, and the family of a dying loved one. This person guides the family and the client around the maze of the healthcare system, educates on hospice, offers practical information about death and provides emotional support around the entire process.
Who do death doulas serve?
A death doula serves the dying person as well as their loved ones. The goal of a death doula is to make sure that their client’s final wishes and needs are carried out before, during and after their death. This creates a healing and easier transition for the client and family.
When should a death doula be called?
You don’t have to have a terminal diagnosis to hire a death doula. There are some doulas who focus on helping their clients plan so that they know what they want at the end of life, and instructions on what the family needs to know to carry out those wishes. This is extremely helpful to the family and client since the topic of death and final wishes are not popular conversations in today’s world.
How do death doulas charge for their services?
Every death doula is different. Most offer free consultations and then an hourly rate of anywhere from $30-$100 an hour. Some offer packages for legacy planning along with being present for the client at the time of death. In middle Tennessee there is a Death Doula alliance, made up of local doulas that have been trained specifically for this role. They come from all backgrounds but usually from nursing, social work, counseling or clergy.
Over the last century, death has been viewed as a medical failure even though we all know one day we will die. A death doula helps to normalize these conversations and talk about these topics that no one wants to bring up. The death doula starts with the end in mind, to ease client’s fears, knowing they have a plan and someone at their side when the time comes.
