Published in The Courier-Post by Kim Mulford

David Mayer didn’t talk about death or funerals or end-of-life decisions with his mother. Didn’t want to.

“Because it’s difficult — you don’t talk about it, ” the Gloucester Township mayor said. “People don’t talk about it. That’s not abnormal.”

Instead of having that difficult conversation, the family faced difficult decisions. In her final days, as diabetes shut down her organs, Henrietta Mayer could no longer tell her family what she wanted. In the meantime, there were medical choices to make, legal and financial matters to tend, a service to plan.

Within months of her passing, Gloucester Township became one of three pilot communities to hatch the Mayors Wellness Campaign’s Conversation of a Lifetime, an experiment to prepare their residents for the most tender of topics — one’s own death. With its local success, the work is expanding to three New Jersey counties: Camden, Mercer and Bergen.

“You don’t ever want to lose anyone,” said Mayer. “But you have to discuss it. It’s really important.”

The campaign is supported with a grant from the Horizon Foundation for New Jersey, and backed by the New Jersey Health Care Quality Institute, which nudged the mayors of Princeton, Tenafly and Gloucester Township to tackle the taboo subject.

“We know that when it comes to end-of-life care, New Jersey is one of the states that’s most challenged,” said Linda Schwimmer, the institute’s chief executive officer. “There’s a real disparity between what we say we want in terms of end-of-life care, and what we actually end up getting.”

Though 62 percent of New Jerseyans have talked about their wishes in the event they become terminally ill or are suffering in great pain, most haven’t taken the next step, according to a Rutgers-Eagleton/New Jersey Health Care Quality Institute Health Matters poll taken in April.

Six in 10 New Jerseyans say they have not put their final wishes in writing.

That’s a problem. Patients without advance directives or other end-of-life documents are more likely to receive unwanted medical interventions toward the end of life, such as feeding tubes and ventilators.

In New Jersey, nearly 27 percent of patients died in hospitals in 2012, among the highest in the country according to the most recent figures available from the Dartmouth Atlas of Health Care. That means many were likely “over treated” without improving their outcomes, according to the New Jersey Hospital Association.

To address the gap, the campaign prompts community conversations in comfortable settings, like sessions at a senior center or meetings at local churches, synagogues and libraries.

During their first year on the project, the three municipalities held book discussions, film festivals and Sunday breakfasts to draw people in, packing rooms and spilling over their allotted time. At one event, Schwimmer noted, “they literally had to kick people out.”

In Gloucester Township, the mayor seized on a public art project launched in New Orleans by the artist Candy Chang. Her “Before I Die” chalkboard gave her community a place to publicly share their final wishes. In the wake of its success, the artist offered instructions and guidelines for others to do the same. Mayer commissioned a mobile chalkboard to use at public events.

“Once it gets moving and you have people engaged, it takes on a life of its own,” Schwimmer said.

In Camden County, the work is led by its new surrogate and a former freeholder — who also happens to be Mayer’s wife. Already touched with the loss of her mother-in-law two years ago, Surrogate Michelle Mayer regularly encounters residents struggling after a loved one has died. The surrogate probates wills, and handles adoptions, guardianship matters and trust funds.

“A lot of them don’t have their paperwork properly prepared,” Mayer noted. The conversation campaign will be incorporated into public events throughout the county. She hopes to persuade each municipality to host at least one.

And that mobile chalkboard that’s become a fixture in her own town will inspire a part of the county-wide campaign, too. She plans to tote a table-top version to her public appearances. Anyone over age 18 should have their wills and advance directives prepared.

“The minute you have assets is the minute you need to make sure you have all your wishes in order,” Mayer said. “This is making sure your wishes during life and during death are fulfilled — this will make it easier for your family members.”

The Mayers know that personally. When dealing with a medical crisis, emotions run high and decisions are tough to make, David Mayer said.

It’s natural to avoid the discussion, he noted. But once those decisions are made and written, “it’s a gift of clarity that we are communicating to our family members.”