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When Bob Mauterstock asked how many financial advisers in the room had elderly clients showing signs of diminished mental capacity, a few hundred raised their hands.
Next, he asked, how many have a protocol for these clients? Fewer than 10 put up hands.
With the U.S. population over age 85 growing at a rapid clip, advisers increasingly are facing this issue, he explained last week at the Financial Planning Association meetings in Boston. A 2009 Fidelity survey backs him up: 84 percent of advisers said they had clients touched by Alzheimer’s disease.
Mauterstock, the author of “ Passing the Torch, Critical Conversations With Your Adult Children ,” shared seven tips to help advisers, clients, and their families. While many of his suggestions apply to wealthier people receiving comprehensive financial services, they’re also useful to people dealing with a parent experiencing cognitive decline.
Recognize the symptoms .
“Diminished mental capacity is a slow, gradual thing,” he explained. Don’t wait until the signs become crystal clear before taking action. He used the example of his own client – a Harvard-educated anesthesiologist – who started calling repeatedly and asking to speak with his accountant. Mauterstock’s staff gave him the accountant’s phone number – only to get the same call over and over again. Better to recognize the signs early, contact the client’s family, and devise a plan.
Do the Homework.
Advisers should have a complete checklist of things to discuss with clients before they experience cognitive issues, from a durable power of attorney to the handling of trusts held in their name. He also recommended documenting client meetings once cognitive decline sets in. Having another adviser in these meetings is in the client’s interest – as well as the adviser’s – and helps ensure that good decisions are being made. An advocate for the client should also sit in, to help with decisions as they become increasingly difficult to work through.
Hold Family Meetings.
The most important thing an adviser can do when cognitive decline starts setting in is to ask the client to call a family meeting.
In the meetings, an adviser can earn the family’s trust over time, Mauterstock said. They also provide an opportunity for family members to become familiar with the client’s long-term care plans and to agree on things like who the future caregiver – often a daughter – will be. Once established, family meetings can evolve to encompass other difficult issues, such as the client’s end-of-life wishes.
Get Organized.
Mauterstock believes all elderly people should be asked to “keep all of your information in one place – anything an aging client’s family or caregiver might need.” This includes: names and phone numbers of doctors, lawyers, and advisers; names of companies with financial accounts, account numbers, user names and passwords; instructions for paying the mortgage, rent, or insurance and when it’s due; Social Security numbers; wills and other legal documents.
Discuss Long-term Care.
Assets can vanish quickly if a client must move into a long-term care facility. Mauterstock said it’s critical to clarify for clients that Medicare does not cover long-term care (except for rehabilitation after a three-night hospital stay) and to explain the circumstances in which Medicaid, a federal program for the indigent, begins paying for care. While some people may think they want to live alone after a spouse dies, he said, a visit to an assisted-living facility can change someone’s mind – this helps them envision “a new life” full of activities and socializing. He also suggested presenting clients with information about long-term care insurance – “whether or not you believe in it, so they can choose for themselves.” [Keep in mind the research , which shows that the typical stay in a long-term care facility lasts months – not year.]
Connect to Experts.
Financial planners can’t be expert in every field. He suggests building a network of professionals to call on for tricky issues, including elder law attorneys, geriatric care professionals, or insurance agents who understand products that might protect their aging clients.
Investment Policy Statement.
As a client’s mental capacity diminishes, he believes that it’s helpful to have an investment policy statement, signed by the client – “in case they forget what they’ve agreed to.” This document can be shown to the client or to family members who raise questions.