Ideas. Lessons Learned, and Occasionally, Opinions
When Bill Gates pledged $100 million for research on controlling or curing Alzheimer’s disease in our lifetimes, it focused much-needed attention on this dread disease. At Corgenius, when we teach about preparing for it, signs to watch for, and protocols to follow, we often ask the audience how many have a family member affected by Alzheimer’s. Well over half of the hands in the room go up; often it’s nearly unanimous.
Statistically, 1 in 8 people aged 65 and above have Alzheimer’s disease. Every five years after the 65th birthday the chance of diagnosis doubles. Nearly half of people at age 85 have Alzheimer’s, and one of every three seniors dies with the illness. This epidemic has profound implications for all of us, and especially for financial advisors, who are charged with guiding clients through their elder years in ways that protect their best interests and their financial viability. Here are some resources to help.
For your own education: Our vote for the best recent resource is “In Pursuit of Memory: The Fight Against Alzheimer’s” by Joseph Jebelli. This British neuroscientist has carefully crafted an understandable and comprehensive examination of the history of the disease, causes and characteristics, past and current research, and currently available treatment options. He details the major drug testing failures in the past several years, but ends with hope that in 10 years we reduce Alzheimer’s to a manageable chronic disease like diabetes rather than the debilitating fatal illness is currently is. If you want the best education on the subject and if you appreciated “The Emperor of All Maladies” (which was published in 2010 and examined cancer in the same way), this book is for you.
For your clients with a diagnosis in the family: “The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss” by Nancy Mace and Peter Rabins is a comprehensive listing of what to expect from someone with Alzheimer’s disease along with a wealth of information, tips, skills, and language. The authors incorporate humor, compassion, and realism as they help caregivers and family members cope with the progression of cognitive and physical diminishment while maintaining as much communication and life as possible. Give it to clients and their families as a reliable and highly practical guide.
For everyone: The Alzheimer’s Association. This dedicated organization offers a wealth of resources and services for anyone concerned about or affected by Alzheimer’s disease. They provide in-home care consults, tracking programs for those who wander, free brochures you can provide in your office, a trial match so clients or their family members can be enrolled in appropriate clinical trials, and more. Check out what your local chapter has to offer.
Let me be clear at the outset: it was Terrance's prerogative to make his end-of-life decisions as he saw fit. It was his prerogative to include his wife Amanda in those decisions apparently as co-equal partner during the long final chapter of his life. With that firmly in mind, let's consider what she has to say about that journey.
In this Ted Talk film (“We need a heroic narrative of death”, October 15, 2013), Amanda Bennett is a fine story teller, occasionally poetic in her own voice and concluding with a quote from and for the ages. There are nuggets of utility in here and her final thesis -- there is a way to have a courageous and graceful goodbye -- is imperative to absorb. Her narrative has an almost connect-a-quote corniness about it despite its obviously heartfelt and sincerely sorrowful nature. However, because most of us know that a long and gradual decline is how we will die, Ms. Bennett's notion of "hope” is flawed, despite some utility.
She says "hope is part of our DNA as humans" but inaccurately and unhelpfully conflates acceptance of her husband’s approaching death with "you're prohibiting me from hoping." Her statement, "it's not a bug, it's a feature," is an intellectual sleight of hand that serves no one because she and her husband were, in fact, in profound denial that Terrance would soon die until the final six days of his life.
Again she says, "[I hoped], you might say irrationally, that I could keep him alive forever." I do say "irrationally" because hoping for what one can reasonably know is impossible is denial. That circle can't be squared. Although Bennett insists she was “redefining hope", in reality she kept extending a singular definition of hope (in this case a cure) until it was long-past possible. There is nothing in her narrative to suggest she was "redefining" hope.
She continues by asserting that "what the experts call denial I call hope." False. Once again intellectual and emotional sleight of hand. "Redefining hope" actually means that hope exists until we take our last breath or until our loved one takes her last breath. But, and this is the necessary and essential notion, hope changes. Initially we hope for a cure. Then, when we know that a cure is impossible, we hope to live until our daughter's wedding or our trip to Norway is complete or we finish painting the boat, or . Then, when that hope is fulfilled, or becomes impossible to realize, our hopes change again, until the final hope is to die in the presence of our most treasured loved ones in peace and in as little pain as possible.
That is what redefining hope looks like.
Here is one more example of the sleight of hand she practiced on herself: She claims "our system isn't built to accommodate it [hope and a graceful goodbye]." Actually, there were systemic accommodations available for Terrance and Amanda and they proactively chose to reject the most obvious one, the services of hospice. That's a textbook, Brittanica-grade example of denial.
Amanda and Terrance's correct response to his oncologist's assertion that "better days are ahead" was "I'll discuss that with my rabbi or priest or spiritual leader. As for you, medical profession, tell me the truth, please. Do so with warmth, compassion, humility, and sorrow for me and what you cannot achieve, but just do it."
Indicting an entire group of people is seldom efficacious and never fair but for expediency I do so here: The medical profession is flagrantly wrong to use phrases like "there's nothing more we can do for you” (the dying person) because there is always more we can do for a dying person. It may be true that there is nothing we can medically do but there is always something we can do to achieve Ms. Bennett's goal for each of us "… bid her farewell the Alexandria you are losing."
There is so very much we don’t understand about dementia. Yet every study contributes valuable information that may be crucial in the future as we work to develop prevention and cure. Recently, there were two developments – one on sense of smell and one on personality changes - to which you can alert your clients.
Regarding smell, scientists studied several factors in reasonably healthy people and then followed them for five years to see who developed dementia. They found that when combined with baseline cognitive function at the start, the most important factor was sense of smell. They specifically studied five scents – orange, leather, peppermint, rose, and fish. The greater number of scents that created difficulty and the more poorly a person could discern these smells, the more likely they were to exhibit dementia five years later. Researchers noted that this can’t be relied on as a singular test, but rather as a realization that sensory function is closely related to brain function, and may be among the first areas to exhibit deficiencies.
Another study focused on the long-recognized fact that personality changes are an early sign of Alzheimer’s disease, especially becoming uncharacteristically angry, aggressive, paranoid, or inappropriate. Now researchers have developed a 34-question quiz that can help determine the breadth and depth of behavioral changes, and they are proposing an intermediate diagnosis of mild behavioral impairment. You can see the quiz here. Note that these changes should persist for 6 months and be fundamental changes in behavior in order to indicate problems.
An older test, developed in 2014 by The Ohio State University Wexner Medical Center, is called the SAGE test. You can download a copy here and take the test. Then take the results to your doctor for evaluation and to see whether further tests are justified.
These are all items that you can include in your newsletters for your clients. Let them know you are keeping up to date with this growing issue. Guide them through every transition of their lives.
February is upon us, and a significant number of your clients are dreading it. No, it isn’t the cold, or the dreariness of winter. It’s Valentine’s Day.
In the past, this holiday of love was a day or warmth, surprises, celebration, and hugs. Spouses anticipated receiving a special card, candy or a carefully selected gift, extra attention, and reassurance of their lovability. Yet for widowed spouses, the day is cold and bleak. Hearing the ads and watching couples make goo-goo eyes at each other rubs the scab raw and thrusts the cold spear deeper into broken hearts.
The worst thing you can do is ignore your clients in this painful time. Remember, many people avoid calling on days like Valentine’s Day. That leaves them feeling even more alone and isolated. At the very least, send a card with a small gift. For instance: “No gift could make up for Jim’s absence. Still, I hope you can enjoy a few chocolates from someone who cares. We are thinking of you today.” Or “A single rose in memory of Karen. Her love for you and for so many people lives on in our hearts forever.
If you really want to make a long-term impression, consider organizing an event early in the day for widowed clients. Invite them to a breakfast or brunch, and do it up right. Have a nice meal, an attractive centerpiece, and attentive staff, so they feel pampered. When all are seated, welcome the group, saying you know Valentine’s Day can be difficult for widowed people and you wanted to give them something fun to anticipate along with the pain the day is sure to bring. Print a list of questions for discussion and place it at each table to break the ice and get them sharing with each other. Examples: Tell how you and your spouse met each other. Tell one thing that drove you crazy about your spouse. Tell one well-meaning thing someone said to you after your spouse died that was unintentionally hurtful to you.
After the meal, thank everyone for coming and tell them you plan to make this an annual event so they can return the next year. Perhaps have a drawing for the centerpieces at each table. As your guests leave, give them a small token such as a real or chocolate flower. Tell them you will call in a week or two to see what they liked best and if they have any suggestions for how you could improve the event next year. Then, of course, do call and take their feedback seriously.
These suggestions bracket the range of possibilities. The important thing is to be there for your clients in ways that most other people aren’t. When you demonstrate that you understand their grief and you care about more than just the money, you gain a client for life. And when their friends and associates are widowed, what will they tell them about their uncommonly wise and compassionate advisor?
New FINRA regulations that passed in 2017 will take effect on February 5. One major provision requires every broker-dealer to make a good-faith attempt to keep on file an alternate contact form for every client. This will function somewhat like the medical HIPAA forms, giving permission for a specific person who can be called if the client can’t be reached or there is an emergency. I’m delighted to see this development, as I’ve been calling for this protocol for many years as a way to protect both your clients and your firm.
I believe, however, that the FINRA rule is only a start. As you may recall, I developed a Corgenius Diminishing Capacity LetterTM. It goes beyond the minimum required for compliance with the FINRA rule, since it allows clients to name more than one person plus the powers of attorney and it gives broader permissions for contacting those in the client’s trusted circle when there is a potential problem.
My simple template is as follows:
“I, [client name], give [advisor names] of [company name and location] permission to call my Durable Powers of Attorney and the following people if they suspect any diminishment in my physical, cognitive, mental, or psychological capacity.”
The form then has space to list at least three people, with their names, addresses, relationship to the client, and contact information. Your clients sign and date it, and you keep it in their files. Every year, you revisit the form to see whether names or items of contact information need updating.
With this form, you have greater leeway, as an emergency or inability to reach the client is not the triggering factor. If you have noticed worrisome signs and suspect a problem in any of these areas, you have explicit permission to call others, including those the client designated as having decision-making power over financial and healthcare matters.
In that call, of course, remember not to make a diagnosis, i.e. “I think your mom might have dementia” or “Your dad appears to be in a serious depression.” Instead, list what you see. “I’m calling to let you know I observed some disturbing signs in my appointments with your mom. She asked the same question three times in 25 minutes, even though I’d answered it each time. She has been unable to follow multi-step directions and forgets decisions we made at the last appointment. There may be an underlying medical cause, and I want you to be aware of it so you or other family members can watch for similar things and take appropriate steps. In the meantime, I am contacting my compliance department to make sure we are protecting your mom’s financial well-being in case there is an issue with her capacity.”
Be sure to document your observations and the phone call itself as evidence that you are doing everything you can to protect your client. This may also help you connect to other family members, who see you as a comprehensive advisor who cares about more than just your clients’ money. Be a wise guide for your clients, even in cases of diminished capacity.
Life is fragile. We truly never know how long we will have on this earth. It is not true that my parents will surely die before me. It is not true that my children will not die before I do. It is not true that good and deserving people will live long lives. It is not true that “til death do us part” means we have unlimited time. Death always comes too soon. It is not logical, and it is never fair when it is someone you love.
Once I comprehend this reality, I have to choose how to respond. I can become a cynical complainer - Life is not fair, it’s too cold outside, the sun doesn’t shine enough (or the sun glares off the snow when it does shine), nobody appreciates what I do, etc. I can become withdrawn and unwilling to invest in life or relationships – after all, everyone I love is going to die anyway so I may as well save myself the hurt by not loving in the first place.
Or I can respond with unconditional investment in life and love. I know that when I do so, I risk everything. There is no love without hurt, no attachment without loss, no life without death, no summer without winter. But the alternative is to die myself. What do I choose?
Bard Lindeman was a nationally syndicated newspaper columnist for years. After his wife died, he wrote the following in his column:
“As a 41-year-old widower, father to three motherless children, I surely knew loneliness and rampant confusion. However, when someone suggested joining a support group, I balked…I was stupid, mistakenly believing in macho self-reliance, for the way back leads through the community, the world around you.
When you’re ready, you need to get up, get out, and get going. Get with people. Find a hobby, take a class at a community college, become a library regular, learn something new, adopt a pet, find a gym and get regular exercise, volunteer to deliver Meals on Wheels, escort a young relative to a baseball game, write letters, plant a tree, subscribe to a newspaper (be informed; your conversation will improve), join a choir, feed the birds, rejoin your veterans association…
You get the idea: Construct an action plan that fits your ‘new life’ and stop trying to reclaim the past. Invent a future.”
It is hard to get the energy and motivation to change your life. It takes time to get comfortable being alone without always being lonely. It takes a certain amount of healing before you can envision a future different than what you had planned before. But those are exactly the things that lead to renewal, happiness, and a life well lived.
Today, decide one thing you can do to invest in a new future. You don’t know how long your life will be;
The holiday season is laced with minefields for grieving people, especially if they are facing the first holiday season without loved one. Homes get decorated with sentimental ornaments, candles, and trimmings. Songs carry unbidden emotions. There are countless gatherings of friends and family where the empty chair is all too evident. And because expectations for joy and cheer are so high, these mourners often feel lost, alone, and sad. Your employees, clients, and associates will never forget it if you reach out compassionately during this time, letting them know you understand how hard it is.
Remember not to write cards and notes wishing a “Happy” or “Merry” holiday. Instead, choose texts that wish peace or hope. Then include a hand-written message acknowledging their reality. Here is one possibility: “Wishing you Happy Holidays at a time like this seems hollow. Instead, I wish you peace. I wish you healing. I wish you hope.”
Or: “During this holiday time, I wish you moments of lightness in the midst of the pain. I wish you companionship of beloved people in the midst of the loneliness. I wish you healing as you learn to survive these days. Most of all, I wish you peace.”
Or: “You may find that few people understand what you experience during this holiday season. Try to be patient with yourself and others, as you find your way through the ups and downs it will surely bring. In the meantime, do what seems right to you and take care of yourself. Concentrate on what is most important, and know that I am here for you.”
You may also wish to give or recommend these helpful books:
You may wish to give one or both books to your grieving employees, clients, or associates. These books are small, easy to navigate, cost less than $15 each. With the different formats, the recipients and everyone in their families will be able to find understanding, consolation, and practical help in these pages.
In the past, the holiday season was a time of warmth, surprises, celebration, and hugs. Yet for grieving people, these days are cold and bleak. Hearing holiday songs, reading the ads, and walking into festively decorated stores only serves to rub the scab raw and thrusts the cold spear deeper into broken hearts.
The worst thing you can do is ignore your recently bereaved clients in this painful time. The second worst thing is sending them the same “Happy Holidays” card that you send to everyone else. Do something a little extra for a grieving client that acknowledges the loss. Send a card wishing Peace instead of Happiness. Consider sending a small gift with a card that reads: “Nothing could make up for Jim’s absence this season. Still, I hope you can enjoy this small gift from someone who cares. We are thinking of you, especially at this time of year.” Or “A single rose in memory of Karen. Her love for you and for so many people lives on in our hearts forever.” Or “It may feel out of place as everyone raises a glass in celebration this holiday season. We hope that in your own way, you can use this little bottle of Nate’s favorite wine to toast the memories of past holidays with him and the love that you carry with you through all the holidays yet to come. We’re raising a glass in his honor with you.”
If you really want to make a long-term impression, consider organizing an event early in December for clients whose loved one has died. You can segment if you’d like, i.e. by inviting your widowed clients. Host them for a breakfast or brunch, and do it up right. Have a nice meal, an attractive centerpiece, and attentive staff, so they feel pampered. When all are seated, welcome the group, saying you know the holidays can be difficult for grieving people and you wanted to give them something fun to anticipate along with the pain the coming weeks are sure to bring.
Print a list of questions for discussion and have them placed at each table to break the ice and get them sharing with each other. Introduce it by saying that everyone grieves in their own way, so what one person finds helpful may not be helpful to someone else. However, most grieving people do find some comfort in sharing experiences. Invite them to pick one card at a time and go around the table with answers, accepting whatever someone else has to say.
Examples for the questions: Tell one thing you loved about the person who died, and one thing that drove you crazy. Tell one well-meaning thing that someone said to you after the death that was unintentionally hurtful to you. Tell one thing you wish people would do or not do around you this holiday season.
After the meal, thank everyone for coming and tell them you plan to make this an annual event so they can return the next year. Perhaps have a drawing for the centerpieces at each table. Tell them you will call after the holidays to see what they liked best and if they have any suggestions for how you could improve the event next year. Then, of course, do call and take their feedback seriously.
These suggestions bracket the range of possibilities. The important thing is to be there for your clients in ways that most other people aren’t. When you demonstrate that you understand their grief and you care about more than just the money, you gain a client for life. And when their friends and associates experience a death in the family, what will your clients tell them about their uncommonly wise and compassionate advisor?
When we talk about medical decision-making, especially in the later stages of life, there is a huge disconnect in our society between attitudes and implementation.
In fact, according to the American Journal of Preventive Medicine, only 26% of Americans have living wills or advance directives, even though 86% says it’s important to have their wishes written down.
As a financial professional who cares about your clients’ lives and the impact of healthcare on their finances, make it a part of your practice to recommend advance directives for every client, and offer the following basic information as a guide.
In broad terms, an advance directive is any document that allows a person to state “in advance” how they wish to be treated if they are unable to make those choices themselves. The most common advance directive is a living will. Contrary to what many people think, living wills do not have to limit treatment or “pull the plug”; they can also be used to request every medical intervention available. It is up to your clients to state what they wish.
Also, if someone is conscious, capable of making decisions, and able to sign permission forms, there is no need to consult the living will. Living wills only take effect when a patient is unconscious, demented, in the recovery room after surgery, highly medicated, or otherwise incapable of making their own decisions.
Rather than a cursory document with a couple of boxes checked off, the living will ideally is the clearest description possible of that person’s desires. Clients often list their wishes based on various situations, as they may want different treatments when imminently dying of cancer than when in a coma from which recovery is likely. Because perspectives change with age and state of health, these documents should be revisited at least once a year.
The advantages of living wills:
Common problems of living wills:
Just because there are a number of valid concerns about living wills doesn't mean that financial advisers should discourage their clients from creating the documents. Instead strongly encourage clients to write their desires as clearly and specifically as possible.
Some of these concerns are addressed by another form of living will. Consider giving your clients a form called The Five Wishes. It is available at www.agingwithdignity.org for $5 per copy, or $1 per copy when purchased in quantities of 25. It’s a very inexpensive way to provide real value to clients and their families.
The form includes everything found in a standard living will from the states. It also includes one legally binding part: The appointment of power of attorney for healthcare. Additional directives include comfort measures a person desires in their room (music, lighting, blankets, religious items), messages to leave with loved ones, and wishes for services. It is a more comprehensive form than the states provide, and almost all states accept it in lieu of their standard form. The only exceptions are AL, IN, KS, NH, OR, OH, UT, and TX, which accept it as long as it is attached to that state’s standard form.
In other words, The Five Wishes is a more complete form that addresses several concerns rather than only one, and it is accepted in every state (given the minor restriction in the eight states named.) If you are working with estate planning attorneys in your COI network, inform them of The Five Wishes and of your desire to have all of your clients use that form. Then there is less chance of discrepancies and overlap between your work and theirs. Like all forms of this nature, the latest one that is signed, notarized, and dated supersedes all previous copies, so it is not a problem to complete the more comprehensive form even for clients who completed the state’s standard form already.
Regardless of what form clients choose, schedule a follow-up to ensure they actually do complete a living will/Five Wishes, and that it is properly signed and notarized. Encourage them to distribute copies to their family members and to any person or institution involved in their care, including primary doctors, specialists, nursing home, hospice, rehab center, and hospitals. Offer to keep a copy in the client’s files at your office, in case a family member needs one and cannot locate it.
When you educate your clients and prompt them to complete a living will, you ease their fears that someone else will dictate their medical decisions. You keep them in greater control and take a burden off their family members. The resulting peace of mind is invaluable to your clients and consequently good for your business.
Imagine a scenario: In the course of a regularly scheduled meeting, you notice that your normally astute and proper client has grown visibly thinner and isn’t dressed to the usual standard. You also observe disturbing memory lapses and mental mistakes, including trouble understanding the concepts you explain.
You express concern, ask the client about it, and encourage him or her to make an appointment for evaluation or medical assistance, but then what? Can you call a family member? How do you avoid violating privacy and confidentiality while still taking action you believe is in your client’s best interest?
There is a simple but highly effective way to resolve this dilemma that goes one step farther than the usual emergency contact forms that are standard issue in business: Ensure that each of your clients signs a Diminishing Capacity LetterTM. A simple template is as follows:
“I, [name], give [your name(s); company name; location] permission to call the following people in case of illness, emergency, or if they suspect any diminishment in my physical, cognitive, mental, or psychological capacity.”
The form then has space to list at least three people, with their name, address, relationship to the client, and contact information. Your client signs it, preferably in the presence of a notary public, who dates and notarizes the document. Every year, you revisit the form to see whether names or items of contact information need updating.
Once the Diminishing Capacity Letter is in place, you no longer need to worry about violating privacy or confidentiality. The client has explicitly given you permission to call specific people, not just for emergencies or medical illness, but also if you are concerned about their cognitive or mental state.
Making the Call
When you call, remember not to make a diagnosis, i.e. “I think your mom might be heading toward dementia.” While it is typical to think diminished capacity is related to aging or dementia, remember that there are other reasons for cognitive difficulty that have nothing to do with dementia, such as interactions of medications, infections, a vitamin B12 deficiency, emotional trauma or grief, and more. Regardless of the cause, it is always important to first talk to your client and then to follow up with their contacts if the client does not respond promptly and appropriately.
So rather than suggest a cause, simply list what you see. “I am calling to let you know that I have observed some disturbing signs when I am in contact with your mom. She asked the same question three times in 25 minutes, even though I’d answered it each time, and had trouble following a conversation that normally would be no problem. She also had to think for several minutes before she remembered her grandson’s name. I want you to be aware of what I’m seeing in case you or other family members observe similar things, and you may wish to get her to a doctor for evaluation of the cause.”
Be sure to document your observations and the phone call itself as evidence that you are doing everything you can to protect your client in all aspects of life. Be a wise guide for your clients in all the situations they may encounter.
Have you ever seriously worried about having to live on the streets? Interestingly, that is one of the most common fears of a widow, even if she has more money than she’s ever had due to insurance proceeds. She is afraid it will somehow disappear and she will become a bag lady. In some cases, her situation is precarious enough that the fear is justified and you have to work carefully to preserve whatever funds she has. In many cases, though, the fear is irrational
Allow me a parallel example. My son Steven threw fits at bedtime, because he was convinced the ghosts in the closet would come out at night and “get” him. I used all the logic at my disposal. We turned on the lights and examined every square inch of the closet without finding any ghosts. I sat with him for hours in the dark waiting in vain for ghosts to appear. I garnered the testimony of his older brothers. Nothing worked.
Finally, instead of trying to talk him out of his belief, I acknowledged it as if it were true. “OK, Steven, since there are ghosts in the closet who could come out at night and get you, what would help you feel safe?” We brainstormed ideas until he decided he needed two things: a night light by his bed, and an adult to firmly close the closet door and tell the ghosts they had to stay put until morning. When I implemented his simple solutions he peacefully drifted off to sleep.
With a widow or with any other client with irrational fears, then, do not try to talk her out of being afraid, no matter how compelling the evidence of her safety. She will not feel heard or understood by you unless you acknowledge her fears and find ways to help her feel safe.
This strategy may help:
When you follow this simple procedure, you provide something for a fearful client that few others ever do. You hear her, take her fears seriously, and develop effective strategies for coping with them. That is a sure way to build long-term trust and lifetime loyalty.
At the opening session, I sat with over 300 other widowed people. The diversity amazed me – all ages, cultures, sexual orientations, and length of marriage (including several who were engaged or unmarried but committed to being together for life). I saw significant numbers in their 20’s, along with the grey-crested faces of older age. Some had young children, many had older kids or adult children, while others had no children at all. For some, the death was sudden, unexpected, and tragic; for others, it had been a long struggle with cancer or illness that finally took their spouse. A few were widowed only weeks before they came; for others it had been months or years.
Throughout the weekend, tissue boxes were everywhere and, for some, tears sometimes flowed like rain, as one expects and welcomes without reservation. But there were also lots of hugs, and it was anything but a sorrowful cry-fest. In fact, I’ve never been around so many widowed people and had so much fun! People were eager to share their stories and honor the love they had, but their main purpose was to gain wisdom and support as they grappled with the challenges of building lives that would be very different from what they had planned. It was comfortable and comforting, and people walked away with new friends plus a good dose of hope.
All of this is made possible by a non-profit organization titled Soaring Spirits International. Founded by a determined young widow, Michele Neff-Hernandez, the group now offers three Camp Widow® events a year (Tampa, San Diego, and Toronto), online support, a packet for newly widowed people, and a host of other resources. I am so impressed with this organization that I am now a member of the Advisory Board.
In my professional and personal spheres, I work to shine a light into the darkness of grief, to educate those who want to support the people they care about when they are grieving, and to help people heal. That is also the mission of Soaring Spirits. If you have widowed clients – men or women, young or old – feel confident in referring them to www.soaringspirits.org for resources and help. Perhaps I’ll even see them at an upcoming Camp Widow ® weekend!
National Healthcare Decisions Day kicks off on April 16th with a week of planned events to “inspire, educate and empower the public and providers about the importance of advance care planning.”
As a financial professional, you may find clients turning to you for information, especially as they approach retirement or, more likely, when they face issues with aging parents. In order to guide them wisely, it is essential that you are educated on advance directive documents.
In broad terms, an advance directive is any document that allows a person to state “in advance” how they wish to be treated if they are unable to make those choices themselves. The most common advance directive is a living will. Contrary to what many people think, living wills do not always limit treatment or “pull the plug”; they can also be used to request every medical intervention available.
Also, if someone is conscious, capable of making decisions, and able to sign permission forms, there is no need to consult the living will. Living wills only take effect when a patient is unconscious, demented, or otherwise incapable of making their own decisions.
The living will should be the clearest description possible of the person’s desires. Clients often list their wishes based on various situations, as they may want different treatments when imminently dying of cancer than when in a coma from which recovery is likely.
The advantages of living wills:
Common problems of living wills:
But just because there are a number of valid concerns about living wills doesn't mean that financial advisers should discourage their clients from creating the documents. Instead:
When you educate your clients and prompt them to complete a living will, you ease their fears that someone else will dictate their medical decisions. You keep them in greater control and take a burden off their family members. You help them have valuable discussions with those they love. The resulting peace of mind is invaluable to your clients and consequently good for your business.
Perhaps you have noticed that those who most effectively teach skills and protocols to others are sometimes the most remiss in their own recommendations. For example, I know a doctor who ignored her own early warning signs of cancer, and an insurance agent who left his wife with nothing because he let his life insurance policies lapse. While it’s easy to roll your eyes, consider yourself as a financial professional and whether you have your own house in order.
The president and CEO of a prominent asset management firm recently proposed that although sex was a taboo subject for a long time, the last remaining taboo in our society is money. I’d like to take issue with that assertion.
It does seem that sex is no longer taboo, at least in the public arena. Sex is used to sell everything from clothes to vacations, sex education is required in schools, and sex is the subject of more web sites than any other topic. There are a number of gurus dispensing advice on sexual matters, and in recent years companies selling remedies for sexual dysfunction have recruited prominent politicians and entertainers as spokespeople. Indeed, sex is no longer taboo.
Yet money seems to be in a similar category. It is the subject of endless conversations, speculation, and media coverage. Well-known pundits spout opinions and give advice on all things financial. Morning news shows regularly interview investment experts. Magazines, newspapers, and online columns wax eloquently about economics, savings rates, the best stock picks, and IRA’s. Political candidates consider money – who has it, who spends it, and where it is spent – to be a central issue. Money hardly seems a taboo subject.
What, then, IS the final taboo? What issue has no talk show pundits or advice columnists offering tips? What is generally pushed out of our collective consciousness, suppressed, denied, and avoided?
Check your own response when you read the word "death". If you are like most people, you recoil at the very thought of it. There are no key spokespersons giving information and advice about the process and how to deal with it. Elisabeth Kubler-Ross was long recognized as an expert, but her book On Death and Dying was published in 1969 and Elisabeth herself died several years ago. She temporarily opened the topic, but most of us simply avoid talking about death or facing its inevitability.
The interesting thing is that death used to be familiar. In generations past, grandparents lived with or near their kids and grandkids. When elders got sick, the family cared for them at home. When they died, family members lovingly washed and clothed the body, and the wake occurred in the living room. Children were exposed to death as a natural and normal part of life as the entire clan gathered to remember the one who died.
In recent generations, families began to scatter and both spouses started working. With no fulltime caregivers at home, sick and dying people were moved into hospitals and nursing homes. Medical technology prolonged life, often seemingly conquering death. Once death did occur, care of the body was shifted to funeral home personnel who quietly performed their duties out of sight.
As a result of these changes, public perception shifted. Death was no longer considered a normal, natural, and expected part of life. It became the unexpected and unnatural interruption to normal life. In modern society, we seem to believe that death is not inevitable, that it won’t happen to us or to anyone we love (at least not until we’re 99 years old and ready to die anyway). We actively avoid talking or even thinking about it. When death happens, we are shocked and look for someone to sue.
The last taboo, then, is not sex or money. It is death. This means most people you encounter, both professionals and clients alike, are unconsciously ignorant about what to say, what to do, and how to support someone who is facing death or grieving the death of a loved one. The flip side of the equation is that if you do know what to say, what to do, and how to support grieving people, you immediately distinguish yourself in the field. You serve your clients more compassionately, genuinely, and effectively, and build a reputation for understanding a client’s experience in a way that few other professionals do.
It is very good for your clients, and consequently it is very good indeed for your business.
When a client or colleague receives serious diagnosis or needs to undergo surgery, chemotherapy, or other treatments, people often rally around with support. They offer to bring food, provide rides to doctor’s appointments, watch the kids, etc. While grateful for all the offers, most people are still overwhelmed by trying to keep their network informed of medical progress, juggling responsibilities at work, and coordinating the needed help, all in the midst of the intense emotional and physical drain of the situation.
You can help alleviate that stress. There are several ways you can provide support that is different than what most people do. For example,
Spare your client or colleague the legwork by providing resources like these. Depending on your relationship, you may even wish to participate in offering practical help to the family. Regardless, let them know you care by providing concrete assistance at a tough time
Mid-winter can be a difficult time no matter your life circumstances. The weather is colder, days are darker, and it can seem like life retreats for a while. This is especially true when you enter a new year without a beloved person who died. How do you cope?
Here are ten tips for finding comfort in 2017.
It’s almost time to send out holiday greetings to your clients. Yet what if your client’s family member died this year? If you send them a card wishing "Happy Holidays", then at best you tell them you treat your clients generically, sending the same card regardless. At worst, it lets them know you don’t understand at all and, like the rest of society, expect them to paste on a smiley-face and “be happy for the sake of the season”. In either case, the card heads straight to the trash, never to be remembered.
It is never a good idea to wish “Happy Holidays” to people going through the toughest time of their lives. Instead, you can offer authenticity and genuine comfort, distinguishing yourself from everyone else and helping your client at the same time. The first step is to choose a card that does not say Happy Hanukkah, Merry Christmas, Happy Holidays, etc. Choose one that either has no words or that wishes peace or hope. Then include a hand-written note inside and consider including a gift card for a cup of coffee, a movie, a massage, or something else comforting.
Here are some possibilities:
Imagine a client’s daughter was in a bad car accident and is now in the hospital for what looks to be an extended stay. You call your client and spend 30 minutes asking questions and listening as the client pours out the story. As you hang up, you promise your continued contact and support.
Then what? How do you best fulfill that promise?
Here are three effective steps you can take that are different than what most people do:
These items give families a range of foods for breakfast, lunch, and snacks.
Each of these steps offers concrete, tangible benefits for the family of a hospitalized loved one. At the same time, they are things that fewer people will do, making your contribution even more notable. Use or modify these ideas to allow you to do the right thing for your client at a very difficult time.
We do a lot of training at Corgenius in choosing appropriate cards and knowing what to write in them, especially when there has been a loss or life-changing transition. Countless times, people have asked me why I don’t just create a line of cards. That’s not something I have time or interest for, but today I offer you the next best thing.
I met Anne Kertz Kernion a couple of years ago and now I buy a majority of my cards from her company, Cards by Anne (www.CardsByAnne.com). These hand-designed cards are thoughtful, beautiful, and high-quality. Most agree with the principles I teach at Corgenius. And they are an incredible bargain at only $1.25 each.
Another benefit - you can now get a condolence card with one of my quotes on the cover. Recently, Anne encouraged me to submit quotes for her consideration in designing cards. She then sent a mailing to her very large database and asked them to vote on a wide range of submitted quotes, promising that the top three vote-getters would be incorporated into cards. One of my quotes won by a landslide. (I even out-ranked Pope Francis! I don't imagine that will happen again!)
Of course, Anne's cards still don't solve the problem of what you will write inside. To learn more about this sometimes thorny issue, consider checking out my book “No Longer Awkward”, which contains over 100 texts that you can modify and use for various purposes.
So when you go to the Cards by Anne web site, you will see my card displayed there. Hopefully there will be more in the future. I encourage you to peruse Anne’s other cards as well. I suspect you’ll find yourself returning there again and again for both personal and professional purposes.
Picture this scenario, which gets repeated all too frequently:
A young man goes to college. Two months later he is rushed to the hospital and into the operating room for an emergency appendectomy. His mother calls the hospital in a panic and asks to know what is happening with her son. The hospital says, “I’m sorry; I cannot give you that information.” She says “But I’m his mother!” The response: “That doesn’t matter. For all of our adult patients, we can only give information to those authorized to receive it, and you are not authorized.”
You’ve educated your clients on the need for a Power of Attorney for Healthcare (aka healthcare proxy) for themselves, listing who can make their medical treatment decisions if they are unconscious or incapable of making those decisions. Clients may also be aware that HIPAA forms, which they regularly fill out at the doctor’s office when they have appointments, detail who can have access to their medical records.
What most clients don’t realize is that their kids need to have these documents in place as soon as they turn 18. Then they are legal adults, and no one gets access to their medical records or treatment information without express permission.
To avoid nightmare scenarios, take the following steps:
If the aforementioned young man had these documents in place, his panicked mother would have been given full access to his medical records and the details of his situation. She would also have had the right to make treatment decisions on his behalf while he was unconscious and unable to make them himself.
Especially given the state of our healthcare system, your clients and their family members need to take control of assuring who has access to medical information and the right to make treatment decisions. Addressing these areas with your clients helps you protect them and also extends your reach into the next generation. Any client who encounters such a situation will be forever grateful for your wise and prescient guidance.
A salesperson called me a few days ago. He was so convinced of the value of his product that after our initial pleasantries, he praised its attributes for several minutes. I asked one question and he talked on for several more minutes. His mistake was that he didn’t stop talking long enough to find out why I might need his product or how it could best serve me. He lost the deal because he knew how to talk about what he was selling but he didn’t know how to listen to me.
How does this relate to serving clients experiencing loss or transition? Like the worst salespeople, the least supportive advisors are those that don’t know how to ask good questions and listen.
There is often a chorus of objections at this point. Usually they sound like these:
Sound familiar? Let’s look closer.
First of all, consider the flip side. What are the consequences of refusing to ask questions? If you carefully avoid the topic and do not bring your client’s grief into the room, there is a big white elephant sitting on the table between you. You both know it’s there but you are trying to ignore it, look over it, slide it to the side, or otherwise pretend it’s not there. It adds a level of tension as you participate in the game of mutual deception.
This feels very familiar to grieving clients, because they encounter it everywhere. Most people, from family to casual acquaintances, don’t know what to say so they say nothing at all. They talk about anything and everything except the person who died. They try to cheer grievers up, hoping to make them feel better. The bereaved people, not wanting to make others uncomfortable, go along with it, but it feels inauthentic and they walk away alone, isolated, and unsupported. Is that how you want your clients to leave your office?
The minute you acknowledge the truth, the big white elephant disappears. For instance, you can ask something simple such as: “What do you wish people knew about what it’s like for you now, a month after Paul died?” or “What has surprised you about the experience of going through Paul’s death?” When you ask an invitational, open-ended question like these, the big white elephant disappears and the tension evaporates. They know you care enough to ask, whether or not they choose to accept your invitation and talk about it. They know you aren’t avoiding the topic or hiding behind your spreadsheets.
Additionally, if they do choose to tell the story and you listen with care, you offer them support they aren’t getting from others. You genuinely help and comfort them, and at the same time you distinguish yourself in the field. You build a level of trust and loyalty you can’t get anywhere else. It’s good for your clients, and it just happens to also be good for business.
The bottom line: You have a lot to lose if you don’t ask; you have nothing to lose if you do.
Grief hurts—psychologically, emotionally, and physically. A duo of psychiatrists (Thomas Holmes and Richard Rahe) created the Social Readjustment Rating Scale (SRRS) after research with over 5000 patients. They found a high correlation (0.118) between stressful life events and physical illness, and their results were validated in subsequent studies. On this scale, the two most stress-inducing events are death of a spouse and divorce. This comes as no surprise, since these two events change every moment of one’s life.
What is surprising, though, is that three of the top ten are positive transitions, including marriage, retirement, and marital reconciliation. Likewise, the top twenty includes positive events like pregnancy, gaining a new family member, a change in financial state (for worse or for better), and changing to a different line of work (whether unwanted or, more often, a positive choice). Outstanding personal achievement ranks as 25th in stress-inducing events. We think of these as happy occurrences, worthy of parties and celebrations. Yet each one carries a high level of stress and grief as people move from one state of life to another.
In other words, your clients grieve when they go through positive transitions as well as negative. Can you be the wise advisor who recognizes their mixed emotions? Distinguish yourself by asking good open-ended questions so clients know you understand in ways that others don’t.
A few examples:
Picture a scenario in which your client’s father dies after a lengthy illness. Countless people come through the services and say to the family, “At least he’s no longer suffering.” They intend to be comforting, to help the family feel better and focus on the positive. But that’s not what happens. Instead, what survivors hear behind those words is “It’s not right for you to be sad over his death. You should be relieved and happy that he’s out of pain, and instead you’re focusing on yourself. How can you be so selfish?”
The reality is that survivors are indeed glad he’s no longer suffering. They are also relieved that they don’t have to suffer any more watching him die inch by inch. At the very same time, though, they miss him. They long for his presence, his smile, his hug. At times they focus on the relief, and at times they are overwhelmed by the void. Death is a “both-and” event, both happy AND sad, both relieved AND lost.
It is much better to acknowledge both sides of the equation. Instead of saying “At least he’s no longer suffering,” say “We’re all relieved that he’s no longer suffering. No one would want him to suffer. And yet, we’re really going to miss him.” Ideally, follow that up with an anecdote that illustrates the loss, i.e. “I’m especially going to miss his big bear hugs. No one could hug like that!”
If you can't offer an anecdote yourself (many advisors have not met the father of their clients), then after you remark that no one would want him to suffer, ask the client for a memory: “And yet, your family is really going to miss him. In fact, tell me something you will miss, or some story you hope people will remember about him.” Using techniques like this to authentically recognize the intensely mixed emotions of grief demonstrates profound understanding and offers genuine comfort. Your clients will not forget it….nor will they forget you.
Beta amyloid plaques, or build-up of “sticky” proteins on the neurons, is one characteristic of the disease. Not all people who have beta amyloid plaques have Alzheimer’s, but every person with Alzheimer’s has beta amyloid plaques. With the aid of improved brain scan techniques that more accurately detect them plaques, one focus of research is to prevent, slow, or dissolve the proteins.
Many antibodies have been in clinical trials for some time. Crenezumab, for instance, is showing some promise in early-onset Alzheimer’s. But recently another antibody called Solanezumab became the first one proven to show definitive results in slowing beta amyloid plaque build-up on neurons, at least temporarily.
We are still a long way from a cure. There is no drug or treatment, including Solanezumab, which is capable of preventing or curing Alzheimer’s. All we can do is slow the progression of symptoms for anywhere from a few months to a few years. There is no “fix”. Sooner or later the disease takes over again. Yet every step helps.
What can you do?
For future success, it is therefore crucial that financial professionals educate themselves so they understand the grief process and are equipped to communicate with and support widows. Use these five easy starting points to improve your service to widowed women:
These are just a few of the concepts to put into practice so you can serve the ever-growing numbers of widowed women who will cross your path.
Continue this pattern, always asking questions based on what the client is saying. You will notice the pitch of the voice lowering, longer pauses and slowed breathing as the anger gets spent and the client calms. Only then can you begin talking about what you can do together as you go forward. Ask what steps the client would like to take. Make appropriate suggestions for portfolio review, redistribution of assets, or simply keeping in contact every week or two.
At the end of the conversation, make sure you thank clients for being honest with you. Tell them your door is always open, and you will listen even when it is hard. Reassure them that although times are really tough right now, you can weather the storm together and come out on the other side.
If you can master these skills, your clients will come out of even angry conversations feeling heard, supported, and most of all, loyal to you.
If you find yourself at a loss for words, you are not alone. There has never been a financial advisor’s guide that explains what to say (or what not to say) and how to handle these potentially challenging and professionally awkward situations. When I became a 25-year-old widow with a 7-month-old baby boy, believe me, no one knew the right thing to do or say around me, including the financial professionals I needed to rely on. And I’ve heard the same stories countless times since then, from more than 2000 grieving people. Instead, what most professionals do is either ignore the painful reality and stick to business, or pick up what other people say and inadvertently perpetuate the mistakes.
You can do better than that. You can learn to do the right things and offer genuine comfort and support, no matter what your clients go through.
However, as I continue to get feedback from research and in my support groups, I find that many grieving people don’t appreciate it. They especially resent it when, as sometimes happens, the words are dripping with drama – “I can’t IMAGINE what this is like for you!” Yet even if you take care not to go over the top when you say it, you risk isolating people. They hear your implication that they are so crazy or outside the realm of normalcy that no one else can even imagine what it’s like. And since no one can imagine it, no one can be there and help. It builds a moat around your grieving client that can’t be crossed.
Besides, it ultimately is not true. We have very active emotional imaginations. Most of us can indeed imagine something of the pain and loss, the empty chair, the unanswered phone. In fact, imagining it is one key to building empathy, which is core to who we are as human beings and serves a crucial function in binding us together in mutually helpful ways.
So if you aren’t supposed to say “I know how you feel” or “I can’t imagine what you’re going through”, what do you say instead? Consider asking one of the following questions, modified for the situation if necessary:
Never assume you know what someone else is experiencing. Instead, ask open-ended questions and allow a grieving client to tell you, and then let your imagination take you as close as possible. That allows you to respond more effectively and serve your clients in ways others don’t know how to do.
When you know how to walk your clients through the toughest times of life, you build trust, loyalty, and referrals.
Imagine a usual day. You grab a coffee and settle in at your desk. You conduct two productive client meetings and go for lunch before the afternoon’s tasks. There’s nothing unusual; it’s just a typical day. Then you answer the phone, you hear the hospital chaplain’s voice …..and nothing is ever the same again.
Now imagine it’s the 5th anniversary. That fateful day is seared into your consciousness and it will never be just typical. Though others may expect you to be “over it” by now, you will never forget what happened or the person you so loved.
Perhaps we can learn something from our public memorials of tragic days. Everyone older than 50 remembers exactly where they were when JFK was assassinated, and can still hear Walter Kronkite’s somber voice. It has been 25 years since the Shuttle Challenger exploded, but we remember the name McAuliffe as we mark the day. Ten years after 9-11’s smoke, sirens, and crashing buildings, we pause on the anniversary to show videos, tell stories of heroes, wipe away a tear, and proclaim that we will never forget. Whenever we experience a major loss as a nation, we remember, celebrate, and honor that loss for years to come.
As these examples illustrate, when you are supporting grieving clients and friends, acknowledge that the goal of grief is not to forget or “put this behind us and get on with life”. Instead, we move on precisely because we remember, because we create an enduring memory to carry with us into a future that is different than anything we could have imagined before. We tell the stories and share appreciation for the privilege of having these people in our lives. We try to prevent this kind of tragedy from happening to someone else. We change in more ways than we thought possible. We live with grief and healing, allowing both to co-exist in the everlasting interplay between loss and gratitude, sorrow and joy.
In your practice, never assume your clients are “finished” with their grief at a particular point in time. Honor their need to remember and let them know you understand.
Two simple steps you can take: