Q: I was surprised to learn my stepmother does not have an advance directive. Several years ago she had to make difficult decisions when my father was dying, she was his Health Care Power of Attorney. I can’t understand why she hasn’t taken the same steps to make sure her wishes are honored since she has been through this herself. She is an educated individual and knows the implications of becoming a health care advocate. How do I address this subject with her?

A: The underlying issues for why an adult may not have an advance directive differ greatly. These could range from a belief the directive isn’t really needed, not knowing enough about health care decisions, needing help to fill out the forms, lack of time to discuss the issue with the doctor. Ethnic or cultural background could also be a barrier. From what you have indicated these reasons most likely do not apply to your stepmother.

For some people facing their own mortality is very challenging and they don’t want to think about death or serious illness. The individual may not want to burden someone else with having to make the final decisions. It is possible your stepmother may still be haunted by the steps she had to take when your father was dying even though she was honoring his wishes. When a person knows what needs to be done it can still leave them with painful memories and doubts.

The Conversation Project provides tools to assist families/friends in discussing end of life issues. The guide can be downloaded and printed for free at www.theconversationproject.org. Other family members have found this can be a situation that requires patience and time. The first attempt at discussing the subject may be just that — the first — and could require additional conversations. Feb. 19 is National Health Care Decisions Day, we encourage families to talk about end of life decisions with their loved ones.

Are you struggling caring for an older adult or having difficulty locating resources? Our staff is available for a no-cost consultation, set up at your convenience, to help guide you through your caregiving experience. For more details or to schedule an appointment, please call 800-892-0890.

Do you have a question? We encourage inquiries and comments from our readers. Please direct your correspondence to ageinfo@esmv.org or Elder Services of Merrimack Valley and North Shore, Inc., Age Information Department, 280 Merrimack Street, Suite 400, Lawrence, MA 01843. Joan Hatem-Roy is the Chief Executive Officer of Elder Services of Merrimack Valley and North Shore.

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