How to Have 'The Talk' During COVID-19

For parents of adolescent children, the toughest talk is sitting down with the kids and discussing the facts of life. But for adult kids, the toughest talk can be sitting down with their elders and discussing their life and death decisions. COVID-19 has made that very personal talk far, far more complex — but even that much more critical.     

Right about the time that Kai Drewry was first considering having "The Talk" with his dad, Perry, who has early-onset Alzheimer's, COVID-19 muddied the family picture. 

Kai contracted the virus and quickly isolated himself for two weeks, although his symptoms were fairly minor. The 27-year-old resident of San Rafael, Calif., came out of isolation intent on helping his 56-year-old father as best he could. He knew that one way to help not only his dad, but the entire family, was to find the right time to discuss the many very personal life and death decisions his father needed to address before his early Alzheimer's advanced to the next stage.

For many families like the Drewrys, the pandemic is making a very tough situation even worse. 

"It's always better to have 'The Talk' before you actually need to have it," says Michelle Feng, chief clinical officer at Executive Mental Health, a provider of clinical psychology services in Los Angeles. Keep in mind, some 57% of U.S. adults do not even have a written will or trust, according to a 2019 survey by Caring.com. And while many adult children don't know it, 75% of adults surveyed by the National Council on Aging say they want to live the remainder of their lives at home.

In fact, because COVID-19 is so prevalent in the news and in many family discussions, this can be the perfect time for adult children to bring up the end-of-life wishes topic with their parents.

"It won't feel like it's coming out of the blue," says Feng. "In this environment, a lot of people are thinking about getting sick or finding themselves in the hospital, and it's a reminder that we're all mortal."

Even then, finding the perfect time during the pandemic to speak with his father about end-of-life issues has been very difficult for Kai Drewry, co-founder of Bomani Cold Buzz, an alcohol-infused cold brew coffee company. That's partly because Drewry has done a lot of traveling from coast-to-coast while establishing his relatively new company. But he plans to finally move to southern California next year, which should make it somewhat easier to finally have "The Talk" with his dad.

In the midst of the pandemic, waiting too long to have this discussion can have life-altering results for a family, says Dr. Zaldy Tan, director of the memory and aging program at Cedars-Sinai in Los Angeles. He relates the case of a husband and wife in their 70s who both contracted the virus. While the wife recovered, the husband did not. 

Because they had not previously discussed end-of-life issues with each other or their children or doctors, there was no advance directive document for the husband's treatment, nor did his family know what he actually wanted. His wife and children were not permitted in the hospital where he was isolated. "A lot of people get confused and delirious when suffering with COVID-19, and can't make these kinds of decisions during the process," Tan says.

So, in a COVID-19 world, how, when, where and in what manner should adult children have frank discussions about end-of-life issues with their aging parents? 

Here are several critical steps to keep in mind — particularly during the pandemic:

• COVID-19 is topical, so use that to your advantage. It makes perfect sense to approach a parent with the idea that the entire family is making plans about how to deal with COVID-19 in case any family member gets sick. Make the parent feel that they are an important part of the family planning. Remind them that an end-of-life directive is a critical part of the plan, says Feng.
• It may require more planning. As if it's not emotionally difficult enough to speak with a parent about this uncomfortable topic, the complexities can quickly multiply during a pandemic that presents so many limitations. So you may want to think — and plan — more about how, when and where you do it, says Feng.
• Reflect on past conversations. Even before you talk with a parent about end-of-life planning, think back on pertinent past conversations you've had with them. In other words, do a self-assessment of what your parents have already told you, says Feng. For example, do you know where their wills are? Have you, perhaps, exchanged any emails or letters on the topic in the past that you can re-read before speaking with them?
• Be specific. Since COVID-19 is a new disease, the treatments are not fully established and some involve the use of ventilators that are very invasive and artificially breathe for people who can't breathe for themselves. It's important to specifically ask the parent how they feel about the use of these machines, says Tan.
• Find a time that works for everyone. The last thing you want in an environment that's already high-stress during the pandemic is to cause even more anxiety. "Keep in mind, you don't want to put your parents on the spot," says Feng. "If it doesn't feel like the right day or the right time, don't do it."
• Make it a series of conversations. Because of all the stress inherent in the current pandemic, it may be more comfortable having a series of short conversations with your adult parent about end-of-life options than having a single, long conversation, says Feng.
• Don't discount the benefits of the phone. While many presume this end-of-life discussion is critical to do in person — and not on the phone — that's not necessarily the case at all with older adults. "Many older people actually feel more comfortable on the phone," says Feng, noting that a phone call means no one has to wear a mask or social distance. 
• Don't forget to listen. During COVID-19, some hospitals in certain parts of the country continue to face a shortage of essential equipment, particularly ventilators. Some older parents — perhaps those in their 90s — might be more inclined to specify in advance that if the hospital's resources are scarce, they should be used on younger, healthier patients first who have a lifetime ahead of them, says Tan. "They might say, if resources are scarce, they'd rather give it to the other person."