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?