Posted on: Sunday, December 12, 2004

Discuss crucial issues while they're able

By Dan Nakaso
Advertiser Staff Writer

It took her mother's death in October to prompt 70-year-old Michie Takemoto to begin the delicate task of talking to her two sons about her finances and legal affairs.

Even in her grief following the death of her 92-year-old mother, Tsuma Matsuyama, Takemoto had to research basic information such as her mother's Social Security number, place of birth and maiden name.

"Until someone dies, you don't realize the things you don't know," Takemoto said. "I don't want to leave that for my sons."

Starting a conversation about the practical issues surrounding death can be as emotionally complicated as discussing death itself, according to experts who deal with elderly legal and financial issues.

Some parents worry that their children are more interested in their assets than their health. Others don't like the idea of giving up control or reversing roles of responsibility. And children and parents alike are often uncomfortable talking about any issue related to death.

In extreme cases, families can be torn apart arguing over who should get what or whether life support should be continued for a critically ill elderly parent.

"You can see people just frankly flat-out yelling and hollering at each other," said Ken Zeri, president and chief professional officer of Hospice Hawaii. "You can see incredible guilt. You can see incredible angst. ... It can be financially and emotionally costly.

"In worst -case scenarios, some family members who have been estranged on the Mainland and completely disconnected come in and upset the cart, if you will," Zeri said. "They'll say, 'We have to do absolutely everything to prolong that life.' What you end up with is what I'll call futile care."

Simply starting the conversation about financial arrangements and healthcare can be difficult. It helps to remember that you are not the first person to face this issue and much has been written on the topic. One source in Hawai'i is Kokua Mau (www.kokuamau.org; 585-9977), a nonprofit devoted to helping people with end-of-life care, including suggestions on how to discuss those issues with family members.

"It's so difficult to have those conversations because they evoke the pain of knowing that we're talking about Dad dying," Zeri said. "My wife is a physician, I'm a nurse and my sister-in-law is a hospice nurse. Even though we're professionals, it still hurts."

But Zeri is glad that his family had had a series of conversations with his father-in-law, Robert May, before he died 15 months ago at the age of 78.

"Dad had some dementia and it became more and more difficult to have those conversations," Zeri said. "So we relied on the conversations we had before. ... Think of it as a gift to my family. It's the gift of clarity — not leaving them confused about what my wishes were, my wishes for burial, my wishes for my estate, my wishes for my healthcare."

The goal should be to educate children so they can carry out their parents' wishes, said James Pietsch, director of the University of Hawai'i Elder Law Program.

His mother, 86-year-old Alla Pietsch, doesn't mind discussing her estate and where she wants to be buried. But James Pietsch, who deals every day with elderly legal and health issues, said: "Even I'm reluctant to push that conversation with my mother."

"I'm the one," he said. "You always think of them as your mom or dad."

In awkward situations, Pietsch suggests that parents or their children begin by simply sharing a brochure or an article about health, legal and financial plans following a death. Showing them this story, for example, could help start the conversation.

"Use these words: 'Mom, Dad, here's something interesting we should talk about,' " Pietsch said. "If they're reluctant, set a date on Mother's Day or Father's Day or on their birthday and say, 'For one half hour we are going to talk about this.' Most of the time they'll say, 'Sure, sure.' You need to have an object or date to focus around.

Every family has to decide how best to have the conversation, Zeri said. "What works varies from family to family. There's no right or wrong way to have the discussion. But have the discussion," he said,

Reach Dan Nakaso at dnakaso@honoluluadvertiser.com or at 525-8085.