Entering and Exiting: Preparing for End of Life

| Grief Author and Speaker

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Entering and Exiting: Preparing for End of LifeEntering and exiting life certainly has a transformative effect. Both require enormous internal preparation. When a birth is expected, a family’s priority is dominated by the coming arrival. The new family must adjust emotionally, spiritually and financially for the additional responsibilities. Even though a new arrival might cramp the pocket book with the purchase of a crib, clothes, diapers and all the other necessary paraphernalia, it is gleefully accepted. On the other hand, people act like fire ants have just invaded their trousers when you try to discuss preparing for your exit from this world. The fact is simple. We entered this world therefore we will exit it at some time. Most of us aren’t privy to when we will die, how we will die, what will actually cause the death and whom we will outlive; but we do know we will die.

People with terminal diseases have more of a definite idea of the meaning of finite time. Most of the terminal patients I have worked with were not only eager to get their affairs in order; they also wanted to discuss their decisions. The main complaint I heard from terminal patients was their loved ones didn’t want to accept the inevitable, they didn’t want to talk about the death. The loved ones would spew forth catch phrases of hope filled with a stiff upper lip feigning of courage. People who are dying need to talk and plan. When we refuse to look a dying person eye to eye to listen and to discuss soul enriching experiences about life and wishes, we cheat each other. We cheat each other out of the humanness of respect.

All adults who have responsibilities need to plan for their exit. Planning isn’t an option – it’s a necessity. Preparing for one’s own death is a testimonial to what makes us tick on an emotional, spiritual, and financial level. A person needs to think how their death will challenge the day to day living experience of those left. For instance, you may need to look at providing for children, pets, housing and financial situations not to mention planning for funeral and cemetery arrangements. Some may choose to be sung out of this physical plane with a chorus of Amazing Grace while others would choose an immediate no frills cremation and a quick toss in the ocean. Spiritual and religious preferences also need to be shared and fulfilled as requested. You can’t reach out and give needed information to survivors from the other side but you can leave detailed necessary information that is immediately available upon a devastating or medical situation or a death.

Whether you are faced with making decisions for yourself or for a loved one, financial considerations are part of the complex decision making process. If you are dealing with a loss of a loved one, many people feel the best the funeral home has to offer is not good enough. Unfortunately, that leads to an emotional decision rather than a logical one based on facts of the current financial condition. The reality is a casket is only seen for the time of a visitation/service. An outer container is a box that houses the casket in the ground which many cemeteries require for the sake of the beauty of the grounds not the protection of the casket. The decision on materials used and gauge of the protective outer container and/or the casket is only for the “peace of mind” for the survivors. The memorial is what is visited and seen yet so many families put their priorities on the casket and vault.

The numerous families and individuals I have counseled have opted to put more emphasis on memories. They have placed favorite quilts, pictures, and items at services. One popular idea was to take a twin sized white sheet and ask visitors to share their memories by writing down a few lines on the sheet. The sheet would then be hung or draped over the casket.

Years ago I was working with a young dying man. He wanted to leave something personal for his friends. After looking at many options, we realized he was a “clothes horse”. He had gobs of beautiful jackets made from wonderful fabrics. The idea was born. A pillow would be made from the jackets. Pillows with a little pocket where he placed a meaningful personal note for each person’s designated pillow. Part of my job was to deliver the pillows to those left behind at the end of his service. The memory is still vivid. The touching miracle of the moment, giving those pillows, out still brings tears steaming down my face. The gathering of a small group eagerly reading their private note. Laughter, tears, hugs and deep felt love for a wonderful person filled the room. This young man not only left a gift of lasting memory but left a piece of himself with each cherished person. For him, the act of choosing which jackets would be utilized in the process, figuring out what to say while remembering wonderful life events helped him say goodbye to his physical life and to accept the inevitable.

My friend, Kathy Bosworth, is also an author. Kathy didn’t decide to be an author, she simply wanted to share and educate others about her true -life experience. While doing so she proclaimed tribute to her mother. Little did Kathy know she would become a guest speaker, as well as written up in Caregiver and National Stroke magazines and honored by her state senator. In her book “Your Mother has Suffered a Slight Stroke” Kathy takes you through an ordeal of shock, scrambling for advice, not being able to find answers and the change and challenge to the family dynamics. Kathy shared this with me when I asked her about preparing for death.

“Can anyone really prepare for the death of a loved-one? Most of us try to put the thought out of our minds completely. Yet, it is a fact of life that we will all have to face the loss of loved ones, as well as our own departure from this world. Why is it so hard to properly prepare for it?

I found that I am no different than the average person. Until the death of my parents, I blocked it out too. Then I was forced to face the harsh realities that led me to write a book about the things I learned. It floored me when I realized that there are many things people can do but avoid at all costs.

Since my book has been published, I have had the opportunity to talk to many people that found themselves floundering for answers. Their stories have helped me to see that this seems to be a universal problem. When a crisis occurs, we wonder what the deceased or incapacitated would have wanted in regards to life support, living wills, funeral arrangements, organ donations, and financial wishes. The only way we would know is if we had discussed it. How many times have you brought up those subjects to people and they thought you were being morbid? However, a ten-minute conversation could save people the guilt and soul searching that usually accompanies times of loss.

On a practical level:
We are all going to die. Face it and prepare. Issues such as organ donations and living wills are far too important to shove aside when you are honestly talking to your children or parents. I have found that people “think” they know what their loved ones would like as far as funeral arrangements vs. cremation; organ donations vs. not being a donor: being kept alive on life support vs. dying when your brain has ceased to function. When they actually ask the person, they find that the person wants something entirely different than what they thought. We tend to impose our beliefs into our expectations of other’s wishes. Take the time to find out exactly what people want!!

On an emotional level:
That’s the hard one. I have lost relatives suddenly and also expectedly. Neither is easy. With or without notice, once the person is gone, the finality is a grief process that must be dealt with. Whether you do it with the help of a good therapist or are able to do it on your own, do not get stuck in a deep hole of depression that you cannot get out of. A period of mourning is expected, but it should not control and destroy your life. Death is a natural process of life. To allow it to swallow you into a deep pit for years is unhealthy. Do get help if you need it.

On a financial level:
Contrary to popular belief; you will not be the first one to “take it with you.” Let your loved ones know what your wishes are as far as your financial portfolio. Make it legal. At the very least, MAKE A WILL! Look into a living trust if you are fortunate enough to be in a high tax bracket. It should be taken care of verbally and legally as to who gets the family jewels. Make sure you use the services of a reputable Estate Attorney that is up to date on all of the newest laws regarding estate planning.

The nicest compliment I ever got about my book came from an elderly lady. She was in her early 80’s. She read my book and called me one day to comment on it. She told me that her son was a lawyer and had been after her for ten years to get her affairs in order. She kept ignoring him. After she read my book, she called her son and told him to get all the papers in order; she was ready to do the responsible thing. She wanted me to know that her son loved me. I was thrilled that my story touched one person’s life in a positive way. Yet, I couldn’t help but wonder why she listened to a virtual stranger and wouldn’t discuss the important things with her son?”

I have worked with thousands of people who were coming to terms with losing their own life. One of the most loving gifts a person can provide for those they leave behind is a record of your thoughts, wishes, precious memories and vital statistics along with necessary information for survivors. This information should be placed in a location or given to a trusted someone for when needed. This information must be easy to retrieve. Do not put this information in a place where it is not easily found such as a safety deposit box.

Decisions are many when determining what to do when dealing with life ending issues. Below you will find considerations and why they are important. All of these are items you would want to discuss with medical and/or legal counsel as well as family members.

  • Wills: if you do not have a will someone will have to take care of finalizing your affairs. Most people don’t realize that even the IRS wants that last tax return filed. Don’t leave your affairs to chance. Make a will and name someone (an executor) who is willing to take responsibility of administering your estate.
  • Advance Directives, which directive is right for you: Living wills give instructions about the use of medical treatments at the end of your life. A healthcare proxy appoints a person to make medical decisions when you can’t. Keep in mind different states have different laws, communication along with the existence of the papers is important, and in emergency situations the advance directives generally are not recognized.
  • Funeral choices: There are different types of services and dispositions for the body and can become costly.
  • The difference in preplanning and prepaying: You can pre-plan your arrangements by writing them down or having them on record with a funeral home. The cost will be whatever it is at the time of death. If you prepay for your arrangements in advance with the funeral home, the money will be placed in a trust until the goods and services are used. By pre-paying your costs of goods and services should be locked in at today’s prices. You can also set aside a certain amount for final expenses but that is not the same as pre-paying or pre-planning.
  • Plan ahead for Incapacity: Carry a wallet size information card with pertinent information such as blood type, allergies, doctor, who to contact, a contact person to watch over children, pets, home.
  • Organ donation: Communication of your wishes is of extreme importance. Some states have this option on driver’s license.
  • Having information written down for the person who will be handling the situation after a death: if something happened to you tomorrow whether it be a death or a devastating situation, what would someone else need to know about your life in order to take charge.

Listing necessary information along with how a person has spent their lifetime can be very uplifting and freeing. A person may want to include their accomplishments, hopes and dreams. Add a collection of favorite pictures; write about hobbies, and pets. Include your achievements and how you would like to be remembered. One consoling thought to those of us left behind is to know that no one really dies as long as their memories are alive within our hearts and our minds.

Vital information, needed by the Funeral Director as well as for an obituary, you should include:

  • Full name along with nickname and maiden name if applicable
  • Birthplace and date of birth.
  • Father’s name and mother’s name along with mother’s maiden name
  • Present address with years of residence
  • Former address
  • Social Security number. The National Social Security office is 1-800-772-1213
  • Veteran information. Department of Vereran’s Administration is 1-800-827-1000
  • Marriage Certificate location
  • Children’s Birth Certificate location
  • Employer
  • Spouse’s name
  • Siblings and addresses
  • List of immediate people to notify

You should also include locations of important papers and financial information. I can’t tell you how many people I have worked with that intensely believed there was an existing bank account or insurance policy, only to be unable to locate it. Or spending money with attorney’s and taking years to finalize things. Here are suggestions for what you need to record:

  • Where are: will, birth certificates, marriage license, safe deposit keys, house/car insurance policies, life insurance policy, income tax information, mortgage, deeds, military records, citizenship papers, stocks and bond certificates
  • Record all credit cards numbers, all bank accounts – location and numbers, insurance agents along with policy information and beneficiaries, retirement plans and benefits, stockbrokers, financial planners, CPA, executor of estate and attorney

For immediate care, tape your medication list and your allergies to the back of your medicine cabinet door. You may also want to place a copy in a plastic sealed baggy in the refrigerator. I know this sounds odd but paramedics and police will look in your medicine chest for clues to medical conditions. They look in the fridge because many medications need to be kept in a cool place.

Funerals and Cemetery arrangements will require the following planning.

  • Choose a funeral home and cemetery
  • Choose type of disposition of remains (cremation, embalming, organ/body donation, hand washing by family)
  • Type of burial (below ground, above ground, at sea)
  • Type of service (closed casket, open casket, one day or two day visitation, religious requirements)
  • Type of memorialization (flat bronze, granite or marble, upright monument, flower vase or perhaps a bench)
  • Clergy and religious considerations
  • Casket (wood, steel, copper, bronze) vault if required (bronze, copper, steel, concrete), if cremated type of urn (bronze, marble, wooden, keepsake jewelry)
  • Clothing, what to do with glasses, rings, bible’s and other items that may be placed in casket at the viewing
  • Pallbearers
  • Personal preferences

Insuring permanent care for pets that will out live us is also a necessary element. You may decide to name a caretaker for your pets in your will but keep in mind a will isn’t read until after the death therefore your wishes for your pet could get delayed. Here are some tips to help with planning for the care of your pets.

  • First: have a temporary agreement with someone who will step forward to care for animals in case of a disaster or medical situation in which you can not care for your pets.
  • Second: be realistic about who will have a stable enough life to take care of your pets. You may have a terrific person in mind but they may have traveling jobs or may possibly have children that may change their lifestyle, which would not accommodate your pet.
  • Third: determine what kind of funds you will be able to leave for pet care
  • Fourth: carry an “in case of emergency” card alerting to how many pets you have and who can be called to take care of them
  • Fifth: try to find at least two trusted people who are willing pet guardians and make sure they have pertinent information as well as a key to your house.
  • Six: check back with these people on occasion to make sure nothing has changed and their commitment is solid.

There are pet retirement homes available if you do not feel you can find anyone suitable. They either have fees or ask for donations to help care for the pet. Your veterinarian and your local Humane Society and your legal counsel may also help in your decision making process.

Parceling out information is a paradoxical experience when figuring who should have our “sheets of life”. Those pages with all our written secret dreams, wishes and usually unknown to others, our financial truth. Who will not breach our boundaries and will make sure our wishes are carried out. Once you know you are dying, you also have to figure out the best way to live that life out. Some people own their homes and want to benefit another with a gift while they are alive and yet still are using the residence. Some people choose a retained life estate. This allows a donor certain financial benefits through donating the personal residence to charity or another person and yet retaining the right to life enjoyment in the dwelling. Once the life estate ends the charity or person can use or sell the house and use the proceeds as directed by the donor. It is necessary to discuss this with your financial and legal advisors.

Sometimes those of us who love those we know are dying, do whatever we can to stay in denial. When the dying person’s body and the mind have had enough, a survivor must face letting them go. Many times a loved one has climbed into bed with the one moving out of the physical bounds to let them know its OK to pass on. We will never stop loving them and yes, we suffer heartache but we will survive. We owe it to those we love to love them enough to honor their wishes.

We are all going to die. The difference being that some people get advanced notice. Its important that if you know you are dying or you love someone whom is terminal, talk to each other. Talk about views of life. Talk about spirituality and about religion. Discover lessons learned and ponder what makes life worth living every day. Today you have a chance to talk with a loved one, to breathe the same air, to laugh, to cry, and to cherish the human touch. Plan appropriately for the day of exit and enter each new day with confidence of the radiant spark of eternal bonds.


Copyright Sherry Russell 2003


| Grief Author and Speaker

Sherry Russell has worked in Grief and Crisis Management for over twenty years. She is the originator of a series of educational Grief and Trauma Workshops(R) which are currently being utilized in Funeral Hom...