It has become quite fashionable these days to apply the concept of a spectrum – traditionally considered in terms of autism (as in being on the autistic spectrum) – to many aspects of our lives. So whether we’re talking about our sexuality, character traits or intelligence, there is a recognition that we may not conveniently fit into one category or another. Having a strong dislike of boxes and labels, I rather like this loosening of definitions, and I’m not surprised to find it true of people’s position on planning for later life as well.
People’s priorities differ wildly as to what is important when discussing the future, so asking what matters to them regarding later life inevitably throws up a huge variety of responses. They might be discussing appropriate adjustments to their home with an occupational therapist but have never considered what level of treatment they want if they get ill. Someone else may already have gone round the local care homes, picked out their favourite and got an Advance Decision in place but is in no hurry to appoint a power of attorney.
How far, and in which direction
There is also huge divergence in where the boundary lies as to how far people are prepared to take the conversation, and in which direction. “I’m not prepared to think about dying but I know exactly what music I want played at my funeral”, “I know I should… I’ll get round to it one day”, “No thanks, it’s not something I’m prepared to talk about”, “I must get this done now, before I need it”, “I’ve got it all sorted and my family know exactly what I want” and so it goes on.
No surprise then that attempts to increase the numbers of people completing advance care plans meet with limited success, when the forms tend to focus on collecting information the healthcare system would like to know, and may fail altogether to address the issues that are important to the individual.
Our approach with the My Future Care Handbook has essentially been one of: ‘Here is the information you need to make some informed decisions about your future, and the tools to act on those decisions. It is now within your power to choose which decisions and actions you wish to take, and when’.
We have aimed to cover everything, with a clear message that not all sections are relevant to everyone. From feedback received it seems there are a variety of approaches taken in terms of how it is used: some like to start at the beginning and work through to the end, others flick through and use the page markers to identify the sections they want to focus on first, and then there are those who dip in and do a bit at a time.
Keeping the scope as wide as possible makes it potentially relevant for every adult, regardless of age or state of health, and that approach was welcomed by Wendy Mitchell. “The front cover does not say it’s for people with dementia, people with cancer, people that are dying. The front cover is saying it’s for everybody.”
That wide remit called for input from a wide range of experts, both professional and by experience. So we were extremely fortunate to have a large group of people give generously of their time to help shape the content, tone and format of the Handbook, and it is undoubtedly the richer for it.
A thousand voices (well, a hundred anyway)
The value of this diversity of input was one of the themes to emerge during a Zoom chat with a group of people living with dementia, who had kindly put the Handbook through its paces.As Agnes Houston put it: “It’s very clear this wasn’t done by a medical professional alone. The carers voices are through it, the voices of the people with long term conditions are through it. That’s what makes it so precious. You usually either get a carer’s view or a professional medical view or you get the view of the person with the long term condition. This is the first time I’ve ever seen anything where it is so, so inclusive.”
Wendy Mitchell agreed: “You can tell the minute you start looking through it that it’s not healthcare professional led and that immediately brings you in because it’s not some official thing that you are being told to read.”
That’s such valuable feedback for us, because we knew it would not be enough to provide a fact-filled resource, it had to be something that was going to get those of us reluctant to consider our future (and that’s, let’s face it, most of us) to make a start.
Alison Barclay, carer of her husband Gordon who lives with dementia, admits she’s a procrastinator and would rather do housework than start planning for later life… and she hates housework! But even she acknowledged that ‘if this book doesn’t get me doing it then nothing will.”
Sarah Reed, founder of REAL Communication Works, found she’d completed five or six pages before she’d even noticed. “It’s just so easy to follow. I’ve been thinking about my own will, my own needs… and what was surprising was how easy it was. Filling in a form on a page where you are being asked straightforward questions just makes it so simple. But if someone had asked me what I want, I wouldn’t have the faintest idea!
I didn’t realise…
This is something we frequently hear about one or more of the topics covered in the Handbook, and often from people who thought they’d covered most things. Alison didn’t realise there are now doulas for dying as well as for birthing. Wendy remembered she had not updated both her daughters about her funeral preferences, Frances found it made her think of things she hadn’t considered before.
Because the Handbook is designed as an interactive workbook, what you end up with is a set of documents and decisions that are unique to you, reflecting your wishes, needs and aspirations for later life, end of life and beyond.
So, one size fits all? That’s perhaps going too far, but what we can say with confidence is that there’s something for everyone in the My Future Care Handbook, and whether you just fancy creating a bucket list, want to prepare a complete Advance Care Plan or need a prop to take the awkwardness out of the conversation with a loved one, all the feedback tells us it will work for you.
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