You have our sympathy. We're not going to recommend watching “The Bucket List,” because Jack Nicholson hasn't done a good movie since “The Departed” and because no amount of feel-good schmaltz can paper over the serious questions you have to answer.
Dimespring is a financial planning site, so we worry about money here. But in this moment, it should be clear to you that time is worth much more than money. You want to effectively turn money into time. And barring that, you want to make the very most of the time you have.
There are three places to look for that maximizing tradeoff right now: Your legal and financial affairs. Your treatment options. And — help us for invoking the term — your bucket list of things you really want to accomplish while you still can.
Legal and Financial Issues
First, you are going to have to learn how to speak plainly and frankly if you can't now, and to get the people around you to speak frankly and plainly to you. There are entirely too many things that are going to happen in the next year that cannot abide ambiguity.
The appointment of a health care proxy or power of attorney for someone to manage your affairs when you're incapacitated falls into this category, said Jon Radulovic, vice president of communications for the National Hospice and Palliative Care Organization.
“Without such a document, it’s someone like your spouse,” he said. “But if you're, say, a widow with adult children, you might want to appoint one. But what that requires is a frank and honest discussion with your loved ones.”
The creation of living wills or advanced care directives shouldn't cost money, he said. Neither should a regular old fashioned will, as long as it's properly witnessed and notarized. “Where there is a cost is that it takes time. Some of the questions that a directive asks may require research, and may require discussions with religious advisors and family.”
Additional information about the process is available at CaringInfo.com. “Nobody knows for sure what the course of a serious illness will be, but it gives you a way to say 'no feeding tube if there's no way to live without it,' or to say you want every kind of possible medical intervention.”
If you don't have life or health insurance right now, you can probably forget about getting it. “You can't get insurance once you get a diagnosis like that. They still have options, but typically, insurance isn't one of them,” said Jesse Slome, Executive Director at The American Association for Long Term Care Insurance.
This would be a good time to find your life insurance documentation, though, along with the other essential financial documents in your life like your birth certificate, bank statements, retirement account information and anything else documenting assets you expect to pass on to others. Often, as relatives begin managing the affairs of a lost family member, “It's all over the place, and they leave it for the family to discover,” Slome said. “It happens with such frequency, it's scary.”
Active life insurance policies can be sold on the market to third parties in what's called a viatical transaction. Essentially, a living beneficiary can sell the policy to someone else for a bit less than the face value. That person is then on the hook for making the life insurance payments. In return, the living person covered can make use of the insurance benefit while they're still alive. And if the person covered by the policy happens to get better … well, they keep the money and the other guy is on the hook for the life insurance payments.
They say dying is the most expensive thing someone can do in America, but that's not quite true. Not dying is often considerably more expensive. Still, I think framing the choice between palliative care emphasizing pain management and quality of life, and aggressive try-everything treatment in terms of cost doesn't really capture the problem. It isn't enough to say that palliative care is usually less expensive because it doesn't speak to the odds any given person may have beating any given disease at any particular stage of illness, nor to the quality of life question.
What we can say is that this is not a moment for self-delusion.
“Have a really frank discussion with your health care providers, to get best and worst circumstances,” Radulovic said. Are there things you don't want, like feeding tubes? Do you want a do-not-resuscitate order? Or do you want all methods on the table? What are the chances of survival, given aggressive treatment, and what will my quality of life be during this time?
Radulovic said many people ask if hospice care hastens death. Others may ask, quite frankly, if there are ways to hasten their death legally.
“People who are terminally ill are very concerned about the effect that their illness will have on their caregivers, their loved ones,” he said. “They're finding out what kind of support would be available. I think the way we're wired as human beings, we're not ready to accept this. That's why palliative care is so important, emphasizing quality of life over curative and care. Ideally, there would be a more seamless process, but the system in this country is fractured and siloed.”
With a year to live, you are actually in a better position than most people trying to sort out how to manage these affairs, Radulovic said. “A lot of people don't think about calling a hospice until they're in the final leg of a journey.
The Bucket List
We can talk about skydiving lessons and punching out the kid from high school that tormented you, but as a practical matter there are things everyone worries about.
Here's the short list.
• Writing letters or making a video while still relatively healthy, to be given to loved ones (or your mortal enemies) before you go. If you're feeling clever about it, the site DeadMansSwitch.net will arrange to have e-mail sent by you after you die, to whomever you like.
• Deciding where you want to be buried, or if you prefer cremation, and who should manage those affairs. Also, arranging for a priest, minister, rabbi or other spiritual advisor to officiate services. … and what those services will be like. If you're not much for the Irish wake, this would be a good time to tell someone.
• Making sure your favorite baseball card, pictures of your parents, family Bible or what not lands with the right people.
• And, in this day and age, designating someone to delete your browser history before anyone else can get to it.