Sometimes you just have to begin with the end in mind.
That’s the message from local professionals who are helping residents prepare their affairs for life’s end.
While this may not be the easiest subject to discuss around the family dinner table, making sure legal and medical documents reflect a person’s wishes—and that their loved ones know what those are—can be a relief, according to Ashley Thompson, with Scotts Valley-based Beautiful Life Estate Planning.
“You’re planning for life by thinking about death,” she said. “You’re getting your ducks in a row.”
A mid-pandemic study conducted by VITAS Healthcare found 69% of Americans say talking about their views on end-of-life care is important to them, but just over half had actually done this. However, this appeared to mark an increase from 2019, when a Conversation Project study found less than a third had brought up the matter.
Strikingly, around a quarter of respondents said the reason they had not yet made their end-of-life plans official was that they consider it a “depressing” process, or they were unsure about how to go about making such a plan.
After graduating from Scotts Valley High School as a valedictorian in 2005, Thompson studied law and went on to work as a lawyer for the Navy, in financial services litigation and as an assistant district attorney in Santa Cruz County.
But she wanted to make a difference in people’s lives in a way that was less adversarial.
She decided to take on estate planning and helping people to overcome their fears about mapping out their end-of-life vision.
Expressing feelings about how a person wants things to go as they age can be viewed as a continuum, with investment and savings decisions on one end, and palliative care and hospice choices on the other.
Taking the leap and dealing with this now will help a person’s family members stay out of probate court, or prevent disputes about medical care, Thompson points out.
She advocates for people not to put these considerations off for a rainy day.
“There’s a human aspect to this,” she said. “People are going to have different desires and wishes. Some people will want to prolong their life—and in a specific way.”
It’s never too early to bring up these sorts of conversations, according to Dr. Lisa Segnitz, a palliative care physician with Palo Alto Medical Foundation, who serves people in both San Lorenzo Valley and Scotts Valley.
“Everybody’s different, of course, and some people don’t want to think about end-of-life or talk about it, so it’s not something that we force people to do,” she said, adding she’s noticed the trend clocked by the VITAS Healthcare study, too. “There’s a lot of interest, which is exciting, because it really can make a difference in outcomes and satisfaction, as people approach the end of life, or deal with a hospitalization.”
Palliative care generally refers to the portion of the medical system that treats people who have a prognosis of 1-2 years, whereas hospice care is for patients who expect they may die in six months or less, she explains.
“There’s many ways to complete the documents and start the conversation,” she said, adding that people as young as 18 should begin to fill out some of the forms. “Some patients are eager to do this because of the peace of mind that it gives them and their family members.”
They help people create Advance Care Directives (a witnessed or notarized document, also called a living will, for when you become incapacitated), as well as Physician Orders for Life-Sustaining Treatment forms (which is a medical document signed by a doctor, nurse practitioner or a doctor’s assistant with direction about resuscitation and ventilation).
They also have a chaplain for both medical and spiritual support.
Vanessa Silverstein was once a Brook Knoll Eagle, and then a Scotts Valley Middle School Dolphin.
Now she works as the community education and outreach program manager with Hospice of Santa Cruz County, in their Scotts Valley office.
She says a lot of people want to create a solid end-of-life plan, but just never get around to it.
“Completing your Advance Directive is a gift to yourself and your loved ones,” she said. “And it’s really empowering.”
According to a 2017 study published in the peer-reviewed Innovation in Aging, waiting to have these discussions until a person experiences a health crisis may be “too little, too late.” This is because the discussions often occur following “triggering events,” when the patient and their family may be too distressed to make the right decisions about imminent care needs.
But having a plan in place allows health care workers to know they’re giving the patient the treatment they want, Silverstein says.
“Ideally community members would have this plan done well in advance,” she said. “We don’t know what our next steps will be, and when we might be in a situation where we can’t voice our own preferences.”