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What would be a good end of life?

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And I'm talking about the very end.

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I'm talking about dying.

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We all think a lot about how to live well.

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I'd like to talk about increasing our chances of dying well.

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I'm not a geriatrician.

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I design reading programs for preschoolers.

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What I know about this topic

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comes from a qualitative study with a sample size of two.

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In the last few years, I helped two friends

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have the end of life they wanted.

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Jim and Shirley Modini spent their 68 years of marriage

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living off the grid on their 1,700-acre ranch

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in the mountains of Sonoma County.

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They kept just enough livestock to make ends meet

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so that the majority of their ranch would remain a refuge

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for the bears and lions and so many other things

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that lived there.

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This was their dream.

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I met Jim and Shirley in their 80s.

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They were both only children who chose not to have kids.

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As we became friends, I became their trustee

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and their medical advocate,

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but more importantly, I became

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the person who managed their end-of-life experiences.

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And we learned a few things about how to have a good end.

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In their final years, Jim and Shirley

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faced cancers, fractures, infections, neurological illness.

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It's true.

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At the end, our bodily functions

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and independence are declining to zero.

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What we found is that, with a plan and the right people,

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quality of life can remain high.

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The beginning of the end is triggered

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by a mortality awareness event, and during this time,

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Jim and Shirley chose ACR nature preserves

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to take their ranch over when they were gone.

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This gave them the peace of mind to move forward.

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It might be a diagnosis. It might be your intuition.

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But one day, you're going to say, "This thing is going to get me."

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Jim and Shirley spent this time

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letting friends know that their end was near

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and that they were okay with that.

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Dying from cancer and dying from neurological illness

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are different.

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In both cases, last days are about quiet reassurance.

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Jim died first. He was conscious until the very end,

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but on his last day he couldn't talk.

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Through his eyes, we knew when he needed to hear again,

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"It is all set, Jim. We're going to take care of Shirley

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right here at the ranch,

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and ACR's going to take care of your wildlife forever."

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From this experience I'm going to share five practices.

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I've put worksheets online,

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so if you'd like, you can plan your own end.

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It starts with a plan.

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Most people say, "I'd like to die at home."

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Eighty percent of Americans die in a hospital

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or a nursing home.

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Saying we'd like to die at home is not a plan.

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A lot of people say, "If I get like that, just shoot me."

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This is not a plan either; this is illegal.

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(Laughter)

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A plan involves answering

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straightforward questions about the end you want.

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Where do you want to be when you're no longer independent?

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What do you want in terms of medical intervention?

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And who's going to make sure your plan is followed?

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You will need advocates.

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Having more than one increases your chance

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of getting the end you want.

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Don't assume the natural choice is your spouse or child.

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You want someone who has the time and proximity

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to do this job well, and you want someone

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who can work with people under the pressure

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of an ever-changing situation.

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Hospital readiness is critical.

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You are likely to be headed to the emergency room,

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and you want to get this right.

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Prepare a one-page summary of your medical history,

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medications and physician information.

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Put this in a really bright envelope

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with copies of your insurance cards, your power of attorney,

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and your do-not-resuscitate order.

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Have advocates keep a set in their car.

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Tape a set to your refrigerator.

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When you show up in the E.R. with this packet,

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your admission is streamlined in a material way.

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You're going to need caregivers.

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You'll need to assess your personality and financial situation

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to determine whether an elder care community

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or staying at home is your best choice.

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In either case, do not settle.

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We went through a number of not-quite-right caregivers

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before we found the perfect team

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led by Marsha,

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who won't let you win at bingo just because you're dying

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but will go out and take videos of your ranch for you

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when you can't get out there,

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and Caitlin, who won't let you skip your morning exercises

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but knows when you need to hear

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that your wife is in good hands.

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Finally, last words.

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What do you want to hear at the very end,

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and from whom would you like to hear it?

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In my experience, you'll want to hear

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that whatever you're worried about is going to be fine.

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When you believe it's okay to let go, you will.

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So, this is a topic that normally inspires fear and denial.

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What I've learned

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is if we put some time into planning our end of life,

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we have the best chance of maintaining our quality of life.

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Here are Jim and Shirley just after deciding

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who would take care of their ranch.

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Here's Jim just a few weeks before he died,

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celebrating a birthday he didn't expect to see.

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And here's Shirley just a few days before she died

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being read an article in that day's paper

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about the significance of the wildlife refuge

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at the Modini ranch.

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Jim and Shirley had a good end of life,

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and by sharing their story with you,

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I hope to increase our chances of doing the same.

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Thank you.

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(Applause)