How do you talk to aging parents about their plans? 7 questions, asked before a crisis

People asked to predict a loved one’s end-of-life choices got nearly 1 in 3 of them wrong, in a study the National Institute on Aging cites in its planning guides. A talk with your parent closes that gap, and it goes best in small pieces, long before anyone needs the answers.

The first step is a single question. At your next visit or phone call, ask your parent who they’d want making medical decisions if they couldn’t speak for themselves. You don’t need a folder, a lawyer or a plan for what comes next.

When should I bring it up?

Bring it up while nothing is wrong, on a quiet afternoon, not in a hospital hallway. The National Institute on Aging, or NIA, says an early start matters most after a diagnosis that affects memory or thinking, while your parent can still take full part.

Openings come up all the time: a friend’s stroke, a move, a new prescription. A yearly Medicare wellness visit works well too, since Medicare covers advance care planning as part of it, and going along puts a doctor in the room.

Whichever opening you use, keep the first talk under 15 minutes and end it before anyone gets tired.

How do I start without sounding like I want their money?

Start with health care and leave money for a later visit. A question about who should speak for your parent in a hospital is about their voice, while a question about accounts can sound like it’s about your inheritance.

It also helps to go first. NIA’s tips for families suggest sharing what matters to you. If you’ve filled out your own health care proxy form, say so, and say who you picked.

When money does come up, say plainly that you don’t need to know amounts. The Consumer Financial Protection Bureau, or CFPB, calls that role a “conversation partner” in its caregiver guide, someone who gets an overview of a parent’s finances without the details.

Which 7 questions should I ask?

Ask these seven over several visits, roughly in this order, health care first and money later.

1. If you couldn’t speak for yourself, who would you want making decisions?
2. What matters most to you if your health changes for good?
3. Have you put your wishes in writing, and who has a copy?
4. If you went into the hospital tomorrow, where would I find your papers?
5. Who would pay your bills if you were sick for two months?
6. Is there a will, and where is the signed original?
7. Who else in the family should hear this from you?

Write down each answer the same day, with the date. Memory blurs fast, and those notes are what you’ll share with siblings later.

What should I ask about health care wishes?

Ask who your parent would want as their health care proxy, and whether that choice is on paper. The paper is an advance directive, and it comes in two common kinds: a living will, which lists treatments a person would want or refuse, and a durable power of attorney for health care, which names the proxy.

Fewer than 4 in 10 adults have one. A 2017 review in the journal Health Affairs pooled 150 studies covering 795,909 people and found that 36.7 percent had completed an advance directive.

People with chronic illnesses came in at 38.2 percent, barely above the 32.7 percent for healthy adults.

Without a directive, state law decides who speaks for your parent, usually a spouse, a parent or an adult child, according to NIA. An unmarried partner can be left out entirely.

Most states offer the forms free, and you don’t need a lawyer, though a form may need witnesses or a notary. A proxy must be at least 18 in most states and 19 in Alabama and Nebraska.

If your parent names you, ask for a copy, then ask what they’d want you to weigh: comfort, time at home, a faith tradition. NIA calls an advance directive legally recognized but not legally binding, and those answers fill the gaps a form leaves.

Where are the important papers?

Ask your parent directly, and ask where the papers are before you ask what’s in them. NIA’s checklist suggests keeping them in one place, telling a trusted person where that is, and keeping copies at home if the originals sit in a bank safe deposit box.

For each of these four documents, ask whether it exists, when it was signed and where the signed copy lives.

Wills are more common than advance directives. Gallup’s 2021 survey found that 46 percent of US adults had one, and 76 percent of those 65 and older did. A will does nothing while your parent is alive, though, so it won’t help with a hospital stay or a missed mortgage payment.

Make a one-page list of what exists and where each original is, and keep it with your own important papers.

Who pays the bills if they can’t?

The agent named in your parent’s durable power of attorney for finances can, within the document’s terms. Without one, a court can name a guardian or conservator once it decides your parent can’t manage money alone, the CFPB’s caregiver guide explains. The CFPB’s separate guide for agents lists four basic duties:

• Act only in the person’s best interest.
• Manage their money and property carefully.
• Keep their money and property separate from your own.
• Keep good records.

Two details catch families out. A power of attorney doesn’t reach Social Security or VA benefits, so the agent needs a separate appointment from the agency, as a representative payee or a VA fiduciary.

The other is joint accounts. A joint owner automatically gets the money when the account holder dies, the CFPB notes, while a helper on a “convenience account” can pay bills but owns nothing. That gap can leave one sibling holding money a parent meant to split. Which setup fits your parent is a question for an elder law attorney.

If you think someone is already taking money from your parent, call your local Adult Protective Services office or the National Elder Fraud Hotline at 833-372-8311, which takes reports involving anyone 60 or older. The federal Eldercare Locator, at 1-800-677-1116, can point you to local legal aid.

What if they refuse to talk?

Let the no stand, and try again in a few months with a different opening. Your parent is an adult making their own call.

Some people would rather discuss these choices with a doctor or someone from their faith community, NIA’s tips note, so offer that. A parent who won’t sign anything may still tell you what they want, and NIA puts the conversation first.

Having meaningful conversations with your loved ones is the most important part of advance care planning.

You can help in ways that don’t need agreement, too, like gathering loose papers into one drawer or listing their doctors’ names and numbers.

Unpaid bills piling up, or a new acquaintance with access to your parent’s accounts, is worth raising with their doctor or the hotline above.

What if my siblings disagree?

Go back to what your parent said. While they can decide, the decision is theirs, and later a proxy may need to carry out those wishes even when other relatives object, NIA notes.

Share your notes from each talk with every sibling the same week, so no one hears about a decision secondhand. Better still, ask question 7 and let your parent tell everyone at once.

If one sibling handles the money, the CFPB’s guide suggests sharing summaries of spending unless the parent has said not to. The guide’s reasoning is that questions are easier to settle when a decision is made than months later, when suspicion and anger have set in.

When a disagreement hardens, a neutral person such as a social worker, a clergy member or a family mediator can run a meeting, and a standoff over a parent’s care deserves that kind of help.

Open with one question

Choose a moment this week, whether it’s the next phone call, a drive to the pharmacy or a walk after dinner. Skip the speech about getting older, and leave the forms at home. Give one sentence of reason, a friend’s parent in the hospital or your own paperwork. Then ask the question the rest of this article builds on: “If you couldn’t speak for yourself, who would you want making decisions?”