Ideas. Lessons Learned, and Occasionally, Opinions
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:
Advisors are increasingly faced with deaths among their clients and the clients’ families. In large firms, there may be more than one a month. If you can serve clients really well in those most difficult times, you create a bond of loyalty with the client and with the family members. Those who don’t know how to talk with grieving people are going to lose clients to those who do. Here are a few ideas to consider when communicating with a client after the death of a loved one:
Welcome the client
When a client comes into the office for that first appointment after the funeral, you can recognize the reality that is right in front of you and yet genuinely make them feel welcome with something like this: “I’m so glad you were able to make it in today. I only wish it were under better circumstances. Still, there is so much we can do together and I’ll do everything I can to make this very difficult process just a little easier for you and your family.”
Then, before you get to business, remember that grieving people hunger to talk to anyone who is willing to listen. So invite clients to tell you about their experience. They will let you know if they don’t want to talk and you always follow a client’s lead, but most of the time telling the story is the most healing and cathartic thing they can do.
So ask an open-ended question such as:
Even if you had a similar grief experience, do not say “I know how you feel” or “I understand just what you’re going through.” Doing so is a sure way to alienate grieving clients because you are always wrong.
Instead, let them know you’ve had a similar experience or have some knowledge of the grief process, but then allow for their unique situation by asking a question such as “How is it different?” or “But what is it like for you?”
For instance: “When my mom died, I kept picking up the phone to call her before I remembered there wouldn’t be an answer on the other side, and that was one of the hardest things for me to accept. Is it like that for you? What do you struggle to accept?” This so much better than “I know how you feel” because you don’t.
Tell your clients that some things have to happen on a timeline, such as estate tax filings and trust funding deadlines. Show the list of those things and reassure them that you will make sure they get done without letting anything fall through the cracks.
Other than that, most financial professionals understand that it’s not a good idea to make major decisions too soon, especially if they are irrevocable. In practice, though, this too often means advisors leave clients alone until they call to say they’re ready to talk. That is a mistake, because surely clients will be inundated with ideas from others about what they should do with their money, who they should talk to, or how they should handle things.
Instead, after reassuring about the timeline, say something like: “Did you know that both science and financial regulations say that it’s better not to make major decisions right now? Physiologically, your brain just isn’t ready yet. So this is my recommendation. Take some time to breathe, take care of yourself and your family, get the estate settled, and just put one foot in front of the other. I will be calling you every week or two just to check in and see whether you have any questions or ideas you’d like to talk about. In fact, if someone offers you an idea that sounds good, bring them in. I’ll help you objectively look at whether that’s the best thing to do, and whether it’s best to do it right now. We’ll work together to make sure we’re protecting your loved one’s legacy and your financial future.”
These are just three examples of skills that distinguish you in the field and build lifetime loyalty. Remember, when deaths occur, as they inevitably will, survivors have their choice of hundreds of thousands of financial professionals who do a really good job investing money, insuring people, advising on retirement plans, and more. What is the differentiator clients want? They look for relationship and a financial advisor who understands their lives and knows how to support them in their grief. That is who will get their business.
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.
For many in our society, closure means leaving grief behind, a milestone they usually expect within a matter of weeks or months. Closure means being “normal”, getting back to your old self, no longer crying or being affected by the death. It means “moving on with life” and leaving the past behind, even to the extent of forgetting it or ignoring it. Yet for those who have experienced death, this kind of closure is not only impossible but indeed undesirable.
Closure, if one even chooses to use the term, is more of a process than a defined moment. The initial part of closure is accepting the reality. At first, survivors keep hoping or wishing that it weren’t true. They expect their loved one to walk through the door. They wait for someone to tell them it was all a huge mistake. They just can’t accept that this person has died, that they will never physically see their loved one again or hear the voice, feel the hug, or get that valued input on a tough decision. Usually it takes weeks or even months for the reality to finally sink in. In time, they come to know, in both their heads and their hearts, that their loved one has died and is not coming back. They still don’t like it, but they accept it as true.
As your clients accept this reality, they can more actively make forward-looking choices that help them heal. They slowly begin to envision a life different from what they had planned before, a life in which they no longer expect their loved one to be there. They still feel the pain and loss, but except for short periods of time, they are not crippled by it.
For most of your clients, especially if it was a significant person who died, this healing phase is long and slow, and it involves a lot of back-and-forthing. They may alternate between tears and joy, fears and confidence, despair and hope. Sometimes they feel like they are taking three steps forward and two steps back.
It is important to give clients permission for whatever they are experiencing. Everyone else is telling them to put it behind them and get on with life. Set yourself apart by encouraging them to tell the stories and build memories that they will never “put behind them”. Reassure them that healing does not mean forgetting; it means taking the life, love, and lessons into the future with them.
Eventually your clients are able to let go of what can no longer be. Yet at the same time they realize they are taking the past, with all its pain and pleasure, into a new tomorrow. They become different and hopefully better, more compassionate, more appreciative, more tolerant people. They fully embrace life again, connecting, laughing, and loving with a full heart.
Still, there is no point of “final closure.” There is no point at which your clients can say, “Ah, now I have finally completed my grief.” Or “Yes, now I have healed.” There is no point at which they stop missing their loved one or wondering what life would be like if they were still alive. There is no point at which they will never cry again, although as time goes on the tears are bittersweet and less common. Because we never forget, we carry our loved ones with us forever.
“Closure”? No, or at least not in the way people usually use that term. Acceptance – yes. Peace – yes. A future enriched with love, joy, and hope – absolutely. But putting a period behind the final sentence, closing the door and locking it behind you? No, life and love are much too complex for that. This part of your client’s story does not end; instead it awaits the next chapter, which will undoubtedly build on all that came before.
Stand with your clients as they grieve. Let them know they do not have to forget or leave the past behind. Encourage them to create memories out of what can no longer be, and to live their lives as fully as possible enriched by those memories. Offer them the patience and understanding that few other advisors do. You will reap rewards both personally and professionally.
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 a parent with young children is diagnosed with a life-limiting illness, the emotional devastation disrupts every facet of a family’s life. It is a nightmare all of us hope we never have to face. But, at this very moment, you may well have this occurring in your corner of the world.
Do you know what to do when this nightmare strikes one of your clients?
Beyond financial advice, how can you do more to serve these clients? One way to start is by learning to ask thoughtful, open-ended questions and following their lead on how much they’d like to talk. Excellent questions are things like:
For the kids themselves, there is a relatively new resource on the market that you can give as a gift. It is titled “Sammy’s Story” by Erica Sirrine. This simple, 25-page book is a tenderly written and colorfully illustrated read-aloud book for children ages 3 – 7 who are facing a parent’s death. It sensitively conveys concepts about illness and death, including what children can expect as the illness progresses. It also thoughtfully gives ideas on how the child can maintain a continued bond with the parent even after the death. Intended as a resource to be read with caring adults, it is perfect for family members or other adults as they support children through this most difficult anticipatory grief and what will follow.
Don’t let your own discomfort keep you away. Be there for your client and the family. You will make more of a difference than you know.
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.