The conversations that need to happen at your kitchen table (not a hospital corridor)

Michael stood in a hospital corridor at 7pm on a Thursday, trying to make life-and-death decisions about his mother Elena's medical care. She'd had a stroke. She couldn't speak clearly. The doctors needed decisions.

Did she want aggressive treatment? Would she want to be on life support? What mattered most to her - quality of life or quantity? Where would she want to be cared for if she couldn't recover fully?

Michael didn't know. They'd never talked about it.

Not at the kitchen table over Sunday lunch. Not during quiet weekend visits. Not when she was healthy and they had time to think clearly.

Now, in the worst possible moment - stressed, scared, time-pressured - Michael was trying to honour preferences he didn't know.

The data is stark: 86% of Australians don't have any kind of plan in place for preferences and care through the later chapters of life. But it doesn't have to be this way.

 

Picture two different conversations:

Hospital corridor, 7pm Thursday: Your parent is three rooms away, possibly dying. Doctors need decisions now. Family members are crying, arguing, and panicking. Everyone's trying to guess what your parent would want based on fragments of memory: "She once said something about not wanting machines..." "But that was years ago, maybe she changed her mind..."

You make decisions under the worst possible circumstances ... emotional overwhelm, time pressure, incomplete information, vulnerable and stressed.

Kitchen table, Sunday afternoon: Your parent is sitting across from you with a cup of tea. No crisis. No deadline. No life-and-death pressure. You ask: "Mum, if something happened and you couldn't speak for yourself, what would you want us to know about your care?"

She has time to think. To consider. To tell you what actually matters to her. You can ask follow-up questions. Clarify. Write it down. Come back to it next month if needed.

These conversations need to happen at natural milestones and trigger points - not just once, but repeatedly as circumstances change.

 

When your parent turns 75
Turning 75 doesn't mean someone's going to die soon - many people live vibrant, healthy lives well into their 80s and 90s. But it does mean they've entered a different chapter of life, the later stage, where having these conversations becomes essential.

If your parent is approaching or has passed 75, this conversation should happen. Not because they're declining, but because they're in the life stage where planning matters. The data confirms that a large proportion of deaths (65%) occur among individuals aged 75 years and over. 

After a serious diagnosis
A cancer diagnosis, heart disease, COPD, or any life-limiting illness changes the timeline. This is when people often become ready to discuss what matters to them.

Following a dementia diagnosis
This conversation needs to happen early in the diagnosis, while your parent still has the capacity to express their wishes clearly. Waiting too long means losing the window.

After any hospitalisation 
Planned surgery or unexpected admission - both remind families that health is fragile. The weeks after someone comes home from the hospital are often when they're most open to discussing "what if it had been worse?"

When a spouse or close friend dies or becomes seriously ill
Loss makes people reflective. When your parents' friend is diagnosed or dies, it often opens the door: "When Frank was in hospital, it made me think..."

The numbers reveal an uncomfortable truth about the gap between what Australians want and what actually happens:

Up to 90% of people say they want to be cared for at home with appropriate supports, and at least half say they would prefer to die at home - yet as few as one in twenty deaths actually happen at home.

Let that sink in. 90% want home. 5% get it.

Why?

Because more than 80% of deaths happen in hospitals and aged care facilities.

Not because people prefer hospitals, but because families don't know preferences, care isn't arranged in advance, and crisis forces hospital admission.

The system statistics are equally telling:

• In the last 12 months of life, people average four hospital episodes and 33 days in hospital

• One in every four beds in the public health system is occupied by a patient in the last stage of life

• Almost one-third of emergency calls in hospitals are for patients nearing end of life, most of them older than 75

We're cycling elderly people through emergency departments, intensive care, and hospital beds - often receiving low-value care. The research shows that up to 38% of hospitalised patients receive non-beneficial, low-value interventions at the end of life.

Not because it's what people want.
Because nobody asked what they wanted when there was still time to plan.

 

These are important conversations - but they don't have to be morbid conversations about death. They're practical conversations about the last chapters of life: how someone wants to live and be cared for as health declines.

1. What matters most to you?

Not what treatment you want. What truly matters to you in this chapter of life

Some people value independence above all else. Some prioritise being with family. Some want comfort over prolonging life. Some care deeply about staying in their home. Some don't care where they are as long as they're not in pain.

The question: "If you were seriously ill and couldn't fully recover, what would matter most to you? Being at home? Being comfortable and pain-free? Being able to talk with family? Maintaining dignity? Being near your community?"

Understanding values helps families make decisions aligned with what the person actually cares about.

2. What kind of care do you want - and what don't you want?

This is about care preferences, not just medical treatment.

The questions:

• Would you want to be cared for at home with support services, or in a facility with 24/7 care?

• Are there treatments you'd definitely want? Definitely not want?

• How do you feel about aggressive medical intervention vs. comfort-focused care?

• At what point would you say "enough, just keep me comfortable"?

For context on care options, read Vera's article: 
Types of Care for Ageing Parents: A Simple Guide 

3. Where do you want to be cared for?

Place matters enormously to the quality of life.

The questions:

• If you couldn't live independently, where would you want to be? Your own home with support? Living with family? Residential care near your community?

• Are there places you absolutely would NOT want to be?

• What matters more: staying in your house, or being near the people you love?

Given that 90% want to be cared for at home until their death, but only 5% achieve it, this conversation needs to include honest discussion of what's actually possible and what support would be needed to make it work.

4. How do you want decisions made about your care?

The decision-making process matters as much as the decisions themselves.

The questions:

• Do you want to be involved in all decisions as long as you're able?

• Who do you want included in discussions about your care?

• Are there family members whose opinions matter more to you than others?

• How much information do you want to know about your condition and prognosis?

5. Who speaks for you if you can't speak for yourself?

This is the most important question, and the one most people avoid.

If you're unconscious, confused, or unable to communicate, someone needs legal authority to make medical and care decisions on your behalf.

The questions:

• Who do you trust most to make decisions that honour your wishes?

• Is there someone you'd want consulted, even if they're not the final decision-maker?

• Are there people you specifically do NOT want making decisions?

Only 14% of Australians have advance care plans, and financial documents are far more likely to be completed than healthcare documents. We'll plan who inherits the house, but not who makes medical decisions.

This can be formalised legally. See Vera's article on:
Power of Attorney and Advance Care Directives: Get them done before you need them.

6. What information do you want shared, and with whom?

Privacy and information-sharing preferences vary widely.

The questions:

• Do you want all family members kept fully informed about your health?

• Are there specific people who should always be told what's happening?

• Are there topics you'd prefer remain private?

• How do you want information shared - family meetings? Individual updates? Group messages?

 

Sarah's father, Dương, is 74, originally from Vietnam, living in Cabramatta. Sarah lives in the Blue Mountains with her family.

After Sarah's mother died two years ago, Sarah kept meaning to talk to her father about his wishes. She worried. She planned to bring it up. She never did. It felt too soon after Mum's death, too morbid, too uncomfortable.

Then Dương had a minor stroke. He recovered fully, but it shook everyone.

Three weeks later, Sarah drove to Cabramatta on a Saturday. After lunch, over tea, she said: "Baba, when you were in the hospital last month, I realised I don't know what you'd want if something more serious happened. Can we talk about it?"

Dương was quiet for a moment. Then: "I've been thinking about this too. I should tell you."

They talked for two hours. Sarah learned:

What mattered most: Staying in his community near the Vietnamese Buddhist temple and his friends. Being able to speak Vietnamese with carers if he needed them.

Care preferences: He'd try hard to stay home, but if he needed residential care, he wanted somewhere with Vietnamese-speaking staff where he could eat Vietnamese food and practice his faith.

Medical treatment: "If I have another stroke and can't talk, can't feed myself, can't recognise you - I don't want machines keeping me alive. I want comfort, not suffering."

Decision-maker: Sarah, but he wanted her to consult with his closest friend from temple, Uncle Minh, who understood his Buddhist values.

What he feared most: Being kept alive but unable to communicate or practice his faith. Losing his dignity. Being a burden.

Sarah wrote it all down. They reviewed it together. She made copies - one in Dương's filing cabinet, one in her home, one with Uncle Minh, one for the GP.

Two months later, Dương had another stroke. This one was severe. He couldn't speak. Doctors needed to make decisions about aggressive treatment.

Sarah stood in the hospital corridor ... but this time, she knew. She knew what he valued. What he feared. What he'd want. Who to consult.

The decisions were still hard. But she wasn't guessing.

"Having that kitchen table conversation," Sarah said later, "was the most important two hours we ever spent together."

 

Start with your own plans

"I've been thinking about my own future care preferences. It made me realise I don't know yours. Could we talk about it?"

Starting with your own planning makes it feel less like you're assuming they're dying soon.

Use a recent event as the opening

"When Uncle Jonah was in the hospital last month, it made me think ... if something happened to you, I wouldn't know what you'd want. Can we talk about it?"

External events provide natural openings.

Use a milestone as the prompt

"Mum, you're turning 75 next month. That feels like a good time to talk about planning for this stage of life. Not because anything's wrong, just because it's important. Can we have that conversation?"

Framing it as a life milestone normalises it.

Frame it as gift to family

"I'd really like to know your wishes so that if anything ever happened, we could honour what you actually want instead of guessing. Would you be willing to talk through it with me?"

This frames it as helping them ensure their wishes are respected.

Acknowledge it's uncomfortable

"I know this isn't an easy conversation, and I've been putting it off. But I think it's important we have it while there's no crisis. Can we try?"

Naming the discomfort often makes it easier.

Take it in stages

You don't need all conversation topics in one sitting. Start with one:

"Can we talk about what matters most to you if you were seriously ill?"

Come back to others over the subsequent months.

 

Some parents shut down. "I'm not talking about this." "I'm fine, stop worrying."

Try these approaches:

1. Ask what THEY want to know about YOUR plans
"I'm sorting out my own advance care directive. Do you want to know what I've decided?"

Sometimes they'll engage with your planning even if they won't do their own.

2. Focus on one specific thing
Not "let's talk about end of life" but "Who would you want making medical decisions if you couldn't?"

One question is less overwhelming than a full conversation.

3. Share information about resources"I've been reading about planning for the last chapters of life. There are tools coming that might help. Would you be interested in seeing them when they're available?"

Vera will be providing tools and resources to help build out these plans and create the necessary documents in the coming months. Sometimes people engage better with structured tools than open-ended conversations.

4. Accept you might not get everythingIf they refuse comprehensive planning, document what you DO know from past comments and observations. It's not ideal, but it's better than nothing.

Priya's mum, Lakshmi, is 69, living alone in Perth after Priya's father died. Priya lives in Melbourne.

Priya tried three times to have "the conversation" with her mum. Each time, Lakshmi deflected: "Why are you thinking about such things? I'm healthy. Let's not talk about sad topics."

Priya changed her approach. She stopped trying for one big conversation and started asking single questions during their regular phone calls:

Week 1: "Amma, if you couldn't make medical decisions, who would you want to make them - me or Ravi?"

"You. You're the eldest."

Week 3: "When Aunty Prema was in hospital, she said she wished she'd told her kids what she wanted. What would you want us to know?"

"I don't want machines if there's no hope of recovery. Just let me go peacefully."

Week 5: "If you needed care and couldn't live alone, would you want to come to Melbourne, or stay in Perth near your temple and friends?"

"Perth. My community is here. But I don't want to go to residential care if I can avoid it."

Over four months, through brief questions during ordinary phone calls, Priya assembled a clear picture of her mother's wishes. Not through one difficult conversation, but through many small ones.

Document it clearly

Write down everything discussed:

• Values and priorities

• Care preferences (where, what kind, what matters)

• Medical treatment wishes

• Who makes decisions if they can't

• Who else should be consulted

• What they fear most

• What information they want shared with whom

Review it together

Read back what you've written. "Did I capture this correctly?" Make corrections. This ensures you heard right.

Share with relevant people

Give copies to:

• The person who has Power of Attorney

• Family members involved in potential care

• Their GP

• Anyone they've nominated to be consulted

Formalise the legal bits

Conversations are essential, but legal authority matters. Ensure:

• Power of Attorney (medical and financial) is formally documented

• An Advance Care Directive is completed if they want one

• Key decision-makers know they've been nominated and accept the role

See: The documents you need ( before you need them)

Review regularly, especially after trigger events

"Mum, it's been a year since we talked about your care preferences. Has anything changed?"

Preferences evolve. Health changes. After any hospitalisation, serious diagnosis, or significant birthday (75, 80, 85), revisit the conversation. What mattered at 75 might look different at 85.

Plans can change, and that's okay

Health events or ageing might make you rethink choices. Someone who said "never residential care" might change their mind when home becomes genuinely unsafe.

These conversations aren't about locking in unchangeable decisions. They're about:

• Understanding core values that guide decisions

• Knowing preferences at this point in time

• Having a framework when decisions need to be made

• Reducing guesswork when communication becomes difficult

Plans can be updated. Vera's tools (coming in the next few months) will help families review and adjust these plans as needs change, ensuring care always aligns with current wishes and circumstances.

 

Remember those statistics:

90% want to die at home. 5% do.

One in every four hospital beds is occupied by a patient in the last stage of life.

Up to 38% of hospitalised patients receive non-beneficial interventions at the end of life.

These aren't just numbers. They are people receiving care they didn't want, in places they didn't want to be, because nobody asked while there was still time.

The cost of silence isn't just financial. It's families making impossible decisions without guidance, people receiving care at odds with their values, and regret that lasts long after loss.

This week:

• Check if any trigger points apply (parent turning/passed 75, recent diagnosis, hospitalisation, loss of friend/spouse)

• Pick a calm moment with your parent

• Start with one question: "What matters most to you if you were seriously ill?"

This month:

• Have 2-3 brief conversations touching on different topics

• Document what you learn

• Consider who else needs to be part of these discussions

Next six months:

• Cover all six key conversation topics

• Formalise Power of Attorney and care preferences

• Share documented wishes with relevant people

• Look for Vera's planning tools when they launch (coming soon)

• Set a reminder to review after any significant health event or milestone birthday