How to approach end-of-life planning for your loved ones

It may not be a comfortable topic of discussion, nor something that you can readily raise up at the dining table.

However, this does not make discussing your loved ones' future plans regarding their wishes during the end of their lives any less important. After all, we would all want to honour them by making the best possible decisions when times call for it.

Why is it important to plan ahead?

Planning ahead can be seen by the older generation as being "inauspicious". Some may choose not to talk about it for the fear of ill fortune befalling them. However, planning ahead is best to be discussed ahead of time. Some reasons to plan ahead include: 

Higher incidence of disabilities or long-term illnesses with increased longevity

Singaporeans are living longer. With this fact, a longer life would mean an increased likelihood of disability or illness in a lifetime.

One in two healthy Singaporeans could become severely disabled and may need long-term care. In such instances, your loved one may not want to be thinking of longer-term plans in the midst of a tiring care procedure or recovery.

Moreover, in some cases of neurodegenerative diseases such as dementia, your loved one may eventually not be able to make decisions or make their own decisions reliably. 

Ensure the best possible choice is made in accordance with your loved one's wishes

While your loved one is alert and able to think for themselves, having them plan ahead in case of illnesses or death is ideal.

You can follow their ideals and wishes as best as they can, rather than wait for a situation to arise and are not sure about what they wish for.

Moreover, clear directions from your loved one documented legally help to prevent conflict between family members.

Reduce the burden of decision-making on family members and caregivers

Without a plan in mind, families and caregivers find themselves with the stress of making decisions on behalf of their loved ones. They have to grapple with the doubt of making the "right choice", or with the financial consequences of their decisions.

This can be particularly difficult when you have just lost your loved one and are grappling with grief.

Having a plan laid out ahead of time can help family members, like you, to clarify decisions of care for loved ones and help caregivers to know what their loved ones wish for in times when they are unable to communicate.

You can even appoint someone else outside the family to act on your loved one's behalf to avoid conflicts. 

Prevent unnecessary medical intervention if desired

If your loved one does not wish to sustain life with the use of medical devices, planning ahead will help to reduce instances of unnecessary intervention and also costs. 

What does planning ahead entail?

There are various areas to think about in planning ahead. Most importantly, besides thinking of the process of planning ahead, you would want to think about how, where, and when to approach your loved one to initiate a discussion regarding this topic.

Would you want to do this in the presence of other family members, or more intimately? What documents would you refer your loved one to?

All these factors would have to be thought out before approaching your loved one for this conversation.

How can you approach the topic of end-of-life planning?

There are many factors that you would have to take into account when helping with your loved one's end-of-life planning. But for many of us, that is not the most daunting part of this process.

Rather, the intricacies of deciding on how and where to begin this conversation are what many family members and caregivers need the most help with.

1. Bring up the topic casually and ahead of time

Important decisions don't come overnight. Starting your conversations about end-of-life decisions early can help to ease your loved one's decision-making process, as well as to ease them into the idea of making these decisions one step at a time.

Plus, your loved one may need time to think about their choices and preferences. Starting early would give them more opportunities to mull over their own decisions and ensures that they do not make overly hasty decisions.

2. Have your conversation at the right time and place

For many of our loved ones and perhaps even ourselves, death is a sensitive topic to bring up in conversation. Choosing when and where you initiate these difficult but necessary conversations can help your loved one to feel more comfortable about sharing their wishes.

It is best to choose a place that is quiet and serene — for example, a quiet park or a cafe, or even in the comfort of their own homes and bedrooms.

Medical care 

1. Advanced Care Plan:

Advance Care Planning (ACP) is the process of planning for current and future care arrangements. In an ACP, the individual communicates their values, beliefs, and healthcare preferences to a trusted individual or a healthcare team.

The individual also has to nominate a trusted individual as their nominated healthcare spokesperson (NHS), who helps in making healthcare decisions on behalf of the individual should he or she become unable to make credible decisions for themselves.

The ACP is not a legal document and does not bind anyone in a contract.

2. Advanced Medical Directive:

An Advance Medical Directive (AMD) is a legal document specifying the individual's wish not to use life-sustaining treatment to artificially prolong life should the individual be unable to communicate their decisions and when death is imminent.

An AMD can be set up when the individual is at least 21 years old with decision-making capability.

To register for an AMD, you can obtain the forms from polyclinics or hospitals. You will have to sign the form in the witness of a doctor and send it back to the Registrar of Advance Medical Directives at the Ministry of Health (MOH).

3. Organ donation:

In Singapore, the Human Organ Transplant Act (HOTA) states that the healthy kidneys, liver, heart and corneas are to be removed from a person for the purpose of transplantation in the event of death from any cause.

Any Singapore citizen and/or permanent resident aged 21 years and age and are fit and healthy, are automatically included in the HOTA.

4. Caregiving preferences in case of long-term illness:

Prior to any incident happening, it may be helpful to discuss care options with your loved one so you can make specific arrangements. Would they prefer to stay home or are open to nursing homes? Would they want a specialised caregiver or a domestic helper? 

If they want a close family member to look after them in their last days, is there a specific person that they are thinking of?

Assets, financial affairs and property 

1. Lasting Power of Attorney:

The Lasting Power of Attorney (LPA) is a legal document that enables an individual to appoint a donee to handle his or her affairs in the event he or she loses the mental capacity to do so. A donee is appointed to handle events of the individual's personal welfare or financial affairs.

Do take note an LPA does not override an AMD. 

2. Will planning:

Do you know not more than 10 to 15 per cent of Singaporeans have made wills? Without a will, much of the individual's estate and assets ends up being distributed equally among immediate family members (spouse, parents, grandparents, and children).

Also, an administrator (usually the next-of-kin to the individual) has to be appointed to handle the remaining financial obligations and affairs of the deceased, such as gathering information on the deceased's assets and liabilities, transferring funds from the various banks into an estate account, and paying off all debts and liabilities.

With a will, your loved one is able to have more say over what happens to their assets. You can find out how to write and submit a will here. 

3. Insurance policy nomination:

Your loved one can choose to nominate beneficiaries of their insurance policies should anything happen to them. Policies which can be nominated are life insurance policies, accident plans, and health insurance (excluding integrated shield plans). 

4. CPF nomination:

Every Singaporean has a Central Provident Fund (CPF) account which is meant for retirement planning.

With a CPF nomination, CPF savings will be distributed to nominees, according to the wishes of the individual. Without a CPF nomination, CPF savings will be distributed by the Public Trustee's Office to the individual's family members based on the intestacy laws or Muslim Inheritance Certificate.

If your loved one wishes to decide how much family members receive, they should consider CPF nomination. 

Funeral arrangements

Helping your loved one work through their wishes for their own funerals is one of the most important things you can do for your loved one. Here are a few things that you should urge your loved one to share with you during this process of planning ahead.

1. Their preferred type of funeral service

Depending on your loved one's faith and personal preferences, they may wish to have certain rites and traditions at their funeral.

2. Handling of their remains

This option would also depend heavily on your loved one's faith. It is best to ask your loved one if they have a preferred resting place, as well as how exactly they would want their remains to be handled.

Do they prefer a ground burial or a cremation? In the latter, would they want their ashes to be placed in a columbarium, kept at home, or scattered at sea?

3. Other preferences for their funeral and wake

Apart from the major decisions to have to make for your loved one's wake, there are other pertinent details when it comes to your loved one's preferred arrangement for their wake. You could ask them to share:

• The photo that they wish to be displayed on their casket during this funeral
• The types of songs, music, and hymns to be played
• Their favourite flowers and decorations for the wake

Knowing the ins and outs of your loved one's likings can help you to make urgent decisions with less stress and make sure that your loved one leaves the way that they would like to.

More resources and guides for end-of-life planning

There are a few resources you can use to guide your loved one's planning. Here are some of them: 

• My Legacy: My Legacy helps with end-of-life planning, and is a guide for what to do after death - like planning a funeral, booking a slot with the Town Council, and booking a burial/cremation slot. It also discusses how to manage wills/inheritances/assets.
• Advance Care Planning by Agency of Integrated Care: The Agency of Integrated Care (AIC) has set up a page to guide users how to start an ACP, and provides information more about ACP as well. You can also start the ACP process by going to My Legacy and clicking on the choices available. 
• Lasting Power of Attorney by Ministry of Social and Family Development (MSF): You can apply for a LPA here and find out more as well. 
• Make a CPF nomination by CPF: Make a CPF nomination with CPF directly by using this website. 
• Organ Donation by Live On: Find out more about organ donation in Singapore, and also modify your opt-in for organ donation here by obtaining the required forms to do so. 
• Advanced Medical Directive by MOH: The forms and information regarding an AMD are available on this page done up by the Ministry of Health. 

Planning ahead is an emotionally laden topic to discuss, and is not easy to bring up. Your loved one may react in ways you may never expect, or certain touchy topics may be brought to the table.

However, in time to come, both you and your loved one would have appreciated this discussion for clarity of mind and the reassurance that things are being done as much as possible to adhere to your loved one's wishes when the time comes.

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This article was first published in Homage.