My mom always had a desk drawer full of greeting cards ready to send. The cards were for birthdays, anniversaries, a variety of holidays, get well wishes - and sympathy cards.

I followed in my mother's footsteps and have always had birthday cards on hand. But now, I'm stocking up on sympathy cards, too, for I'm a baby boomer, and we boomers have reached the age when our own parents are dying.

Last summer, it hit me when my father died. Although I, like my mother, had sent cards when my friends' parents died, I did not truly know how overwhelming the grief would be until my own father passed away. I was anticipating it to be tough, because I was always close to my parents. But, after all, my dad was 85 years old and had lived a great life. I was prepared, right?

There is no way to be emotionally prepared for such a loss. But, besides the raw emotions from the loss, there are family dynamics with siblings, concern about the remaining parent, and in many cases, financial worries.

Saying Goodbye to My Father
My daughter and I had arrived in Iowa for a 10-day summer vacation the evening of July 4. I was jolted awake the next morning before 7 a.m., when I heard my mother shouting at my father to sit down. My "vacation" drastically changed. It was clear my father had had a stroke, affecting his left side.

We knew immediately that it would take a miracle for my dad to recover from this massive stroke. Consequently, one of the family's primary concerns was his quality of life. Would he be kept alive by artificial means? What about surgery? What about feeding tubes? What about respirators?

The doctor doubted that my dad would ever return home. He wasn't well enough for a rehabilitation unit, and Medicare limited the time allowed for his acute hospital care.

During his second week of hospitalization, my mom and sister started shopping for a nursing home. My dad would not be the "typical" nursing home patient, because of the extra care he would need, so the options were limited, and the expenses were high.

Mom found out Medicare would not pay past 100 days, and it wouldn't even pay all the bills during those first 100 days, either. My parents had been successful farmers and bankers and had always lived comfortably. But, simple calculation made it obvious that their nest egg would only last a couple of years if Dad lingered in a nursing home.

"Most families do not realize that in this day and age, with people getting older and living longer, they face the harshest creditor of all - health care," says Bonnie Marshall, an attorney and advocate with NHS (Nursing Home Services), LLC, a company in Glendale, CA, that helps families nationwide obtain Medicaid benefits for long-term nursing home care and asset protection.

Fortunately, my father had made his wishes very clear. He had signed both a living will and a durable power of attorney. He had discussed the issue at length with both my mother and all of his children. When the time came to say our goodbyes and stop any extraordinary care, we were able to do so, knowing it was his wish, and he died less than 12 hours later.

That's not always the way it works. Countless friends have told me of their loved ones who lived years in nursing homes, with no semblance of a life.

"My dad had a stroke like yours, and he lived for seven years in a nursing home, without ever uttering a word or even knowing us," my friend Bill recalls. "But, he didn't have a living will, so we had to let the hospital do everything, even perform surgery to put in a tube to feed him. We knew it wasn't what my dad would want, but there was nothing we could do."

Preparing for the Future
Often called "the sandwich generation" because we are taking care of both our children and now, our parents, baby boomers also are known as "children in denial."

"Children don't want to discuss these topics with their parents, because they don't want to face the reality that their parents are going to die," Marshall says. "We find there is much more hesitation in the children dealing with this than the elderly parents. It's the children who often have so much more to lose."

Christina Norman of Time and Balance Consultants in Santee, CA, has compiled a guide called Being Prepared: A Practical Guide for Organizing Final Arrangements. In it, she writes, "Planning ahead has helped thousands of survivors cope with the complex emotions surrounding the death of a loved one, which provides comfort, assurance and peace of mind. It is important to make arrangements and organize ahead of time before illness occurs and while talking about this subject is easier for everyone."

Marshall says that because no one knows what to expect, there are important tools to have in place so the appropriate decisions can be made at the appropriate time.

"All of a sudden, healthy parents who have a stroke or fall, can within days go from being an independent person to being helpless," she explains. "Many people think that if they have a will, they're OK. A will is not a tool to assist them during their lifetime, just a vehicle to disperse property after their death."

According to the Health Insurance Association of America, seven million Americans 65 and older will need long-term care this year. By 2020, when the boomers are seniors, the figure is expected to reach 12 million.

In the published results of a recent survey it had conducted, AARP stated that, "The national average monthly cost of nursing home care is a frightening $4,654." (Marshall adds that it can be as high as $40,000 a month, depending upon the level of extra care needed). More than 55 percent of those individuals surveyed by AARP mistakenly believed that Medicare foots the bill for nursing home care.

The principles of financial planning that are good while one is working and building toward a future, usually do not apply when protecting an estate.

"Most people, while they are healthy, are not going to give up the reins of control of their property, or their assets to the kids," Marshall says. "But, when all of a sudden, some of the things they did for themselves, they now need help in doing - that's the time to start taking stock and looking into the future."

However, the common tools such as trusts, conservatorships, and long-term care insurance, may not be the answer.

"Many seniors and their family members are under the mistaken impression that expensive long-term health care insurance policies and living trusts are useful and will provide needed financial protection," Marshall says.

"They don't know that trusts are of no value when it comes to long-term illness and will most likely force the family to spend all of their hard-earned money paying for high health care costs. The irony is that with the proper plan in place, Medicaid benefits can be used to meet care costs, and you don't need to be poverty-stricken to receive them."

Marshall adds that families should make sure all adults, regardless of their age, have a durable power of attorney and medical directives.

"It may seem hard to talk about now, but it's easier to follow directives when they can't make decisions for themselves and you know how they wanted things to be done," she says. "Otherwise siblings are disagreeing, you're feeling like an executioner, and it is so much more difficult at the end."

The directives are easy to draw up and should be notarized. It is important that families have conversations about the information and decisions put into the documents.

"(When drawing up these documents) you need to sign over the powers to someone practical, geographically close if possible, dependable and trustworthy, because you are giving away broad powers," Marshall cautions.

It also is important to be involved with your parents' health care before something serious happens.

Learning to Advocate
Marilyn Parker, PhD, learned about being a health care advocate when her mother became ill in 1988, and a brain tumor was found in her father in 1989. Her parents died, respectively, in 2000 and 1993. Because of all the questions from friends and referrals from others, she has expanded her consulting practice from coaching and organizational and management consulting to include consulting on how to be an advocate in the health care system.

In her consulting, Parker addresses such issues as respecting cultural differences, getting families and friends involved, integrating a care provider into the home, dealing with the emotional and logistical issues of transition from being independent to semi-independent to totally dependent, and how to interface with hospital staff, physicians, nurses, administrators, and therapists.

"When care is at a pivotal point, you can make the difference and tip the balance," she says. "If the medical personnel already know you, and they know you are likely to show up at any given time to monitor the care of your loved one, they are going to make sure they are doing things well and maybe even do extra touches that they may otherwise not take the time to do."

As a culture, we have been taught not to question physicians.

"Most people do not know how to become an advocate. They feel helpless when someone is going through the health care process, not even realizing there is something they can do," Parker adds. "This is personal, this is private, and often, family members won't even talk to each other. Being an advocate does not mean being an adversary. An advocate is a person who helps create alliances for families and loved ones with the medical community and services."

Applying What We've Learned
As a family, we are putting all of these points into place with my mom. We are protecting her assets to ensure she will be taken care of in the future, we are getting to know her doctors, and she has already made her funeral arrangements.

In her guide, Christina Norman's step-by-step organizational system helps families effectively handle the many business matters that result from the loss of a loved one. "It is our hope that the booklet enables you to prepare for and deal with your family member's end-of-life transition with clear direction," she writes.

After all, we can never be fully prepared emotionally, and when our emotions are running high is not the time to try to make any type of decisions.

It is best that as many of the financial, legal, medical, and internment issues be discussed and decided - while the family can still talk about it. It actually offers peace of mind now while every one is healthy, as well as when the inevitable event happens.

Ellen Ficklen, writing in Newsweek magazine, put it this way: "I know it sounds odd, but one of the most remarkable, and one of the kindest, gifts my father gave me was to plan the details of his own funeral service."

MARY SCHNACK is a principal with Schnack & Brody Communications, Inc. (www.schnackandbrody.com), a full-service public relations agency with offices in California and Arizona. She can be contacted at 520-204-9834 (e-mail: mary@prworks.ms).