Advance Care Planning: The Conversations Families Should Have Before a Crisis

Most families don’t want to talk about what should happen if a parent, spouse or loved one becomes seriously ill and can no longer make healthcare decisions for themselves.

Carly Hickey has seen what can happen when those conversations haven’t taken place.

Carly is a Registered Nurse and Founder of Advance Care & Emergency Planning Company, also known as ACE Planning. She spent 12 years working in intensive care, where she regularly saw families confronted with a devastating situation: someone they loved was critically ill and couldn’t communicate their wishes, leaving the family to help make incredibly difficult decisions about their care.

I recently sat down with Carly to talk about advance care planning, why families put it off, and how we can make these conversations a little easier.

Her message was simple:

“It’s always better to have it and not need it than need it and not have it.”

What Carly Saw in the ICU

Carly’s interest in advance care planning started at the bedside.

She cared for people who had experienced catastrophic illnesses and injuries and could no longer answer questions about their own healthcare.

Their families were suddenly being asked to help guide that care.

The problem was that those questions were often being asked at one of the worst possible moments.

Families were shocked. Emotional. Overwhelmed.

And they were being asked to make decisions that could have enormous consequences.

Carly remembers situations involving people with advanced illnesses where she wondered whether conversations could have happened much earlier.

As she explained it, sometimes families wanted the healthcare team to do everything possible because they loved the person. But there were situations where Carly felt the interventions being provided were “prolonging death instead of restoring life.”

Those experiences stayed with her.

The issue also became personal. Carly’s father-in-law died following complications after heart surgery. About a year and a half later, she brought her stepfather to hospital for what she thought was a minor issue. He died a week later.

Even as an experienced ICU nurse, Carly found that being the family member was different.

“Even with my nursing hat on, everything I knew, that love for your family to want to save them and do everything really clouds your judgment.”

That combination of professional and personal experiences ultimately helped lead Carly to start ACE Planning.

Why Do We Keep Putting These Conversations Off?

Most of us know that having our affairs in order is important.

Actually doing it is another story.

Carly identified several reasons people procrastinate.

The most obvious is that it’s uncomfortable. Talking about serious illness, death and what we’d want at the end of our lives isn’t something most families look forward to doing over Sunday dinner.

Some people simply don’t know how to begin.

Others think they’re too young or healthy to worry about it.

And then there’s a group Carly specifically mentioned that will probably sound familiar anyone reading this: the Sandwich Generation.

They’re raising children while also beginning to support aging parents. There are jobs, groceries, laundry, appointments, soccer practices and countless other demands competing for their attention.

Advance care and estate planning may be important, but they don’t feel urgent.

So they become something we’ll get around to “someday.”

Carly’s advice is to make the first step manageable. Block some time in your calendar and simply start the process.

You don’t have to solve everything in one day.

You Don’t Have to Wait Until You’re Older

I asked Carly whether there’s a particular age when people should draw a line in the sand and say, “I need to get this done.”

Her answer wasn’t really about age.

Instead, she encouraged people to think about things like their dependents and assets.

If you have children who depend on you, for example, there are important questions about what would happen to them if something happened to you.

And serious illnesses and injuries aren’t restricted to older adults.

Carly has cared for critically ill people in their 20s, 30s and 40s.

That’s why she sees advance care planning as something much broader than planning for old age.

How Do You Talk to Your Parents About This?

This may be the most useful part of my conversation with Carly for Sandwich Generation caregivers.

Imagine telling your 80-year-old dad:

“Dad, you’re 80. You need to get a will. We need to talk about this.”

According to Carly, approaching the conversation with that kind of urgency can immediately put someone on the defensive.

There’s another way to do it.

You could start by explaining why you want to understand their wishes:

“Mom and Dad, you’ve taken such good care of me in my life. I really want to take care of you.”

From there, the conversation can become about understanding what they want and being able to honour those wishes if you’re ever called upon to do so.

Carly describes the principle as:

“Connection before direction.”

Don’t start with a list of things Mom or Dad needs to do.

Start by listening.

Lead By Example

Carly also gave me another approach I really liked.

Do your own planning first.

Then you can approach your parents and say something like:

“I’ve just gotten my affairs in order. I’ve done my estate planning and documented my wishes. Have you done this for yourself?”

Suddenly, you’re not telling your aging parents what they need to do.

You’re talking about something everyone should do, including you.

Carly believes removing some of the sentimentality around the conversation and making it practical can make the subject easier to approach.

It isn’t necessarily:

“We need to talk about this because you’re getting older.”

It’s:

“This is something all of us should have in place, just in case.”

Planning Can Be an Act of Love

There’s another way to think about advance care planning that came through strongly in my conversation with Carly.

You’re not only planning for yourself.

You’re leaving information for the person who might someday have to make decisions when you can’t.

Carly recently spoke with someone who had gone through an overwhelming experience with their own parents. Their takeaway was:

“My experience will not be my children’s experience.”

They wanted to do the work now so their children wouldn’t someday face the same uncertainty.

That’s a pretty compelling reason to have an uncomfortable conversation.

What Does ACE Planning Do?

For people who don’t know where to begin, Carly works with individuals and families through ACE Planning.

She typically starts with an introductory conversation. For someone who needs more support, Carly can review what planning they’ve already completed, identify areas they may want to address, and work with them on advance care planning.

Carly is also very clear about the boundaries of her role. She’s a Registered Nurse, not a lawyer. When something falls outside her scope, she directs people toward the appropriate professional.

That distinction matters because getting your affairs in order can involve several different areas, from healthcare wishes to estate and legal planning.

1,000 Journals for 1,000 ICU Patients

Carly is also working on an initiative that goes right back to where this story started: the ICU.

She created an ICU guided journal and handbook.

Carly remembers families in intensive care receiving an enormous amount of unfamiliar information. Simply telling someone to “take notes” isn’t necessarily helpful when they don’t know which information matters or even what the equipment around them is called.

The journal is designed to help families understand the ICU environment and document what happens each day.

Later, when a patient is awake, well enough and ready to understand what happened, the journal can help them piece together the days they may not remember.

Carly’s goal is to provide 1,000 journals to 1,000 ICU families by Canadian Intensive Care Week, taking place October 18 to October 25, 2026.

Don’t Wait for a Crisis

The biggest thing I took away from my conversation with Carly is that advance care planning doesn’t have to start because someone is dying.

It doesn’t even have to start because someone is sick.

Having these conversations earlier gives families time to actually understand each other’s wishes without trying to figure everything out in the middle of a crisis.

As Carly put it:

“Communication brings so much clarity.”

Her advice is to start having these conversations early and get comfortable talking about them.

Because hopefully you’ll never need the plan.

But if the day comes when someone you love can’t tell you what they want, knowing that you’ve already had the conversation could make an incredibly difficult situation just a little bit easier.

Learn More About Carly Hickey and ACE Planning

Carly shares educational content about advance care planning, aging, illness, end of life, grief, bereavement and caregiving through ACE Planning.

You can learn more about ACE Planning on the ACE Planning website, Instagram, or TikTok.