Post on 14-Jul-2020
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A Fiduciary Approach to Advising Clients with Dementia
• Managing personal finances is one of the first abilities to decline as people develop dementia.
• Noticeable decline up to 10 years prior to a clinical diagnosis of dementia.
American Medical Association
What is dementia?
A brain disease which causes problems with memory, thinking and behavior.
Dementia will affect:
– 1 in 5 women
– 1 in 10 men
– 50% of people over the age of 85
Most forms of dementia are progressive. The symptoms will never improve; they will only get worse.
Risks
For your client
– Quality of life
– Lost financial resources
– Cost of care
– Fraud and family abuse
For advisors
– Inefficiency
– Frustration
– Liability
The value of financial planning
Planning focused on your client’s quality of life.
Relief for caregivers.
Peace of mind for families.
Efficiency for advisors.
Agenda
Signs and progression
Fiduciary process through a period of care
Communication tools
Planning considerations
Working with a client’s advocate
Questions
Signs of dementia
1. Memory lapses
2. Disorganization
3. Declines in checkbook management skills
4. Arithmetic mistakes
5. Conceptual confusion
6. Impaired judgment
Progression of Alzheimer’s
Mild Decline Moderate Decline Severe Decline
8 – 10 Years
Progressive:
Most forms of dementia are progressive. The symptoms will never improve; they will only get worse.
Cognitive impairment symptoms
Mild Decline– More disorganized than normal– Good days and bad days– Bills may go unpaid– Difficulty remembering names or words– Confusion about places and dates
Moderate Decline– Client can no longer manage finances– Client requires help with some ADLs (cooking, clothing,
bathing, etc.)
Severe Decline– Unable to remember recent experiences or conversations– Require help with many acts of daily living
Fiduciary-Grade Decision Making Process
1. Gather and organize information2. Identify options and make recommendations 3. Execute elements of the plan4. Monitor progress and reevaluate
Planning
Get client’s advocate involved.
Recommend your client see a doctor.
Refer your client to a professional care manager and/or other care professionals.
Update financial and legal plans. Simplify Finances
Update Legal and Estate Documents
Update cash and investment allocation
Transfer authority to client’s advocate. Update custodial paperwork as appropriate. (Moderate stage)
Caregivers and Stress
Proportion of Alzheimer and Dementia Caregivers Who ReportHigh or Very Emotional and Physical Stress Due to Caregiving
Source: https://www.alzheimersreadingroom.com/2010/01/sobering-statistics-about-alzheimers_26.html
Chart1
Emotional stress of caregivingEmotional stress of caregiving
Physical stress of caregivingPhysical stress of caregiving
High to very high
Not high to somewhat high
0.61
0.39
0.43
0.57
Sheet1
High to very highNot high to somewhat high
Emotional stress of caregiving61%39%
Physical stress of caregiving43%57%
Therapeutic Alliance
Source: Amy Florian, Corgenius
• Build trust over time.• Help clients feel heard.• Avoid references to other clients, self.• Ask for permission to contact other professionals.• Take detailed notes/keep good records.• Present information simply and clearly (graphics).• Address items over the course of several meetings.
Communication tools
1. Use active listening skills2. Schedule morning meetings3. Limit noise and visual distractions4. Use closed-ended questions and
proper names5. Reassure & be patient6. Understand different types of
grievers7. Uninterrupted story telling8. Humor relaxes everyone!
Planning considerations
Cash planning
Risk management
Tax-planning
Elder Abuse
Signs of abuse Socially withdrawn
New person in a client’s life
Gifts or expenses which don’t fit values or plans
There is something you can do!1. Trusted contact (Advocate) designation
2. Educate client’s Advocate about fiduciary responsibilities.
3. Personal Care Agreement (PCA)
4. In case of emergency - Report to Adult Protective Services or Social Services
A Professional Team Approach
C L I E N T
C A R E G I V E R
A D V O C A T E
E S T A T E A T T O R N E Y
H E A L T H C A R E P R O V I D E R
F I N A N C I A LA D V I S O R
Source: Amy Florian, Corgenius
Questions?
A Fiduciary Approach to Advising Clients with DementiaAmerican Medical AssociationWhat is dementia?RisksThe value of financial planningAgendaSigns of dementiaProgression of Alzheimer’sCognitive impairment symptomsFiduciary-Grade Decision Making ProcessPlanningCaregivers and StressTherapeutic AllianceCommunication toolsPlanning considerationsElder AbuseA Professional Team ApproachQuestions?