Ideas. Lessons Learned, and Occasionally, Opinions
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.
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;
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.
Too much wisdom is lost every day in this country because we devalue our elders. When we highly value them, and take the time to listen and learn from the wealth of their life experience, it can be eye-opening, informative, and quite a delight for the storyteller and listener alike.
My sister and I recently embarked on a project to capture more of my Mom’s life story before it was lost to us. Over a period of several visits we asked her many things - what it was like growing up in a household with six brothers, what stood out about her Mom’s death from cancer at the too-young age of 52, her happiest and most troublesome memories, how people who knew her as a young woman would describe her, and what she hopes people will remember about her after she dies. Together we laughed, cried, and grew closer. We also learned many things we had never known. For example, we were surprised to find out that she’d had two dogs as a teenager, and she was not very fond of Frank Sinatra, even though all of her friends and classmates swooned over him!
In addition to passing on wisdom and life lessons, these stories are important for another reason. As we age, we are increasingly susceptible to the diseases that cause dementia, including Alzheimer’s disease. When people have Alzheimer’s, they lose their short-term memory first. Family members who gather long-term memories build a way to maintain their relationships, because even if their beloved elder can’t remember what she had for lunch, she may well remember that dog or the kind of music she loved in high school.
So, as you meet with clients to close out the year, encourage them to take time over the holiday season with the older generation, asking for their wisdom and life lessons, and gathering their stories and memories. Your clients will often learn things they never knew before, and may deepen their relationship with parents or grandparents. In the process, they may find themselves wiser, more tolerant, and with greater appreciation for those who comprise their heritage.
Of course, if your clients ARE the older generation, encourage the same thing in reverse. Recommend that they write or record their own memories and stories, along with the wisdom, hard-won lessons, and messages they wish to pass on to their families. The compilation could be a welcome gift of lasting value. Regardless of which direction the information flows, it is an exercise your clients will likely never regret. While you’re at it, perhaps you can do it in your family as well. Give the gift of time, curiosity, memory, and wisdom this holiday season. It costs so little, yet it is priceless.
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.
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.
The holidays are over and now you face winter with its longer, darker days. If you have recently lost a loved one, here are some ideas to help you get through and come out on the other side with greater hope and peace.
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 2019.