Ideas. Lessons Learned, and Occasionally, Opinions
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.
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.
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.
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.
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?
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:
We have an unprecedented crisis happening in our country. Every day, 115 people die of an opioid overdose. From 1999 to 2016, 350,000 people have died. A recent survey by the AP and Center for Public Affairs Research found that 1 in 10 Americans know a relative or close family member who died of an opioid overdose. In April, the Surgeon General issued the first national health advisory since 2005, urging families and friends of addicts to carry naloxone, the drug that can reverse the acute effects of an overdose and give a greater chance of survival.
Clearly, we have a huge public health problem with more people dying per day due to opioids than were dying of AIDS at the height of that epidemic. Just as we found the will and resources to combat AIDS over 30 years ago, we need to do it now for opioids.
In addition to scope, there is another aspect of these two epidemics that is similar. When people died of AIDS, their family members were often reluctant to tell others the cause of death because of the stigma. The same is true with the opioid crisis, leaving families unsupported and isolated. It’s bad enough that our society knows so little about how to effectively support the survivors of a loved one’s death; with a stigmatized death, the situation is exponentially worse.
Many people don’t realize that opioid addicts generally begin taking the drugs to relieve intense pain from a medical condition, not to get high. Yet one of the ways opioids work is to increase the levels of dopamine in the body, resulting in a feeling of euphoria while relieving some of the pain. Even if all the pain is not relieved, that which remains seems tolerable because of the underlying “high”.
Addiction begins when the drug rewires the reward centers of the brain, causing the person to perceive anything less than the euphoria as being painful and creating a physiological craving for more of the drug. Tolerance requires higher doses, the euphoria increases, the drug continues to affect the brain, and the addict sinks into an ever-deepening need for opioids just to feel normal. For those who try to reduce or quit, withdrawal symptoms are intense, and they often give up, relapsing into drug abuse to eliminate the pain. It reaches the point where an addict will do anything to get the next hit.
How to Help
After an overdose death, the grief is profound. The family loses a beloved family member. They lose the future they hoped for with that person and the unique place that person held in the family structure. They have exhausted themselves with worry and attempts to help. There are feelings of guilt and inadequacy that the loved one couldn’t be saved. These reactions are combined with anger at the lack of resources for addiction and resentment towards the addict who wasn’t able to kick the habit despite whatever help the family could offer. At the same time, rather than the outpouring of support they would receive if their loved one died of something like cancer, the support is muted, tentative, or absent, replaced by judgment or simply the would-be comforter’s inability to know what to say.
Here are a few suggestions on how you can help a client, friend or family member dealing with this kind of loss: