This year that tension played out on the annual family vacation at the Jersey Shore. Ruth felt she could manage the stairs in the rental house. Her daughters felt it was unsafe. At the end of the week she said she did not want to go back next year. Her children made her record it, saying she’d said the same thing the previous year, but then forgotten it.

“I feel sorry for them, my girls, because I give them a hard time,” Ruth said. “They’re happy to have me. I’m happy I have them. I’m very blessed.”

It is this bond that makes death harder for Ruth to face, not for herself, but for her children. Dying will be her last act as a parent; her last request, that her children let her go.

Judy Willig sees this challenge all the time. But she said it was easier to help her staff talk about mortality with clients than to do so with her own family. Yet they manage, she said.

“I’m going to be very sad,” she said. “I’m very close to my mom. But we also talk about it, a lot. We don’t sit down and say, O.K., let’s talk about death today. But it certainly comes up in our conversation. When we go to make a doctor’s appointment and they say, ‘Come back six months from now,’ she’ll say, ‘I might not be here.’ There’s the constant reality of it. She’s very reality-based in that.”

In her assisted-living building, Ruth, too, sees neighbors dying or deteriorating, the regular appearance of stretchers coming and going. When she watches a neighbor struggle to get to kidney dialysis treatments, she said, “I think to myself, if that were me, I would not go.”

Her children, she said, know that she feels that way. “They agree with that, I think. When death comes, death comes. I don’t discuss it with them.”