It’s Good to Talk - Advance Planning for Dementia

This month I want to talk about talking. So often we don’t talk about the important stuff and sometimes it really matters. Although I am focussing on this from a dementia perspective most of it is relevant for many other conditions.

Some people are great at planning ahead, sometimes to excess! My Granny, Molly, was a fine example of this. She was so keen to make sure that her house was free of any clutter or too many belongings for us to sort out when she passed that she was always trying to give things away. I often felt bad turning down her offer of old wooden furniture or her collection of sheep ornaments. She was always very willing to discuss her future, where she would like to live, in what situations she would like to receive treatment and when she would not. This made it much easier for us all to plan ahead and support her more effectively when things changed.

Although conversations around worst case scenarios or end of life discussions can be emotionally challenging, it is so much better to discuss ahead of time rather than under the pressure of needing to make a life changing decision.

For someone with a diagnosis of dementia their cognitive function will decline, therefore it is even more important to discuss things sooner rather than later. Things like organising a Power of Attorney are just not possible if someone loses the mental capacity to make a decision around this.

There are a number of things that can be discussed and really what is key is to take into account what is important to the person with dementia and what are their worries for the future.

Three things that are generally pretty important to cover off are:

Where to live

• Would they like to move closer to family?
• Is the current accommodation going to be suitable as time goes on?
• You might want to consider space for a live in caregiver.

Care and support

• How would they like to be supported if support is needed?
• Most people would prefer to stay in their own homes if possible. Are there any circumstances when the person would be happy to move to residential care?
• If they are unable, who would they like to make decisions for them (they can arrange a Power of Attorney)?

End of life

• Where would they like to be (most people would prefer to die at home but the majority die in hospital)?
• Is there anything that is specifically important?
• Is there a time when they would like to stop receiving treatment (eg a Do Not Attempt Cardiopulmonary Resuscitation form can be organised through a GP)?

Here in the UK we don’t like talking about end of life but it is something we will all face and is something we really shouldn’t be afraid to discuss. Some of the above should be documented formally and your solicitor or GP can give you guidance on this.

An ex-army friend of mine is very fond of the quote ‘no plan survives contact with the enemy’. A plan is not fixed in stone and needs to be adapted as things change but having a plan does make things easier for everyone.

‘It’s good to talk’.

Alastair Shanks, Owner Right at Home and Dementia Friends Champion