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:

1. They keep clients in greater control of their lives as well as their deaths, even in cases where they are unable to speak for themselves
2. They can promote honest conversations within families.
3. They can help prevent legal battles and courtroom fights.
4. Survivors of a loved one’s death grieve with fewer regrets and less guilt when they do not have to make treatment decisions without clear instructions from the dying person. 

Common problems of living wills: 

1. Only a small percentage of people complete one, and when they do, over half do not give copies to anyone. A living will kept in a safe deposit box or desk drawer is inaccessible when decisions need to be made.
2. As noted previously, the perspectives of a healthy, active person can change dramatically when they actually become ill, and too few people update their documents as they age or diminish.
3. Living wills are not legally binding upon healthcare professionals, and uninformed family members sometimes override them. The clients’ families, and especially their powers of attorney for healthcare (aka healthcare proxies), need to be informed of their wishes, so they can support those desires with medical providers.
4. Although they are valid across state boundaries, each state has their own form. Clients who use the standard living will must therefore complete the form provided by the state of primary domicile. 

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.

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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 Letter^TM.  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.

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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

How do you deal with a client’s irrational fears? Most advisors lay out the facts in logical fashion, often using statistics, charts, and graphs, hoping to demonstrate the groundless nature of the emotion. They don't realize that logic is useless, because emotion and logic literally reside in different parts of the brain. Instead, resolving fears involves giving credence to them, helping her define and list them, and then working with her to imagine solutions.

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:

1. Introduce the topic. “Everyone in your situations has fears and worries about their money. Some worry about losing all of it; some are afraid the kids won’t approve of how they manage it. You may have some fears, too. Let’s see if we can get them out on the table upfront, so we can deal with them together.”
   
   
2. Get her talking freely. “Go ahead and brainstorm. Name all the money worries you have as they come into your head. They don’t have to be rational. Just start talking and we’ll see what comes out.” After she lists some fears, or if she has trouble thinking of any, elicit her deepest fears by asking, "What is the worst thing you can imagine happening to you financially right now?"


3. Take notes as she talks. Whenever she names a fear, nod your head or say something affirming like “Uh-huh” or “Yeah, I’ve heard that lots of times. You're not alone.”


4. Allow silence as she thinks, telling her to take all the time she needs until she’s pretty sure everything is named.


5. Read the list back to her so she can clarify any point or add others. Assure her she can add to it at subsequent meetings if any additional fears surface later.


6. Prioritize. “Of all these things, which ones seem the most important or scary to you?” Circle and number them.


7. Have her write down her top fears. University of Chicago research found that when we write down or write about our fears, it takes away some of their power. If you can, then, have her physically write down the fears that you circled so she can objectively see them in front of her.


8. Help her imagine solutions. “OK, since these are the things that worry you, what can we do together to keep you safe, and what do you need from me to feel safe?” Suggest financial strategies while also listening to and incorporating her input and discussing risks and benefits of each. In addition, look for non-financial input. Perhaps, for instance, she needs you to call her every week in order to feel safe. Continue the conversation until she agrees to strategies she believes will alleviate her fears.


9. Create a two-column table in a word document. On one side, list her fears. On the other side, list what you are doing about them. Print it out on letterhead, keep a copy for your files, and give her a copy to keep with her financial papers. You can also email her a copy as an attachment in case she misplaces the hard copy.


10.  Offer reassurance. Tell her that whenever the fears arise, day or night (and I can guarantee that sometimes it will be in the middle of the night), she can pull out this document, look at her fears, look at what you are doing together, and know that she is safe. Add that if she doesn't feel adequately reassured, she can come in to talk about it again until you find the strategies that work for her.

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.

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I didn’t know what to expect the first time I attended. After John died, I hated the box marked “widow” and the very name made people around me uncomfortable. Yet here I was going to a weekend event called Camp Widow.® Read More »

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:

1. They keep people in greater control of their lives and deaths, even in cases where they are unable to speak for themselves.
2. They can promote honest conversations within families.
3. They can help prevent legal battles and courtroom fights.
4. Survivors of a loved one’s death grieve with fewer regrets and guilt when they do not have to make treatment decisions without clear instructions from the dying person. 

Common problems of living wills:

1. Only a small percentage of people complete one, and when they do, over half do not give copies to anyone. A living will kept in a safe deposit box or desk drawer is inaccessible when decisions need to be made.
2. The perspectives of a healthy, active person can change dramatically when they actually become ill, and too few people update their documents as they age or diminish.
3. Living wills are not legally binding upon healthcare professionals, and uninformed family members sometimes override them. Family should be informed of the person’s desires, so they can support those desires with medical providers.
4. Each state has their own form, so clients who use the standard living will must complete the form from their state of primary domicile.

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:

1. Strongly encourage clients to write their desires in as clearly and specifically as possible.
2. Consider giving your clients a living will form called the Five Wishes document. It is available at www.agingwithdignity.org for $5 per copy, or $1 per copy when purchased in quantities of 25. The form includes everything found in a standard living will as well as names of healthcare proxies; additional directives such as comfort measures a person desires in their room (music, lighting, blankets, religious items); messages to leave with loved ones, and wishes for services.
3. Schedule a follow-up to ensure clients actually do complete a living will/Five Wishes, and that it is properly signed and notarized.
4. Guide clients 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.
5. Add the updating of all advance directive documents to the agenda for your annual review meeting, so your client’s wishes are kept up to date.

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.

Read More »

The Cobbler's Shoes

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.

• Do you and all the adult members of your family have an updated will and power of attorney for finance?
• Do you have accessible and complete copies of your healthcare advance directives, including your healthcare power of attorney?
• Is your personal retirement plan on track?
• Do you have a firm succession plan in place should you retire, die, or become disabled?
• If you died last night, would your family know what to do today, including where to find all your important documents?

Read More »

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. 

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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,  

1. Create a hospital “care package.” Families are often reluctant to leave their loved one’s room when they visit, even if the patient is asleep. Yet hospital air is dry and there is little to do. Create a care package that includes bottles of water and juice, and snacks like protein bars, almonds, chocolates, and pretzels. Add puzzle books like crosswords or Sudoku (with a couple of pencils), and two or three magazines for light reading. If the patient is well enough for visitors, make a brief visit yourself and deliver the package. If not, call a family member to get a time when you can drop it off at the home.
2. Form a team to do errands or work that needs to be done. Examples: Mow their lawn. Pick up dry cleaning. Arrange for house cleaning. Make phone calls. Anything the family needs that you can provide.
3. Create a one-page listing of resources for the patient’s family to use. Do research to find local resources, and also include services such as these free web sites:
   
   •    www.TakeThemaMeal.com  This is a comprehensive meal organization site. The family creates a private online sign-up sheet, friends sign up for specific days and times, and they receive automatic reminders. The site includes a range of recipes for foods that transport well. It also has the option of purchasing items from their store of prepared meals and foods that can be sent directly to the family.  Similar sites include www.Mealtrain.com and www.caringmeals.com.
   
   •    www.CareCalendar.org This is a donor-supported ministry whose site is used to coordinate meals as well as other types of help, such as taking children to their activities or doing yard work. One person or team takes charge of monitoring the calendar. The family lists what help they need and when, and those who can assist sign up. The site sends reminder emails and allows the family to upload photos and post update messages.  Similar sites include www.LotsaHelpingHands.com and www.CareFlash.com
   
   •    www.CaringBridge.org  This provides a way to communicate with many people at once. After the family creates their private personalized Caring Bridge site, a process that takes only a couple of minutes, friends, co-workers, colleagues, and family register on it. Everyone who is registered receives an email whenever the family posts something – i.e. the results of the latest tests, how it’s going that day, or whatever they wish to communicate. Everyone at work and in the friendship circle is updated without the necessity of making countless phone calls or repeating the story endlessly. Those who are registered can then reply on the site if they choose, and the family can read the messages when it is convenient, saving or deleting them as they desire. 

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

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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. 

1. Get outside. Studies show that nature is calming to human brains, and being outside can help reset your mindset. Schedule regular appointments with yourself to go for a walk, snow-ski or ice skate, hike, or do something outdoors. 
2. Drink plenty of water. Staying hydrated is a great way to curb appetite, boost immunity, and maintain energy levels. 
3.  Avoid excess caffeine. A cup of Joe in the morning is fine, but avoid it in the afternoon. Caffeine’s effects last for hours and can interfere with the sleep you so desperately need to maintain your equanimity. 
4. Drink green tea. It has more anti-oxidants than blueberries along with metabolism-boosting benefits that help you maintain your weight, all with less caffeine than coffee or black tea.
5. Help someone else. Even when you're sad, you have something to give that can make someone else's life more enjoyable. Consider simple things - donating an old coat, smiling at every clerk you encounter in the store, or paying it forward in the coffee or fast food line. Mix in volunteer opportunities like serving in a soup kitchen, tutoring kids at school, working on a charity fund-raising event, or anything that gets you outside of yourself to make a difference in someone else’s life. 
6. Find time to relax. Take a bath with Epsom salts and essential oils. If a bath isn’t your thing, get a massage. Or just take a few minutes to breathe deeply and consciously relax your mind and body. 
7. Exercise. Even moderate exercise releases “feel-good” endorphins, focuses your mind, reduces depression, and helps you process your post-holiday and new-year feelings. In fact, some researchers are proposing exercise in place of anti-depressant medication, with studies showing that it can be just as effective.
8. Take time to socialize. Don't assume your friends know how you feel or what you need. Take the guess work out by letting them know what would be helpful. At the same time, it’s OK to ignore all their well-meaning but misguided advice. Actively reach out and work to retain old friends even as you build new ones with people who understand your grief and offer hope. 
9. Break up the usual routine by taking a day trip. Choose a place you've never been, explore a museum at your leisure, attend an interesting seminar, or learn something new. 
10.  Practice gratitude and graciousness. Every evening list at least three things for which you are grateful from that day. Let go of hurts from the past and forgive those who don’t understand or who have hurt you. Carry a thankful attitude into the new year. Any of these things can help. Do as many of them as your energy level allows, and commit to doing more as the year progresses. Even in the midst of loss, life is worth living. It holds surprises and yes, even joy, for those who choose to engage. Don’t let death win. Choose life. May your new year hold healing, peace, growth, and hope.

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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: 

• “Wishing you Happy Holidays at a time like this seems hollow. Instead, I wish you peace. I wish you healing. I wish you hope.”
• “During the holiday season, [name]’s absence is sure to be painful. It may be made even worse because most of the people around you will be afraid to say [his/her] name for fear of making you sad. I know I can’t make that void disappear, but I hope you can at least catch a moment of respite with the enclosed gift card. I am thinking of you and remembering <name>, especially now.” 
• “The holidays will bring a mix of emotions as you remember the happy times with [name] and yet mourn [his/her] absence. I hope you can allow yourself to experience it in your own way, acknowledging the happy and the sad, so you can come out on the other side with greater hope and peace. I’ll call you soon to check in and see how it’s going.”
• “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.”

This should give you some ideas to go on, so you can create personalized holiday cards that support your grieving clients in ways that others don’t. They will notice, and they will deeply appreciate it. From what grieving people tell us, that is priceless. Read More »