AS THE END DRAWS CLOSER

Some elderly people remain in reasonable health and in full possession of their faculties right up until the day they die. Others, particularly if they attain a great age or suffer from a debilitating terminal illness, become increasingly frail and dependent on others – a stage which could last days, weeks or years. Rather than assume that this could never happen to you, you should plan for such an eventuality.

Living independently

Most older people would prefer to live out their days in their own home, rather than go into residential accommodation and lose their independence. If you are of this mind, you should investigate what forms of assistance are available to you – both statutory and voluntary.

The local branch of Age Concern or Help the Aged will be able to provide you with details of local facilities, such as meals on wheels, day centres and home care assistance. You may well be eligible for financial help in the form of an attendance allowance, which would help offset the cost of home care and hospital transport. Many doctors’ surgeries have community nurses attached to them who can assess your needs and obtain the assistance you need.

If you have difficulty in getting about you could apply for a disabled parking permit from the local council, enabling you (or whoever is driving you) to park in restricted areas. Financial help may also be forthcoming to install chairlifts and railings in your home.

Don’t be afraid to ask around about the facilities that are open to you. Anything which makes the evening of your life comfortable and more bearable is well worth exploring.

Living with others

The time may come when you are no longer able to cope, and you may consider moving in with a member of your family, typically a son or daughter. But such arrangements do not always work out satisfactorily and you should endeavour to have a trial run first of all.

Where you are being cared for by a relation or friend, you ought to ensure that they are being offered sufficient help both from the state and the voluntary sectors. I have already mentioned such matters as the attendance allowance and day centres; the organisation Carers UK can provide you with details as to what services and benefits are available to take some of the pressure off those who are looking after you.

Another consideration is that living with your children could well involve moving to another part of the country with which you are unfamiliar, whereas you would prefer to remain in a locality where you have plenty of friends and acquaintances. In this case it makes sense to explore other options, preferably while you are still active.

Sheltered housing offers a certain degree of independence, and you have the reassurance that there is someone keeping an eye on you. A retirement home provides you with all your daily needs – meals, cleaning, etc – and, not least, companionship. If your condition is very grave you will need to find a comfortable nursing home or hospice offering palliative care. Consult with your next of kin to reach the best solution.

Enduring power of attorney

If you are elderly, when you come to make your will the solicitor may suggest that you make an enduring power of attorney agreement. This is a sensible precaution just in case one day you are no longer able to manage your affairs. It enables someone else to sign cheques, enter into agreements for you and carry out other transactions on your behalf. Information on the process is available from the Public Guardianship Office. It is sensible to appoint two attorneys in case one of them dies.

The enduring power of attorney need not take effect immediately. You simply make an agreement which can be activated at some time in the future by the person or persons you have nominated to act on your behalf. In order to do so, a form has to be obtained from the Public Guardianship Office or downloaded from its website. The person designated as your attorney has to give notice of their intention to do so to you and your next of kin, who have the right to lodge objections. There are a number of safeguards, and at any time the agreement can be revoked.

Medical power of attorney and living wills

If you have a serious terminal medical condition, and do not wish your life to be prolonged unnecessarily, you might consider making a medical power of attorney which enables a designated person to make medical decisions on your behalf if you should become unable to make or communicate such decisions yourself.

A living will fulfils a similar function by setting out your wishes in writing regarding medical treatment and intervention. The legal status of such wills is unclear, but doctors and other healthcare staff would doubtless respect any directions you may have made. They are often faced with difficult decisions, such as whether to resuscitate a person if the chances of survival are slim, or whether to relieve pain with drugs which could have the effect of shortening a person’s life. They would doubtless welcome clear directions from you or your next of kin as to your true wishes.

If you are considering going down either of these avenues, you should discuss the matter with your next of kin and medical staff and obtain their agreement, since this is not a decision to be taken lightly. The instructions can be revoked at any time.

The Natural Death Association and the Voluntary Euthanasia Society can provide information about living wills, as well as guidelines on making one.

Spiritual and emotional comfort

I am aware that I have devoted most of this chapter to practical matters and have tended to ignore emotional needs. It would be most unfortunate if those around you are so taken up with attending to your physical requirements that they have no time to spend with you. As a person’s life draws to a close, visitors can be a great source of comfort, even if they stay for only a brief period of time.

Some people may be put off visiting you because they do not wish to disturb you, but you should indicate that everyone is most welcome, even if you cannot offer them scintillating conversation. In time they might come to regret that they did not pay a final visit to you while you were still alive.

If you have been a regular attender at a local church or synagogue in the past your local parish priest or rabbi will probably come to see you as a matter of course, but if the congregation is a large one, a request may have to be given.

If you are not attached to a particular religious grouping, you need not miss out on clerical visits. A message to the appropriate authorities should suffice. In hospitals there are usually chaplains on hand to offer reassurance and cater for your spiritual needs.

It is not unusual for people on their deathbeds to seek spiritual comfort and most clergymen are adept at putting the sick and dying at their ease. They will pray with you and administer holy communion or last rites – depending on your religious persuasion.

Unfinished business

Are there any family problems or misunderstandings that need to be sorted out before you pass on? It is not unknown for friends or family members to fall out and in your final days you are in a strong position to effect a reconciliation.

Also, there may be people who have been particularly kind and considerate to you whom you need to thank personally, and those who will miss you badly who would benefit from words of reassurance from you. Don’t put it off until you are no longer capable of speech.

I have already stressed the importance of tidying up your affairs before the end, and this includes your financial affairs. If you sense your days are limited it would be sensible to call in your next of kin and executors to clarify any instructions you have made and ensure they know how to access the relevant documentation. The checklist in Figure 5 could serve as a model.