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    Understanding Your Health Choices: Conversations Before the Crisis

    When Siblings Disagree-Elizabeth's Family

    Elizabeth's parents, now in their mid-70's, are reluctant to talk about the end of life. She has tried to engage them more than once, using her own plans as an example, but is making no progress. A keen observer, Elizabeth is aware that through her parents are living independently and doing well, change has begun. They tire easily, have increasing difficulty with stairs, and her mother seems to be acting strangely in social settings.

    Elizabeth and her brother and sister do not live in the same area, each has problems and difficulties, and they are not close. Elizabeth knows that there will be conflicts over caring for the parents, making decisions, and about finances. With some dread, she decides that it's better to talk about the future than pretend it's not coming. She arranges a three way phone call.

    "I've asked you to be on the phone with me because I think we need to start getting ready for big changes with Mom and Dad. They are starting to have trouble managing. Mother seems confused, and Dad is just not himself anymore. They feel insulted if I offer my help, they don't want anyone else around the house, and I'm going to be traveling more this year. So I really need your advice and your help."

    "Do they need to move?" asks Elizabeth's brother. "Is there a nursing home or someplace they can go? Do they have insurance? How much is the house worth? Have you talked to the doctor? Exactly what is wrong with them?"

    Elizabeth's sister has her own agenda. "I think you need to plan to be home with them, not start traveling more. I can't help out, and they've always liked you best anyway. Did they ever finish their wills? Mother promised me that the house would never be sold. Why didn't you call us before things got to this point?"

    This family has work to do to avoid major conflicts over the next few years. The siblings do not have a good base of information about the affairs and attitudes of their parents, each is making assumptions about what the others should do, and all are preoccupied with their own problems.

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