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Planning for end of life

Things to consider in planning for end of life in the Tuberous Sclerosis Complex community

At the TSA, we’re passionate about supporting the TSC community through every step of life, including the final stage. Facing and planning for end of life can be an emotional subject for everyone involved. For people affected by TSC, the process can be even more difficult.

This page covers a range of important areas that you might want to think about or remember in end of life topics, including how you might feel if you or someone close to you has received such devastating news, setting up a Will or Trust, what to do if you’re a carer, and setting up power of attorney.

Planning for end of life is not something that anyone wants to think about, but it’s vitally important. Remember, that the TSA Support Line is here for you if you would like any information.

Does a person living with TSC have a normal life expectancy?

TSC impacts everyone living with the condition very differently. This means that determining the life expectancy of someone with the condition is extremely difficult. For some people who live with TSC, the condition will have no impact on their life expectancy compared to those without the condition, whereas others may be affected by TSC in a way that shortens their expected lifespan.

If you have questions about whether your TSC (or a loved one’s) will affect life expectancy, you should speak to your NHS TSC clinic, or any clinicians who have treated and monitored you for the condition.

Lifelong monitoring and surveillance of the impact of TSC on individuals can help to ensure that a person living TSC is receiving the level of care that they deserve.

With every passing year, research into TSC uncovers further things about the condition and how it affects people. The more we learn about TSC, the greater the likelihood of ensuring that everyone with TSC has a normal life expectancy.

Most people who live with TSC can expect to have a normal life expectancy

However, some people living with TSC may have life-threatening or life-limiting issues as a result of the condition

Everyone experiences TSC differently. Regular monitoring of a person’s TSC can help to anticipate and manage any issues that come up

Why planning ahead for end of life is so important

Talking about and being practical about end of your life planning can help to make sure that loved ones and professionals understand and respect your wishes after you’re gone. When planning for the end of life of a loved one, it also helps to make things clearer and easier around their care needs.

End of life planning can also help to ensure that any dependents (like a child, sibling or partner) are safe and taken care of after your death – whether this is financial (such as funeral expenses) or specific care considerations for someone under your care (such as someone with TSC and support needs).

Although it can be difficult to think about, or to get started, many find that planning ahead for end of life gives peace of mind, for individuals but also entire families.

When a loved one is approaching their end of life

Being a carer, including at end of life, can be emotionally and physically demanding, so it is important to take time for yourself and lean on others for support, too.

If you’re a carer for a loved one with TSC and they are approaching the end of their life, this can be devastating for everyone. You may have been caring for your loved one for a long time – possibly even decades – and it is natural to have mixed feelings.

Take your time to process the news. Nurses, doctors, social workers, loved ones and the TSA Support Line are all here to support you.

Carers UK has a range of resources to help carers, including on topics around end of life.

There’s more information further down this page for carers who are planning for the end of their own life.

Preparing for the end of life of a brother or sister can be incredibly difficult, no matter the age or circumstances.

Siblings who have a brother or sister with additional needs can experience the world differently compared to when there are siblings with no additional needs. Often, the connection between siblings where one has additional needs (such as TSC) can be hugely powerful.

Regardless of age, families and loved ones should ensure support for a sibling around end of life situations – whether it is their brother or sister who is preparing for end of life, or a parent.

For older siblings, you may find it helpful to talk about or share how you are feeling with your sibling, and other loved ones.

Sibs, the only UK charity focused on support for siblings of people with additional needs, offer support to brothers and sisters of any age, including those preparing for end of life and facing bereavement.

Some people who live with TSC also have learning disabilities. If someone with learning disabilities is to receive end of life or palliative care (meaning to make someone as comfortable as possible), there may some extra things to think about.

If a loved one with learning disabilities is moving into a hospice, or is to receive additional care in another setting, it is likely that they will have additional needs compared to people without learning disabilities. This could include things like communication styles, managing distress and challenging behaviours.

Marie Curie has fantastic resources on end of life and learning disabilities, with advice on how loved ones and professionals can provide the best care possible for someone with learning disabilities who is in end of life or palliative care.

NHS England also provides guidelines on delivering high quality end of life care for people who have a learning disability.

Planning as a carer for your own end of life

Many people in the TSC community are not only family members or loved ones to people living with TSC, but are also the person’s carer. Securing long-term care for the person that you look after if you were to no longer be around can be a significant and long-standing concern.

According to the charity Sense, 1.7 million disabled people are supported by their friends and families. Yet, there is no plan in place for 75% of the disabled people for if a day came that support was no longer available from friends or family.

The TSA strongly recommends that individuals and families proactively plan for such an occasion, to ensure that any required care continues for the person living with TSC and to also put the mind at ease of the carer and wider family.

As part of their ‘When I’m gone’ campaign, Sense has developed an excellent guide on planning long-term care and support for disabled adults and their families.

If you’re a carer and planning for your end of life, some things to think about are:

  • Appropriate housing. What would be the most suitable housing for the person living with TSC (such as another family member, residential care or supported living)?
  • Access to finances for ongoing care and support. This might include funding from social services, direct support from another family member or a trust put aside for inheritance
  • Appointing a deputy. If the person living with TSC is not able to make decisions about property of finances themselves, an elected deputy can do this for them

Setting up a Will or Trust

A Will is a legal document outlining how you want your affairs, assets and other issues dealt with after you are gone. A Will might include things like the distribution of possessions or funeral arrangements, as well as inheritance and financial matters.

A Trust is a legal document where a person or people are given the right to hold and manage listed assets for a specific purpose or person. In the TSC community, trusts can be particularly important for people who act as carer or guardian for someone with the condition, as it ensures that assets (financial or otherwise) can be managed on behalf of this person – for example, a Trust could be setup to ensure that money continues to be used to pay for a loved one with significant support needs to live in residential care.

Although Wills and Trusts are similar, setting up a Trust for a specific purpose (such as use of your assets for the care of someone living with TSC) ensures more legal protection and guarantees that your assets will be used for this purpose only.

As part of your Will, you may wish to arrange for the legacy gift to us. A legacy gift is when a person generously decides to give to us at the end of their lives, with the gift usually outlined in their Will. The impact of donations through a person’s Will to the TSA cannot be underestimated, funding a high proportion of the work that we do to support people living with TSC.

Mencap offers a guide on Wills and Trusts that is focused on families who have learning disabilities. Their resources cover the finer details of both documents, including guardianships and the care of loved ones.

Put simply: Wills only ensure the distribution of your assets, whereas Trusts ensure the proper ongoing control and management of your assets.

Leaving the TSA a gift in your Will is a wonderful and powerful gesture, allowing you to continue to help the TSC community even after you are no longer here.

Click here for information about TSA legacy giving

Power of attorney – giving someone the right to make choices for you

Power of attorney is a legal document that says that one or more people are allowed to make decisions on your behalf (or to help you to make decisions). You might want a power of attorney in case you are no longer able to make decisions yourself, such as if you have an accident or become ill.

Handing over control of your affairs to someone else can feel difficult, but there are strict rules that determine how and when it can be used. Once signed, a power of attorney does not come into effect until they are needed.

You can choose to make more than one type of power of attorney, but you must make them while you still have mental capacity.

There are fees attached, but if you are in receipt of certain means-tested benefits you may not have to pay anything. If your income before tax is less than £12,000 a year, you’ll only have to pay half.

More information about power of attorney can be found on the UK Government website, which also covers fees and fee exemptions.

There are three types of power of attorney:

  • Lasting Power of Attorney (LPA). Depending on the type of LPA chosen, this could give your attorney the power to decide on things like daily routines, medical care, if to move you into a care home, and decisions on your financial affairs
  • Enduring Power of Attorney (EPA). This gives the attorney power over only financial matters, and not personal welfare (like your routine or health issues)
  • Ordinary Power of Attorney (OPA). An ordinary power of attorney allows someone to look after your financial affairs for a temporary period

If you’re planning for end of life, contact the TSA Support Line for information and support

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