Written by By Andrea Pezel, LCSW & Founder / CEO of Artichokes & Aging
There is often a moment when families remember clearly — when a decision had to be made, but the person at the center of it could no longer share their voice.
For one family, it came during an unexpected hospital stay. What began as a manageable health issue quickly became more complicated. Within days, decisions needed to be made about treatment, next steps, and long-term care. Siblings gathered, each bringing their own understanding, concerns, and assumptions about what their parent would have wanted. They cared deeply, but they had never had the conversation.
What followed was not conflict as much as uncertainty. Questions lingered. Would they want this level of intervention? What would quality of life mean to them now? Who should be making the final decision?
In the absence of clarity, the weight of responsibility fell heavily on everyone involved.
This is a common experience, not because families aren’t thoughtful or engaged, but because these conversations are easy to delay until they are no longer possible.
Today, April 16th, is National Healthcare Decisions Day. Today is a reminder that there is an opportunity to approach these conversations differently, before they are shaped by urgency.
Why These Conversations Matter More Than We Think
Most people have a general sense of what they would want if their health changed. Many hope to remain at home, maintain independence, and avoid prolonged or invasive interventions that don’t align with their values.
But without conversation or documentation, those preferences often remain unspoken.
When a crisis occurs, families are left to make decisions quickly, often in high-stress environments like hospitals or emergency rooms. Emotions run high, information is complex, and time is limited. Even the most well-intentioned family members may have different interpretations of what “the right thing” looks like.
The result is not just logistical difficulty, it is emotional weight. Family members may second-guess decisions, feel guilt, or worry that they are not honoring their loved one’s wishes.
Planning ahead does not eliminate difficult decisions, but it changes the experience of making them.
When preferences are known, decisions become less about guessing and more about following a shared understanding.
What Gets in the Way of Starting the Conversation
If these conversations are so important, why do they so often get postponed?
There are a few common reasons:
It feels uncomfortable
Talking about illness, decline, or end-of-life care can feel heavy. Many people worry that bringing it up will create fear or sadness.
It feels too early
People often think, “We’ll have time later,” especially when everyone is relatively healthy.
It feels overwhelming
There are legal documents, medical terms, and emotional dynamics to consider. It can be hard to know where to begin.
It feels like there’s a “right” way to do it
In reality, there isn’t. These conversations don’t need to be perfect to be meaningful.
The truth is, the best time to start is not when everything is figured out, it’s simply when there is space to begin.
Reframing the Conversation
One of the most helpful shifts is to stop thinking of this as a one-time, high-stakes discussion.
Instead, think of it as an ongoing conversation about values, preferences, and priorities.
It is not about predicting every possible scenario. It is about understanding what matters most.
For example:
- What does quality of life mean to you?
- What would you want if you couldn’t speak for yourself?
- Who do you trust to make decisions on your behalf?
When approached this way, the conversation becomes less about fear and more about clarity and connection.
Practical Ways to Get Started
If you’re not sure how to begin, here are practical, approachable steps that can make the process easier.
1. Put It on the Calendar
These conversations rarely happen spontaneously.
By setting aside time, you create intentional space for a thoughtful discussion rather than trying to address it in passing. It could be over a meal, during a walk, or as part of a family gathering.
The goal is not to solve everything in one sitting, but to start.
2. Start with Your Own Perspective
Sometimes the easiest way to open the door is by sharing your own thoughts first.
A simple statement can be enough:
“I’ve been thinking about how we would handle things if something changed, and I realized we haven’t really talked about it.”
This approach removes pressure and invites conversation rather than directing it.
3. Keep It Focused and Manageable
You do not need to cover every detail at once.
Start with a few key questions:
- Who would make decisions if needed?
- What matters most in terms of quality of life?
- Are there situations where you would or would not want aggressive treatment?
Keeping the scope small makes it more approachable and less overwhelming.
4. Identify a Decision Maker Early
One of the most important steps is identifying who will serve as the decision maker if needed.
This person is often called a healthcare proxy or durable power of attorney for healthcare.
Clarifying this early helps avoid confusion later and ensures that someone is clearly empowered to act.
5. Divide Responsibilities
In many families, multiple people are involved. Clarifying roles can reduce stress significantly.
For example:
- One person gathers medical information
- Another communicates with providers
- Someone else helps coordinate logistics
When roles are defined ahead of time, families are better equipped to respond when needed.
6. Write It Down
Even informal notes can be incredibly helpful.
Capturing key preferences, values, and decisions creates a reference point when it matters most. Formal documents like an advance healthcare directive provide legal clarity, but even simple written summaries can guide decision-making.
The key is accessibility and to make sure the information can be easily found when needed.
7. Treat It as an Ongoing Conversation
Preferences can evolve over time.
Health changes, life experiences shift perspectives, and new information can shape decisions. Revisiting the conversation periodically ensures that it remains aligned with current values.
Think of it as something to return to and not something to “complete.”
The Impact of Starting Early
When these conversations happen earlier, something shifts.
Families often describe a sense of relief and not because the topic becomes easy, but because it becomes clearer.
Decisions feel less like guesses and more like reflections of what truly matters.
There is also a deeper sense of connection. These conversations often reveal values, priorities, and perspectives that might not come up otherwise.
In many cases, families find that instead of carrying the full weight alone, they are supported by a shared understanding.
That understanding can bring:
- More clarity in decision-making
- More confidence in difficult moments
- A greater sense of peace over time
Free Resources for California Families
If you’re ready to take the next step, there are trusted, no-cost tools available to help you get started:
In California, these documents are designed to be accessible. Most can be completed for free and are legally valid with either two witnesses or a notary.
When Additional Support Makes a Difference
For some families, starting the conversation is the hardest part. For others, navigating different perspectives or complex dynamics can make it challenging to move forward.
Support can make a meaningful difference.
Having a neutral, experienced guide can help:
- Facilitate conversations so everyone feels heard
- Reduce tension when there are differing viewpoints
- Clarify values and care preferences
- Provide structure in moments that feel uncertain
At Artichokes & Aging, the goal is not to take over decision-making, but to create a space where families can move through it with more clarity and less stress.
Support evolves with each family’s needs and whether that’s starting the conversation, navigating a current situation, or planning for what lies ahead.
A Moment Worth Using
National Healthcare Decisions Day is not about having every answer.
It is about creating the conditions for better ones.
Even a small step, such as a conversation, a question, a moment of reflection, can begin to ease the path forward for everyone involved.
Because when the time comes to make decisions, what matters most is not having perfect information.
It is having enough clarity to feel confident that you are honoring what matters most.
And that clarity begins with a conversation.
Andrea Pezel, LCSW, CCMC, C-ASWCM is the Founder & CEO of Artichokes & Aging, a care management practice supporting older adults and their families across the Bay Area. With a background in medical social work and care management, Andrea brings both clinical expertise and a thoughtful, personalized approach to every family she works with.
Artichokes & Aging provides support with care coordination, health care advocacy, home safety assessments, hospital-to-home transitions, and aging-in-place planning to help families navigate complex decisions with clarity and confidence.
If you’d like support navigating these conversations or planning next steps:
Artichokes & Aging
artichokesandaging.com
info@artichokesandaging.com