End-of-life planning is not a single conversation about final wishes. It is an ongoing process involving legal instruments, financial decisions, family communication, and medical guidance that most people approach too late, in too much distress, with too little information. Kayla Bonkowski, a social work graduate student in Sterling Heights, Michigan, is training for a specialty where these conversations are the daily material.
The legal layer comes first in most people’s awareness. An advance directive — also called a living will — documents a person’s wishes regarding medical treatment in the event they cannot communicate those wishes themselves. A durable power of attorney for healthcare designates the person authorized to make medical decisions on their behalf. These documents exist in every state, are not difficult to complete, and are frequently missing when they are most needed.
The absence of these documents creates predictable crises. When a person without an advance directive is incapacitated, the family faces decisions they are not prepared to make, often under time pressure, often in disagreement with one another, and without the guidance of knowing what the patient would have wanted. The medical team is then making recommendations into a vacuum of legal and relational authority. The result is almost never what anyone would have chosen.
Kayla Bonkowski’s training at Louisiana State University prepares her to facilitate these conversations before the crisis arrives. Social workers in palliative care are often the professionals who explain what advance directives are, walk families through what completing them involves, and help patients articulate their values in ways that translate into legally useful language.
But legal documents are only the start. The financial dimension of dying is significant and underestimated. A terminal diagnosis changes a family’s financial situation in ways that are immediate, ongoing, and often unanticipated. There may be lost income if a family member reduces work hours to provide care. There are out-of-pocket costs that insurance does not cover. There are questions about life insurance policy timelines, about the financial implications of hospice enrollment, and about what happens to assets and obligations after the death.
Social workers are not financial advisors. What they can do is identify these pressure points early, connect families to the resources that address them, and ensure that financial anxiety does not become an unmanaged undertow beneath the grief.
Family communication is the third layer, and in many cases the hardest. End-of-life planning surfaces every unresolved conflict in a family — about roles, about history, about who has authority and who does not. Siblings who have not spoken in years will suddenly be in the same room making decisions that require agreement. A patient whose autonomy is being subtly overridden by a well-intentioned spouse needs someone to advocate for their stated wishes.
Kayla Bonkowski holds a Bachelor of Science in Psychology from Rochester College, earned Cum Laude in 2017. That background gives her a clinical lens on family dynamics that is directly applicable to end-of-life planning conversations. She understands how stress distorts communication, how historical relationship patterns activate under pressure, and how to facilitate productive exchange when people are operating at the edge of their emotional capacity.
In Sterling Heights, Michigan, she sees end-of-life planning not as a checklist to complete but as a process to facilitate — one that honors the patient’s autonomy, prepares the family for what is coming, and reduces the legal and relational chaos that follows when the planning has not been done.
The conversations are difficult. They are also among the most valuable things a clinical social worker can offer a family moving through a terminal illness — not because they make dying easier, but because they make the dying person’s wishes more likely to be honored, and the grief that follows more likely to be clean.
Kayla Bonkowski is building toward the practice of having these conversations with skill and consistency. In Sterling Heights, Michigan, she sees end-of-life planning as one of the central clinical contributions that social work brings to palliative care — not a procedural checklist but a sustained process that honors the patient’s voice and prepares the family for what is coming.
The planning conversations are also an opportunity to strengthen the patient’s sense of agency at a time when illness progressively reduces it. Completing an advance directive, naming a healthcare proxy, expressing preferences clearly — these are acts of self-determination that the dying person can take. Supporting those acts is part of what makes palliative care social work a genuinely patient-centered practice.