101Careers in CounselingIn this weekly feature, the editors of SpringBoard highlight one career in the health care professions–including a basic description, educational requirements, core competencies/key skills needed, and related web sites and professional organizations where you can find more information!

Along with counselors working with senior citizens in inpatient and outpatient centers, a topic of interest is counseling the elderly on end-of-life decisions. These counseling jobs may be somewhat distinct from counseling in a retirement community or a regular outpatient setting. In most cases, counselors specializing in end-of-life care for seniors may well be working in a private practice.

Degree Required
A master’s degree in one of the counseling specialty areas (e.g., geriatric counseling, rehabilitation counseling, and mental health counseling).

Issues to Understand
There are many sensitive issues regarding end-of-life decisions. Foremost in the minds of many elderly clients is likely the topic of how they wish to end their lives. A growing percentage of seniors wish to end life on their own terms, meaning holding out the possibility of euthanasia (Granello & Granello, 2007). Currently, Oregon is the only state that allows for legal suicide, though other states may follow Oregon in the future. Regardless, many seniors end their lives each year. Euthanasia will likely be an issue for discussion for many.

Counselors counseling the elderly should be prepared to face many clients, discuss their wills, and discuss what to do with their home, land, and so forth. The counselor need not be an expert in law or real estate, but some working knowledge of these issues would be important. Elderly clients may also wish to discuss which family members they wish to “reward” and those they will leave out of their will. Because of the emotional issues involved, counselors will need to elicit the clients to discuss the stories and issues around their decisions, so the client can make
an informed decision.

Best Aspects of the Job
The elderly often represent one of the most vulnerable segments of society. Counselors working with the elderly to assist them in their end-of-life decisions may be able to help protect senior clients from being taken advantage of as they can assist the client in examining the most appropriate beneficiaries for their assets. This responsibility means that counselors must ask themselves, “What is in the best interests of my client?” While all counselors must address this important ethical question, vulnerable clients with assets require sober reconsideration of this maxim by the counselor.

Another benefit of counseling the elderly on end-of-life decisions is likely to be the satisfaction of providing a safe atmosphere for elderly clients to be taken seriously and to be respected and attended to in a manner congruent with their wishes. Many elderly people in our society do not get to experience this type of consideration in significant areas of their lives.

Challenging Aspects of the Job
One reality the counselor will face regarding counseling elderly clients is that the client’s wishes may differ significantly from that of her or his family. Loved ones, even those with honorable motives, may find it difficult to accept the wishes of their elderly family member. This is especially true when the issues concern money, property, religion, and how a client chooses to die. Counselors can expect angry phone calls from family members expressing hostility at the counselor for “making mom or dad give their money away,” “. . . talking them out of a religious funeral service,” or worse, and from extended family fishing to find out what their relative told the counselor. Counselors will need to be resilient in the face of intrusive efforts and maintain confidentiality.

Another challenging aspect of end-of-life counseling naturally involves how to die. Oregon is the only state that provides for legal suicide, though clients in the other 49 U.S. states and territories might commit suicide, and many others will wish to discuss this possibility. Counselors must be able to be present for difficult therapeutic conversations such as euthanasia. The tricky issue is how to have such conversations while keeping oneself from potential prosecution.

End-of-life counseling also is likely to involve an existential (or spiritual) discussion regarding a critique of the elderly client’s life. Many clients may feel that they failed to accomplish what they sat out to accomplish and may be disappointed or even bitter. Other elderly clients will feel a strong sense of satisfaction at life accomplishments and feel a desire to discuss them. Some elderly clients will also see their lives as beginning to unfold in their late years, and they may desire to discuss how to make the most of remaining time.

Occupational Outlook and Salary
At this point, with the lack of tracking from the Bureau of Labor Statistics, salary is hard to estimate. For end-of-life decisions, outside of hospice services, counselors working in this area likely will be in private practice where salaries vary considerably. Occupational outlook is very poor at the moment; however, with life expectancy increasing, counseling services for the elderly are likely to become a regular part of a counselor’s work in the future.


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