Ideas. Lessons Learned, and Occasionally, Opinions
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.
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.
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.