Unpleasant But Necessary Holiday Conversations

Emily Brandon

When families gather for the holidays, it's a good time to talk with older relatives about the realities of aging. Take a moment to find out your parents' or grandparents' health and long-term care wishes, whether they've filled out the correct paperwork and what you can do to make the whole process easier. Here are a few difficult but important topics to broach this holiday season:

What are your health care wishes? Almost all Americans (94 percent) say it's important to have a conversation with older loved ones about their wishes for end-of-life care, but only about a quarter (24 percent) have had such a discussion, according to a recent Kelton Global survey of 1,067 adults commissioned by the Conversation Project, a nonprofit dedicated to helping people talk about end-of-life care. Even fewer people (20 percent) say they have discussed arrangements for a health care proxy or a document specifying someone to make health care decisions if they become unable to do so. "A living will specifies how you would like your affairs to be handled in the event that you are still alive but no longer able to make your own decisions," says Phillip Rumrill, a professor at Kent State University and co-author of "The Sandwich Generation's Guide to Eldercare." "Specify the medical measures you are willing to take to save your life and the people you would like to be in charge of making decisions if you are no longer able to make decisions."

[Read: 10 Ways to Make the Most of Medicare.]

One way to get the conversation started is by mentioning a friend whose parents are having some health problems. You could say something like, "My friend Mary just had a crisis and her mom was put in the hospital and they are talking about looking for care," suggests Sandy Markwood, CEO of the National Association of Area Agencies on Aging. "That really worries me. Is there anything that I can help you to do to organize that?" Ask what your parents or grandparents would want if they were ever in a similar situation.

Where's the will and other important paperwork? Getting the proper paperwork in place can make things much easier in the event that your loved ones develop health problems. "The worst time to try to deal with all of these issues is during a crisis, and a crisis can occur at any point," Markwood says. "Parents get rushed to the hospital and relatives don't know who the doctors are and what medications people are on." Only a small fraction of adults have discussed a will (20 percent) or life insurance policy (21 percent) with their loved ones. "We encourage people to make a kit for the person who is going to be taking care of you in the event that you need help," Rumrill says. "Write down all of your account numbers, include your will and fill a shoebox with these important documents for whoever in the younger generation is going to be taking care of you."

[Read: How to Budget for Health Costs in Retirement.]

What are your preferred funeral arrangements? Discussing funeral arrangements with loved ones allows you to honor them the way they would have wanted. Just 28 percent of adults have had a conversation with their relatives about their desired burial and funeral arrangements.

Will you need to move into age-appropriate housing? Sometimes senior citizens get to the point when they can no longer safely live on their own. "If you need to be in a different kind of environment in order to be safe and in order to get the care that you need, that's a conversation to have with the children or whoever is going to be responsible for their care," Rumrill says. It can be helpful to talk about a future move instead of an immediate one. Consider saying something like: "You've been in your home for 42 years. Are you thinking you would like to stay in it indefinitely, or do you ever get tired of maintaining this house or cleaning the gutter or shoveling snow?" Rumrill recommends. It's also a good idea to offer to help make arrangements instead of simply pointing out the problems.

[Read: Best Places to Retire for Longevity.]

Should you still be driving? Older people with health or vision restrictions may no longer be able to drive. Consider whether your area has convenient public transportation options, affordable senior van or taxi services or if there are nearby friends and relatives willing to help on a regular basis. "Start to use alternatives before you start relying on them to make sure you are familiar with and know how to use them," says Elin Schold Davis, an occupational therapist who coordinates the American Occupational Therapy Association's older driver safety initiative. "If people would start taking the bus or other transportation options in their area, they would have options during that time if they need to stop driving."

Many people put off having a conversation with older relatives about end-of-life issues because it's uncomfortable to bring it up. However, the majority of people age 55 and older (63 percent) say they would welcome the conversation and would be relieved to discuss it, and another 31 percent report they would be willing to take on this difficult topic. Only 7 percent of the oldest survey respondents say end-of-life issues are too upsetting to discuss.

"For many families, they only come together around the holidays. There may have been a lag time since they saw mom or dad, and they might see that mom or dad is slipping," Markwood says. "Probably one of the greatest gifts that you can give a family is to pull this information together to make sure that you can meet the needs of mom and dad and do so in a respectful way."