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Senior suicide

— The silent generation speaking up on a quiet killer

Graham and Bruce from the Ettalong men’s shed in NSW.

Over-85s have become the Australians most susceptible to suicide and a general lack of support is threatening to make the problem worse

By

The age group most at risk of suicide may not be the one you expect.

The highest rate of suicide in Australia, for both men and women, is among people over 85, at 32.7 deaths per 100,000 for men and 10.6 deaths for women, respectively.

The global picture is similar. People over the age of 70 kill themselves at nearly three times the rate of the general population. Suicide attempts are also more lethal among older people, with US data showing that about one in four suicide attempts of older people result in death, compared with one in 25 among the general population.

But even these numbers are likely to be underestimates, says Prof Diego De Leo, emeritus professor of psychiatry at Griffith University.

Unless the death of an older person is very clearly a suicide, it is not likely to be investigated, he says, and deaths relating to misuse of medication or even falls that may have been deliberate are often assumed to be the result of senility or frailty.

“It’s widely reported in literature that there’s much more interest in scrutinising the causes of death of a young body than of an old man,” he says.

Helen Bird, 73, from the inner west in Sydney, believes her grandmother’s death fits in this category.

In 1985, Bird got a call to say that her grandmother Olive, 82, had been found in her nursing home room in Hobart with a serious head injury after falling. She died in hospital shortly after. Bird is convinced her grandmother’s death was suicide, knowing that her grandmother had been depressed and had been stockpiling her medication.

Trained nurse Helen Bird
Trained nurse Helen Bird believes her grandmother suicided in a nursing home, although the death was not recorded as such.

“Nothing stacked up,” she said. “I’m a nurse. But nobody ever asked a question. It was a fall, no one questioned it. It was something that really nobody wanted to hear about.

“It’s something that’s always been with me, with great sorrow really,” Bird says. “She felt, I suspect, there was just nothing more to live for, and that’s really, really sad.”

De Leo says there are very different assumptions around suicide for younger and older people. While suicide by a young person is treated as a tragedy and a mystery, an older person’s suicide is often seen as a rational decision.

“It’s this assumption: ‘he was making a balance between pros and cons in life and he discovered the cons were more than pros and he decided then to exit life’, it’s a rational balance,” he says.

Dr Rod McKay, a psychiatrist with a clinical practice focusing on older people, says it is sometimes assumed that someone dying through suicide later in life has less impact on people.

“Someone dying through suicide later in life does have a different impact on those who know them, but it’s not lesser,” he says.

Both McKay and De Leo are keen to draw a distinction between suicide among older people who are depressed and voluntary assisted dying (VAD), which is now legal in every state in Australia under tight restrictions.

“If someone comes to me and says ‘I want to die because I’m depressed and I see no solution to my depression’, well, as a physician I have to do my maximum best to intervene and try to improve the depression of this person, and I can,” says De Leo. “But [if someone comes with] chronic pain, chronic suffering, no hopes for improvement and inevitability of a progression of the suffering … then I feel different.”

McKay says well-meaning attempts to respect individual choices in regard to VAD, may have meant that physicians have not been proactive in referring older people for treatment of depression.

“That debate and the sensitivities everyone is feeling about trying to act respectfully, risks not identifying or investigating depression or reversible factors to the degree that we might,” he says.

A lifeline for men

Men die by suicide at much higher rates than women across all age groups. Among older men, loss of purpose and identity after retirement, weaker connections to children and grandchildren and to social networks can all be factors.

“We’ve never had anyone here who has taken their own life, or entertained that, that I know of,” says Bruce McLauchlan, president of the Peninsula Community Men’s Shed in Ettalong, an hour and a half’s drive north of Sydney, knocking on a wooden work bench. “Maybe, we hope, it’s the contribution of our shed that helps.

“We look for these things: a person who was lively and talkative goes quiet, then we say: ‘Mate, everything OK with you? Anything we can help with?’. Because we are a family,” McLauchlan says.

The Ettalong group, part of the global men’s shed movement, opens its metalworking and woodworking sheds three mornings a week. On a rainy Thursday, the men are just finishing their monthly barbecue lunch, which is sponsored by a local funeral home.

“It’s publicity for them,” laughs Graham Checkley, 84, a retired Baptist minister who is the group’s welfare officer. “We go to a lot of wakes.”

The group is a lifeline for a lot of men, especially after retirement or bereavement. McLauchlan started coming 12 years ago after his wife died. “The men’s shed helps me manage my grief. Otherwise, I’d be sitting at home watching TV all day.”

Garrick Hooper, 73, started coming three years ago after he retired as a taxi driver, and is still coming, “much to my amazement”.

“I always knew about it and I thought: ‘I’ll be avoiding that like the plague, I’m meaningfully employed.’ And then there comes a time that you’re not and you become officially elderly,” Hooper says. “When you retire, you’ve got to redefine yourself, and that’s just how it is.”

Having a laugh together is a big part of the Ettalong Men’s Shed.
Having a laugh together is a big part of the Ettalong men’s shed.

McKay says this sort of social intervention is incredibly important, and older people have far more resilience than they are often given credit for.

“The vast majority of older people don’t feel as old as other people view them as,” he says. “We look at older people, including older people with lots of problems and say ‘I couldn’t cope with that’. Whereas most older people cope well … so we project that on to them.”

Studies show psychological wellbeing actually improves into older age, though depression goes up again in the over-85 age group.

When that happens, McKay says, social interventions are not enough.

“Older people have extremely low access to psychological treatments, the lowest of any age group,” he says.

This can be as a result of unconscious ageism among medical professionals and a sort of therapeutic nihilism that sees depression as an inevitable part of old age and not something that can be treated.

When older people do receive treatment for depression, it can make a huge difference.

“We know that when you look at things clinically, if there is mental illness there, the likelihood of response to treatment is similar to younger people,” McKay says. “There are a lot of social factors that can be addressed, sometimes there are simple medical factors that can be addressed that can make a huge difference in whether someone sees suicide as an option or not.

“It continues to amaze me sometimes when I meet people and see how poor their quality of life is and then with a good review from a geriatrician or a GP who has the time to do it – and it does take time – just the improvement they can have in their quality of life.”

Complete Article ↪HERE↩!

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Not all mourning happens after bereavement

– For some, grief can start years before the death of a loved one

By and

For many people, grief starts not at the point of death, but from the moment a loved one is diagnosed with a life-limiting illness.

Whether it’s the diagnosis of an advanced cancer or a non-malignant condition such as dementia, heart failure or Parkinson’s disease, the psychological and emotional process of grief can begin many months or even years before the person dies. This experience of mourning a future loss is known as anticipatory grief.

While not experienced by everyone, anticipatory grief is a common part of the grieving process and can include a range of conflicting, often difficult thoughts and emotions. For example, as well as feelings of loss, some people can experience guilt from wanting their loved one to be free of pain, or imagining what life will be like after they die.

Difficult to define, distressing to experience

Anticipatory grief has proved challenging to define. A systematic review of research studies on anticipatory grief identified over 30 different descriptions of pre-death grief. This lack of consensus has limited research progress, because there’s no shared understanding of how to identify anticipatory grief.

Therese Rando, a prominent theorist, has proposed that anticipatory grief can help prepare for death, contributing to a more positive grieving experience post-bereavement. Rando also suggests that pre-death mourning can aid with adjustment to the loss of a loved one and reduce the risk of “complicated grief”, a term that describes persistent and debilitating emotional distress.

But pre-death mourning doesn’t necessarily mean grief will be easier to work through once a loved one has died. Other research evidence shows that it’s possible to experience severe anticipatory grief yet remain unprepared for death.

Carers should seek support

Carers of people with life-limiting illnesses may notice distressing changes in the health of their loved ones. Witnessing close-up someone’s deterioration and decline in independence, memory or ability to perform routine daily tasks, such as personal care, is a painful experience.

It is essential, then, for carers to acknowledge difficult emotions and seek support from those around them – especially because caring for a loved one at the end of their life can be an isolating time.

Where possible, it can also be beneficial for carers to offer their loved one opportunities to reflect on significant life events, attend to unfinished business, and to discuss preferences for funeral arrangements. For some, this may involve supporting loved ones to reconnect with friends and family, helping them to put legal or financial affairs in order, talking about how the illness is affecting them, or making an advance care plan.

Talking is key

Living with altered family dynamics, multiple losses, transition and uncertainty can be distressing for all family members. It may be difficult to manage the emotional strain of knowing death is unavoidable, to make sense of the situation, and to talk about dying.

However, talking is key in preparing for an impending death. Organisations who offer specialist palliative care have information and trained professionals to help with difficult conversations, including talking to children about death and dying.

Navigating anticipatory grief can involve self-compassion for both the patient and carer. This includes acknowledging difficult emotions and treating oneself with kindness. Open communication with the person nearing the end of their life can foster emotional connection and help address their concerns, alongside support from the wider circle of family and friends.

Extending empathy and understanding to those nearing death – and those grieving their impending loss – will help contribute to a compassionate community that supports those experiencing death, dying and bereavement.

Complete Article ↪HERE↩!

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Death and money

— How do you talk to your parents about the uncomfortable conversation?

By Betty Lin-Fisher

Today’s topic: How do you talk to your parents about death and finances – without seeming like you are money-hungry?

Daughter wants to avoid repeat hardships after dad’s death

The dilemma: Last year, Melisa Gotto’s father died.

“We did talk about death and sort of what accounts he had and what his desires were for when he passed, but we didn’t really get into the nitty-gritty of it,” said Gotto, of Green, Ohio.

But Gotto said she – and her father, Dave, – were unprepared for all that came with tying up everything from funeral arrangements to his financial affairs.

Melisa Gotto, right, said she was not prepared to handle financial for her dad, Dave Gotto, right, left after his death. Having the uncomfortable conversation about his finances and wishes would have helped, she said,
Melisa Gotto, right, said she was not prepared to handle financial for her dad, Dave Gotto, right, left after his death. Having the uncomfortable conversation about his finances and wishes would have helped, she said.

For instance, her dad had a burial plot in California but died in Nevada. She didn’t know it cost $10,000 and required special health department permission to transport a body over state lines.

Gotto’s parents were divorced. Now, Gotto wants to avoid the headaches and heartache she dealt with after her dad’s death. She has begun talking to her 69-year-old mom, Kim Slingluff, about how Slingluff will afford to live the rest of her life – and how the two of them prepare for her mom’s death.

“It is a very uncomfortable conversation when you start talking about a taboo topic,” said Gotto, CEO of Scandal Co-Active, a boutique public relations and marketing agency. “As a society, we don’t really talk about death, but it’s something that we all will experience. I think it’s something we should all start talking about.”

Gotto’s dad had communicated verbally that she’d be the executor of his estate when he died. But he left no other instructions for her and her brother, such as his medical wishes or details of what exactly to do after his death.

“He was pretty organized and had everything in a safe, but I didn’t know where that was,” she said.

Melisa Gotto, left, said she was not prepared to handle financial affairs for her dad, Dave Gotto, at right, after his death. Having the uncomfortable conversation about his finances and wishes would have helped, she said,
Melisa Gotto, left, said she was not prepared to handle financial affairs for her dad, Dave Gotto, at right, after his death. Having the uncomfortable conversation about his finances and wishes would have helped, she said.

Gotto said her dad also didn’t have enough finances to cover his funeral expenses. And seven months after his death, she’s still trying to get the title for his car.

Gotto says she doesn’t want to seem greedy discussing her mom’s finances or wishes after her death, but she doesn’t want to repeat what happened with her dad.

She has begun telling friends with kids to “do them a huge favor. Get all of this settled before you get older because it’s so important.”

Gotto said she has been approaching the subject with her mom with compassion and empathy. Slingluff has been verbally telling her things, but Gotto knows she needs to get things in writing.

Melisa Gotto, right, is having the uncomfortable conversation about death and finances with her mom, Kim Slingluff, left, to avoid similar hardship she faced after her dad's death.
Melisa Gotto, right, is having the uncomfortable conversation about death and finances with her mom, Kim Slingluff, left, to avoid similar hardship she faced after her dad’s death.

Gotto’s advice to others: “Make a list of everything you want to ask them because you don’t want to have to keep revisiting the conversation.

“Try to have some patience and understanding. And then if they don’t want to have those conversations, you have to respect that, too.”

Don’t leave grieving relatives with a mystery to solve

The expert advice: Talking about death and finances is an uncomfortable conversation and one that some of certified financial planner Jan G. Valecka’s clients are more willing to have than others.

Some clients feel “they have to disclose everything: their bank accounts, how much … they have, and that’s where I think it becomes uncomfortable and they feel a little bit vulnerable,” said Valecka of Valecka Wealth Management in Dallas.

“If I had to talk to somebody about estate planning, financial planning, legacy (planning), I would start from the benefit of your loved one. ‘Who would you want to take care of or help if all of a sudden something happened to you? … And it doesn’t have to be dollar signs, it just has to be more of what are your wishes,” said Valecka.

Having that conversation and letting your loved one know where the important documents are can be so helpful after a death, she said.

Valecka’s family had its own experience with this subject. Her husband, Bob, knew that he would be the executor of his uncle’s estate. However, his uncle did not want to discuss details of his death or his financial affairs.

Bob Valecka’s uncle, Joseph Valecka, was found dead the day after Christmas in 2022, with his wife who has dementia next to him unaware that he had died.

Bob and Jan Valecka had to quickly work to gain guardianship of the aunt and tend to the uncle’s estate.

But they had no instructions. They couldn’t find a will or any estate documents. It turned out there had been a will and Power of Attorney and other documents drawn up. They didn’t find them until after they went to court for emergency guardianship of the aunt.

Bob Valecka, left, knew his uncle, Joseph Valecka, wanted him to be executor of his estate after his death. But his uncle left no instructions, including whether there were any estate documents.
Bob Valecka, left, knew his uncle, Joseph Valecka, wanted him to be executor of his estate after his death. But his uncle left no instructions, including whether there were any estate documents.

The unanswered questions ranged from the significant to the mundane. Had he wanted to be buried or cremated? The uncle and aunt had a lake house. But the Valeckas had no key and didn’t know the security code to get into it, or how to turn on the wells, or if someone plowed the driveway.

“It was a mystery to us,” she said. “It could have been so much easier with planning and an uncomfortable conversation.”

Gotto’s approach to talking to her mom with compassion is a good one, said Valecka.

Some people are just uncomfortable talking about their death, she said. Some clients say it makes death too real.

Approach your loved one with the idea that they are sharing their wishes and helping the people they love after their death, Valecka suggested.

In that conversation, talk about getting a will, health directives and even user names and passwords for digital accounts, she said. Valecka didn’t know she would need a copy of the uncle and aunt’s marriage license to get the aunt on the uncle’s Social Security benefits. Valecka has now added that to her estate documents.

Complete Article ↪HERE↩!

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A Compassionate Journey

— The Transition from Palliative Care to Hospice

By Mazhar Abbas

The transition from palliative care to hospice is a journey marked not just by the end of life, but by the culmination of a lifetime’s worth of relationships, memories, and the profound need for compassion. In the case of Elaine Arazawa, a 62-year-old woman diagnosed with pancreatic cancer that had metastasized to her liver, the value of community and personalized care in her final days comes into sharp focus. Diagnosed with a condition that led to over a dozen tumors, Elaine’s story underscores not only the medical but also the emotional dimensions of transitioning to hospice care.

Understanding the Transition: From Palliative Care to Hospice

The journey from receiving life-prolonging treatments to focusing solely on quality of life is a critical period for patients with terminal illnesses. This transition necessitates a holistic approach that encompasses open communication and thorough assessment of patient needs. Healthcare professionals play a pivotal role in guiding families through this change, ensuring that care is not only medically appropriate but also aligns with the patient’s and family’s emotional and psychological needs. The story of Elaine Arazawa illustrates the profound impact of a well-coordinated care plan, facilitated by a team of dedicated healthcare providers, death care workers, doulas, nurses, grief counselors, and social workers. Together, they create an environment where patients can find solace and families can navigate the complexities of grief and acceptance.

Key Indicators for Hospice Care

Recognizing the right time to transition to hospice care is crucial for ensuring that patients receive the most appropriate support as they approach the end of their lives. Key indicators include a significant decline in health despite receiving treatment, frequent hospitalizations, and a clear preference from the patient to focus on comfort rather than cure. For Elaine, the decision to enter hospice care came after a candid discussion with her healthcare team and family, highlighting the necessity of open dialogue in making informed choices about end-of-life care. This transition allowed her to spend her final days surrounded by love, reflecting on her life, and engaging in meaningful farewells, emphasizing the importance of timing and communication in hospice care decisions.

Building a Supportive Community

Elaine Arazawa’s experience brings to light the significance of community and emotional support in the hospice care process. Unlike many who faced the end of life alone during the pandemic, Elaine had the fortune of being surrounded by her family and a compassionate care team. This communal approach to end-of-life care not only provided Elaine with comfort and love but also offered her family the emotional support needed to cope with their loss. The involvement of death care workers, doulas, and grief counselors ensured that Elaine’s journey was not only about managing physical symptoms but also about caring for the emotional and spiritual well-being of both the patient and her family.

Complete Article ↪HERE↩!

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What Dying Feels Like

— Palliative Care Doctor

Although a dying person tends to spend more and more time asleep or unconscious, there may be a surge of brain activity just before death

By Denyse O’Leary

Wednesday was Ash Wednesday in the Western Catholic tradition. It marks the beginning of Lent, a season of reflection and repentance. A common custom is that, during the service, the priest traces the sign of the cross in ashes on the penitent’s forehead, saying “You are dust and you will return to dust” (Gen 3:19). It’s one of many customs worldwide that offer a sobering reflection on the inevitability of death for all of us — unless, of course, we are transhumanists who genuinely believe that technology can grant us immortality.

What does dying actually feel like?

Most human beings have always believed that the essence of a human being survives the death of the body though the outcome is envisioned in a variety of ways. But, assuming that pain and distress are controlled, what does dying actually feel like? Can science tell us anything about that?

Caregiver supporting sick woman with cancer dying in the hospital

At BBC Science Focus, palliative care doctor Kathryn Mannix offers a few thoughts from long experience, including:

A dying person spends progressively less time awake. What looks like sleep, though, gradually becomes something else: dipping into unconsciousness for increasing periods. On waking, people report having slept peacefully, with no sense of having been unconscious…
As dying progresses the heart beats less strongly, blood pressure falls, skin cools down and nails become dusky. Internal organs function less as blood pressure drops. There may be periods of restlessness or moments of confusion, or just gradually deepening unconsciousness…
Breathing moves from deep to shallow and from fast to slow in repeating cycles; eventually breathing slows and becomes very shallow; there are pauses; and, finally, breathing ceases. A few minutes later, the heart will stop beating as it runs out of oxygen.
Kathryn Mannix, “What does dying feel like? A doctor explains what we know” BBC Science Focus, February 10, 2024

Surge of brain activity just before death

We are also learning that, contrary to what we might have expected, the brain does not necessarily just die down quietly. Researchers have recorded a surge of activity just before death:

To that end, the brain activity of four people who passed away in hospitals while being monitored by an EEG (electrogram) device was studied.
“The data generated, even though it’s only four patients, is massive, so we were able to only report a fraction of the features that it’s actually showing on the data,” Prof. Borjigin said.
At the time of death, brain activity was detected in the TPJ region of the brain — named because it’s the junction between the temporal, parietal and occipital lobes in the back of the brain.
Dan Gray, “Study finds evidence of increased brain activity in people right before they die,” Medical News Today, May 5, 2023. The paper is open access.

There may be a correlation between the surge of activity and near-death experiences, though that wouldn’t account for the NDEs of people who showed no neurological activity.

In any event, cells deprived of oxygen are doomed. But that does not mean that all of the body’s cells cease to function immediately when a person dies:

The brain and nerve cells require a constant supply of oxygen and will die within a few minutes, once you stop breathing. The next to go will be the heart, followed by the liver, then the kidneys and pancreas, which can last for about an hour. Skin, tendons, heart valves and corneas will still be alive after a day. White blood cells, which are more independent, can keep going for almost three days.
Luis Villazon, “When we die, does our whole body die at the same time? ”BBC Science Focus, nd.

So when a medic declares a person dead, that means that the death process is past the point of no return, not that every cell in the body is dead.

Terminal lucidity — getting in the last word

There are many stories through the ages of people near death suddenly waking up and saying something lucid. Researchers who study the phenomenon call it terminal lucidity. At Psychology Today in 2018, nurse educator Marilyn Mendoza noted regarding research to date::

So far, the response rate to the questionnaire he distributed has been limited. While the results are in no way definitive, out of the 227 dementia patients tracked, approximately 10 percent exhibited terminal lucidity. From his literature review, Nahm has reported that approximately 84 percent of people who experience terminal lucidity will die within a week, with 42 percent dying the same day.
Marilyn Mendoza, “Why Some People Rally for One Last Goodbye Before Death,” Psychology Today, October 10, 2018

As to why it happens, she offers,

There is as yet no logical scientific answer to this medical mystery. There is just not enough information to postulate a definitive mechanism for terminal lucidity. The fact that it occurs in people with different diseases suggests that there may be different processes occurring. Some speculate that this could be a spiritual experience or divine gift. It certainly is a gift for family members attending the death to have one last opportunity to be with their loved one and to say their last goodbyes. Both family members and caregivers who have been witness to this state that they feel changed by the experience.
Mendoza, “One Last Goodbye”

One interesting trend is this: Fifty years ago, slick media commentators expected to report that research into death and dying would explod all those myths about a soul or the hereafter or the human mind. But the opposite has happened. Topics like terminal lucidity and near-death experiences are conventionally researched now. And it’s just as clear now as it was fifty years ago that life is a journey and death is not, itself, the destination; rather, it’s a gateway to one.

Complete Article ↪HERE↩!

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Death Cleaning

— How to Survive an Estate Clean-Out After Loss

Advice from experts including a death doula on processing a home full of items while grieving

By Charlotte Collins

Organizing and clearing out an entire home is not most people’s idea of a good time. Doing so while grieving compounds that sense of dread and overwhelm. So perhaps it’s a bit of a surprise that The Gentle Art of Swedish Death Cleaning, Margareta Magnusson’s 2017 book chronicling her approach to ordering an estate in the wake of a loss, was a smash success. Her humorous, accessible guide amassed a cult following among an audience of fans that grew even larger after Peacock released its eight-episode series of the same name last year. But because both the book and the show it inspired tackled an issue that most people will encounter—and one that’s often swept under the proverbial rug—perhaps it’s not all that surprising that consumers found themselves clamoring for more content on post-loss decluttering.

Public meditations on grief and discussions around it seem more easily broached following the COVID pandemic, which spurred a reckoning in how we deal with mourning. The years since 2020 have been characterized by plenty of discourse on grieving, Zoom grief groups, and other bereavement support efforts, opening the floodgates on conversations that might have struck folks as morbid prior but now feel decidedly necessary to have out in the open. Podcasts like Anderson Cooper’s All There Is serve an audience of those looking to reflect on loss and how to live afterward. In cleaning out the New York City home of his late mother, the celebrated designer and socialite Gloria Vanderbilt, Cooper was guided by a number of handwritten notes Vanderbilt left like breadcrumbs to help him along. “These are Daddy’s pyjamas,” read one dispatch on a piece of paper near a pair of satin trousers.

Family portrait of the Coopers as they play on a sofa in their home Southampton Long Island New York March 30 1972....
Family portrait of the Coopers as they play on a sofa in their home, Southampton, Long Island, New York, March 30, 1972. American author and actor Wyatt Emory Cooper and heiress Gloria Vanderbilt Cooper sit with their sons, Carter (1965 – 1988) and Anderson Cooper.

Not everyone is given such clear direction in how to sort through a loved one’s dwelling after their passing. AD caught up with some experts on the subject, including a professional organizer, the owner of a liquidation and clean-out service, a death doula, and Magnusson herself, to advise on how to face the inevitable task—which all our pros say can, and should, be put into practice before a loss occurs. “Start before you are too old, or too weak, or get that final diagnosis,” Magnusson tells AD. “The upside is a better, easier life in which you don’t have to worry about the people you leave behind and all your crap they have to go through.”

How do I clear out a house after someone dies?

Both Magnusson and Mark Ferracci, owner of the Central Maryland–based clean-out and liquidation service Sanford & Son Estate Specialists, say that age 60 is the time to start organizing the objects of your estate for those who will someday have to clear it all out.

Allie Shaw, a professional organizer operating in the Greater Toronto area, recommends starting off by taking inventory of all the important items inside the abode, including anything of sentimental value (like photo albums, beloved heirlooms, or official documents) or monetary value (such as jewelry or china). When her own mother was given months to live, she became Shaw’s first client. Over 10 months, Shaw and her mother “had lots of conversations, going through possessions room-by-room and item-by-item,” she says. “It was very cathartic and it was a time in my life that I was so grateful for. She often said, ‘I got more months because we had this time.’”

In conversations about death and estate organizing it may go without saying, but Shaw encourages having formal documentation in place, like a will indicating your wishes for certain belongings. Though the act of preparing a will and even death cleaning an abode while the resident is still alive and well might feel bleak to some people, it’s important to remember that setting things in order can alleviate major stress later down the line. “It is a monumental task and often people think they’re leaving everything behind as a gift, when I’d say most of the time it’s a big burden,” Shaw explains.

Consider what you can manage and when to call in the estate cleaning pros

There’s no rule of thumb to tell whether your particular estate will need a whole team of professionals to clean out. But whether it’s a small apartment or a sprawling mansion, clearing a loved one’s spaces after they’ve died is rarely a one-person job. Particularly for those who value sustainability and cringe at the thought of wasting the beloved items of a family member’s residence, estate clean-out services like Ferracci’s might be the way to go as they’re plugged into the proper channels to help prevent waste. His team is trained to recycle materials, to facilitate the sale of pieces that have value, and to donate items that no longer have a place with the deceased’s family members before resorting to the dumpster.

Death Cleaning How to Survive an Estate CleanOut After Loss

Like a number of estate clean-out services, Ferracci’s process begins with a simple conversation—an informal chat for which he doesn’t charge that takes place in the abode. “I always say the same thing to people: Get the personal stuff out, get the financial-related stuff out, get the family mementos out; things that you want, those are key,” he says of his preliminary discussions with clients. Making sure family members have combed through the residence for items they hold dear so that all that’s left are things they won’t mind parting with is crucial. “Before I come in to do the job, I want to know that all that stuff’s gone and that everybody’s picked through it.”

How much does it cost to hire professionals for estate cleaning? And how long will it take?

The cost of an estate clean-out varies by how large the home is, which determines how big of a crew the service will need and how many days to allot for the project. A typical family home will likely take two to three days for Ferracci’s team to process, and he estimates that 90% of his average clean-outs cost between between $2,500 and $5,000. His team will sometimes purchase items to sell from clients’ estates, which can help offset that cost: “One [clean-out] I just started, I quoted them $4,400. I gave them $800 for the contents and the price was $3,600, and I’ll be there about two and a half days.” Condos and smaller spaces will generally cost less, while hoarding situations as well as larger abodes drive the price tag up. Though it’s not the norm, Ferracci has encountered homes where the bill was as high as $20,000 to clean everything out.

If you’re coming at an estate clean-out from the “gentle” perspective, meaning you have time to get things in order while the resident is still with us, an organizer may be the way to get things going gradually. As Magnusson advises, “death cleaning is for the living.” Shaw says that in her experience, organizers will charge $50 to $100 an hour. The process usually takes place across several sessions of two or three hours each in order to get a sense for the volume and how much accounting there is to do.

How can I deal with the death-cleaning process while grieving?

Getting ahead of organizing and cleaning a home before a loss takes place is ideal, but that’s just not always possible. It’s likely that the majority of people faced with clearing out a loved one’s estate are still in the grieving process. Even when it’s not a full estate but rather a few rooms with the deceased’s items, the emotional weight can be heavy. Magnusson found clearing out her husband’s spaces in their shared home after his death, particularly his clothing, was “the saddest thing I have ever done.”

Death Cleaning How to Survive an Estate CleanOut After Loss

Some mourners seek the services of a death coach or death doula to help them navigate the complex emotions that surface during grieving. The process of estate cleaning, which can be stressful under any circumstances, is particularly difficult after a loss. New York City–based death doula Mangda Sengvanhpheng knows that there’s no official guidebook to navigating loss, but when it comes to sorting through the ephemera of a loved one’s life, it’s helpful to have a group of helpers around: “Whether that is with your family members, your loved ones, friends, doulas, therapists, whoever it is that can become a support team, find those people to help you move through that,” she suggests.

Parsing through the objects of a deceased family member’s home can often make for bitter fighting between relatives, something both Ferracci and Sengvanhpheng have experienced in their work. Whether or not there are fights over which items go to whom or which things should be kept versus which should be tossed, finding difficulty in the process of going through these items can be viewed as a microcosm for grief in general. For certain things from an estate that we simply have no place for, it’s ultimately about acknowledging that love and value and then letting go.

“An object is an object, right? A table is a table. But these things have meaning because we imbue meaning in them,” Sengvanhpheng says. “There are stories in the objects, there are memories in the objects. When we lose people, as irrational as it may feel, there’s a reason for [feeling tied to objects]. We lose someone physically and these items—something tangible from them that we’re holding onto—mean so much.”

Parting with a loved one’s things can feel like a jarring reality check in the wake of a loss. Sengvanhpheng’s work involves trying to reframe that: “Letting go of items can be a form of acceptance,” she says. “If, for example, your sister takes something from your mother’s estate that you wanted, you can acknowledge that and then find ways to accept that this is just the reality. How can we start letting go? We consider how you can connect to your mom in a different way.”

Sometimes, there’s a melancholy beauty about ushering these emotionally charged objects into their next phase and assigning them a new narrative. Grief coach Charlene Lam curated an art show on the experience of going through her mother’s home and the objects she decided to keep and discard. When Shaw was taking inventory of her mother’s estate, she happened upon a beautiful rocking chair that had a long history in the family and was very beloved to her mother. They landed on donating it to the local library so that generations to come might make good use of it. “It’s still there and they love it,” she says.

Delaying the death-cleaning process can end up costing you

For many people in the golden years of their life, Ferracci’s seen enough to recommend downsizing when a large family home no longer serves your needs. He’s met clients who have proclaimed that their parents’ move from a big house to a smaller condo in their twilight years was “the best thing they’d ever done”—giving them ability to travel, save money, and ease the burden of sorting through a massive house for their children when that time came. When elderly homeowners aren’t capable of maintaining their houses, issues like accumulated clutter, mold, rot, and overgrown yards can make for an especially pricey clean-out and can even cause the home’s value to go down.

For those looking to list the family home after clearing it out, delaying on a needed clean-out runs the risk of confronting a more difficult selling market later down the line. “You’re going to continue to do the maintenance and you continue to pay the bills for the house, and the house is vacant, and interest rates can start to go up,” Ferracci says. He’s dealt with clients who struggled to sort through items or found themselves in gridlock with family members about what to do with the estate, ultimately leading them to list the residence many months later for thousands less than if they would have been more efficient in the clean-out process.

Ultimately, your pace is your choice. How to prepare for a loss, or even your own death, is not something AD purports to have all the answers on, but dealing with the items of our lives is manageable with the proper tools, outlook, and support. “We are all dying,” Magnusson says. “This is not morbid. It is just fact. Take care of it.”

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End-Of-Life

— The One Decision AI Cannot Predict

We often talk about personalized medicine; we hardly ever talk about personalized death.

By Dr. Tal Patalon, MD, LLB, MBA

End-of-life decisions are some of the most intricate and feared resolutions, by both patients and healthcare practitioners. Although multiple sources indicate that people would rather die at home, in developed countries they often end their lives at hospitals, and many times, in acute care settings. A variety of reasons have been suggested to account for this gap, among them the under-utilization of hospice facilities, partially due to delayed referrals. Healthcare professionals do not always initiate conversations about end-of-life, perhaps concerned about causing distress, intervening with patients’ autonomy, or lacking the education and skills of how to discuss these matters.

We associate multiple fears with dying. In my practice as a physician, working in palliative care for years, I have encountered three main fears: fear of pain, fear of separation and fear of the unknown. Yet, living wills, or advanced directives, which could be considered as taking control of the process to some extent, are generally uncommon or insufficiently detailed, leaving family members with an incredibly difficult choice.

Apart from the considerable toll they face, research has demonstrated that next-of-kin or surrogate decision makers can be inaccurate in their prediction of the dying patient’s preferences, possibly as these decisions personally affect them and engage with their own belief systems, and their role as children or parents (the importance of the latter demonstrated in a study from Ann Arbor).

Can we possibly spare these decisions from family members or treating physicians by outsourcing them to computerized systems? And if we can, should we?

AI For End-Of-Life Decisions

Discussions about a “patient preference predictor” are not new, however, they have been recently gaining traction in the medical community (like these two excellent 2023 research papers from Switzerland and Germany), as rapidly evolving AI capabilities are shifting the debate from the hypothetical bioethical sphere into the concrete one. Nonetheless, this is still under development, and end-of-life AI algorithms have not been clinically adopted.

Last year, researchers from Munich and Cambridge published a proof-of-concept study showcasing a machine-learning model that advises on a range of medical moral dilemma: the Medical ETHics ADvisor, or METHAD. The authors stated that they chose a specific moral construct, or set of principles, on which they trained the algorithm. This is important to understand, and though admirable and necessary to have been clearly mentioned in their paper, it does not solve a basic problem with end-of-life “decision support systems”: which set of values should such algorithms be based on?

When training an algorithm, data scientists usually need a “ground truth” to base their algorithm on, often an objective unequivocal metric. Let us consider an algorithm that diagnoses skin cancer from an image of a lesion; the “correct” answer is either benign or malignant – in other words, defined variables we can train the algorithm on. However, with end-of-life decisions, such as do-not-attempt-resuscitation (as pointedly exemplified in the New England Journal of Medicine), what is the objective truth against which we train or measure the performance of the algorithm?

A possible answer to that would be to exclude moral judgement of any kind and simply attempt to predict the patient’s own wishes; a personalized algorithm. Easier said than done. Predictive algorithms need data to base their prediction on, and in medicine, AI models are often trained on a large comprehensive dataset with relevant fields of information. The problem is that we don’t know what is relevant. Presumably, apart from one’s medical record, paramedical data, such as demographics, socioeconomic status, religious affiliation or spiritual practice, could all be essential information to a patient’s end-of-life preferences. However, such detailed datasets are virtually non-existent. Nonetheless, recent developments of large language models (such as ChatGPT) are allowing us to examine data we were previously unable to process.

If using retrospective data is not good enough, could we train end-of-life algorithms hypothetically? Imagine we question thousands of people on imaginary scenarios. Could we trust that their answers represent their true wishes? It can be reasonably argued that none of us can predict how we might react in real-life situations, rendering this solution unreliable.

Other challenges exist as well. If we do decide to trust an end-of-life algorithm, what would be the minimal threshold of accuracy we would accept? Whichever the benchmark, we will have to openly present this to patients and physicians. It is difficult to imagine facing a family at such a trying moment and saying “your loved one is in critical condition, and a decision has to be made. An algorithm predicts that your mother/son/wife would have chosen to…, but bear in mind, the algorithm is only right in 87% of the time.” Does this really help, or does it create more difficulty, especially if the recommendation is against the family’s wishes, or is delivered to people who are not tech savvy and will struggle to grasp the concept of algorithm bias or inaccuracies.

This is even more pronounced when we consider the “black box” or non-explainable characteristic of many machine learning algorithms, leaving us unable to question the model and what it bases its recommendation on. Explainability, though discussed in the wider context of AI, is particularly relevant in ethical questions, where reasoning can help us become resigned.

Few of us are ever ready to make an end-of-life decision, though it is the only certain and predictable event at any given time. The more we own up to our decisions now, the less dependent we will be on AI to fill in the gap. Claiming our personal choice means we will never need a personalized algorithm.

Complete Article ↪HERE↩!