Posted by Sheri Samotin on Tue, Jan 19, 2010
John and Jane Smith (names and some of the personal details changed to preserve the privacy of those involved) are a lovely couple in their mid-seventies who became southwest Florida snowbirds in 1996 and permanent residents in 2002. When I met them, the Smiths were both healthy and engaged in an active lifestyle. Their two adult daughters live in Connecticut and Ohio and lead busy lives with careers and families of their own. The elder Smiths have always been highly independent and determined never to become a burden on their children. They've consulted with an estate planning attorney and have a financial advisor they trust. Mr. Smith has always handled the bulk of the family finances and it was the Smith's financial advisor who first suggested that they consult with me regarding putting all of their day-to-day affairs in order so that if something happened to John, Jane would be able to take over. As it turns out, that advice was incredibly important.
When I first met with the Smiths, they weren't sure exactly why their financial advisor had suggested the meeting since John was confident that all of their financial details were under control. During that first meeting, we discovered that while John knew all of those details, that Jane had only a vague idea of what investments they had and had no idea what the password was for their online banking service which John used to pay most of their bills. She also didn't know where the insurance policy papers were kept or much about what they covered. Finally, we discovered that Jane did not have a credit card in her own name. During that first meeting, we discussed the various things that need to be done so that Jane could take care of the family finances in the event of John's incapacity. By the end of that first meeting, the Smiths agreed that their financial advisor was right and they needed some help getting their affairs organized.
I use a very detailed approach to helping clients to organize their affairs, the goal of which is to assemble all of their critical information in one place for easy access when it's needed. As we worked through the various topics, we made a list of all of the things that had to be done, the documents that had to be found, the bills that had to be paid, and the decisions that had to be made. Over the next several weeks, I worked with John and Jane to make sure that everyone stayed on track. The end product was a computer flash drive that contains all of the critical information, including scanned copies of important documents. I also prepared one hard copy version of the information in a binder since Jane is more comfortable with holding things in her hands than with accessing them on the computer. In addition to the things you'd expect to find, like account numbers, passwords and copies of military records, this repository also lists important vendors like the air conditioning company with which the Smiths have a service contract and the name and phone number of the dog walker for their beloved schnauzer Sam. The idea is that if something happens, the Smith's daughters (or another trusted person) can quickly take over.
In the Smith's case, we needed for Jane to apply for a credit card in her own name, so that she would have access to credit if something happens to John. We also discussed the Smith's end-of-life wishes and they decided to meet with a funeral director to make pre-need arrangements so that no one had to guess what they would have wanted. Finally, we prepared documents that permitted the Smith's daughters to have access to information about their various accounts in the event that was necessary.
As the final step in our process, I facilitated a conference call between the Smiths and their daughters. The stated objective of the conference call was to bring the girls up to speed in the event that both of their parents became incapacitated at the same time. While John and Jane did not want to turn the flash drive containing all of the information over to their daughters immediately, they did want them to know that this resource existed and where to find it.
As luck would have it, within several months of completing this effort, John suffered a stroke. While he is recovering well, Jane was able to easily step in and take care of the day-to-day matters that had previously been John's domain. The fact that the Smiths had prepared for this in advance meant that both were less stressed than they would have been during an otherwise difficult period.
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Posted by Sheri Samotin on Thu, Jul 09, 2009
A recent NYTimes New Old Age blog post regarding funeral expenses offers lots of important information for caregivers performing their "final act" on behalf of their care recipient. While it is always best for the care recipient to make their final wishes known to their caregiver and other loved ones, we all know that this doesn't always happen.
The big debate in the comments to the post is about whether or not prepaid arrangements are a good idea. The post states that AARP and the Funeral Consumer's Alliance both advise against such plans. However, a number of the comments relate stories about why it WAS a good idea for their situations. In fact, the executive director of the FCA actually posted a comment giving their rationale, which is basically that each state has different laws and protections for consumers, and in some cases, when funeral homes or cemetaries are sold, the prepaid plans are not honored. However, he does acknowledge that a prepaid funeral might make sense in the case of a Medicaid spend-down for nursing home care.
One thing that is not covered by either the blog post or the comments is the notion of "pre-planning" vs. "pre-paying". While it might or might not make sense for your care recipient to pre-pay for his funeral arrangements, I can't think of a reason why pre-planning would ever be a bad idea. With pre-planning, the individual gets to decide exactly what he or she wants and that is documented by the funeral home of choice for later reference.
Posted by Sheri Samotin on Thu, Jun 25, 2009
Yesterday, I had the opportunity to participate in a health fair in a local assisted living community. I was able to engage with several residents and I couldn't help but think about some of the striking differences I observed.
Let's start with the residents themselves. The first lady I spoke with was very sweet, but completely out of touch with what was going on around her. She was calm, polite, and immaculately dressed and if you saw her at the cosmetics counter in Saks Fifth Avenue you wouldn't have thought for a minute that she was anything other than a sweet older lady. That said, upon spending just a few minutes chatting with her, it became clear that she was happily in her own world.
Along came a gentleman who, with the exception of a pronounced limp, looked and acted like he belonged on the golf course. He was charming, articulate, and I was wondering to myself why exactly he was living there, but I'm sure it made sense for him.
A few moments later, a gentleman stopped by in a blue blazer, a crisp dress shirt and trousers and dress shoes. He spoke in French for a few moments, and gave me the two minute version of his life story. And then, he gave it to me again, word for word. When he started in for the third time, it was clear that looks are definitely decieving.
Finally, a woman came in riding a scooter. She was the self-appointed leader of the book group and was concerned that she couldn't find her "flock". She had a mission, and that was to get her fellow residents to read and discuss great works, and to write their autobiographies as a legacy for their families. She and I spent quite a while talking about her frustration that so many of her peers didn't seem to think that anyone would be interested in their life stories. This lady was as together as most people half her age, and it was her body, not her mind that caused her to be there.
If you are a caregiver or a professional advisor for a senior, please remember that each of them are individuals. Don't assume that because their bodies have failed them that their minds are slow. And don't assume that if someone "looks fine" that they will be able to process everything that you are telling them. Each of these individuals is a blessing, and we all need to stop and spend the time to see that, even when we're busy doing what we do with and for them.
Posted by Sheri Samotin on Wed, Jun 03, 2009
Caregivers often struggle with how much to talk with their loved ones about the end of life. In a way, it seems easier to do so when it is abstract, long before it seems like an impending reality. As it turns out, doctors struggle with this too, but recent evidence suggests that quality of life for patients AND their caregivers is better when doctors level with their terminal patients.
In her May 28, 2009 New York Times article, "Doctor and Patient: Talking Frankly at the End of Life", Dr. Pauline Chen speaks both as a physician and as a family member about the importance of having those "difficult discussions" at and about the end of life. She speaks of the conversations that doctors and nurses had with her dying mother-in-law, and also about the important opporunities her husband and the rest of the family had to share with their Mom/Grandmother/Great grandmother.
Dr. Chen quotes a close friend of hers who said, "One of the scariest things in the world is to look someone in the eye and tell them they are dying." But Dr. Chen goes on to say that in her practice she does try to tell patients they are dying because she believes that it is worse when clinicians don't. Yet, she also points out that every doctor comes to these conversations with some anxiety, "... because it is hard not to feel as if you have failed your patients and their families, to wonder if taking out an inch more of bowel when removing the colon cancer, starting with a different antibiotic, or ordering a different diagnostic test might have somehow changed the course of events." She goes on to talk about the conversation itself. As Dr. Chen puts it, death and dying are"... words that can echo in a room long after they are said. Hopes can be shattered in an instant. Patients and families may feel abandoned. It is hard as a doctor not to wonder: Am I doing more harm than good?"
Dr. Chen cites a study, published in the Journal of the American Medical Association, that examined how end-of-life care discussions with terminal patients affected their quality of life and that of their caregivers. The study found that patients who had discussed end-of-life issues with their doctors were more likely to have better quality of life at the end of their lives with less aggressive care. The study also found that their caregivers fared better than caregivers whose loved ones had received more aggressive care.
So it seems that for many people, open and honest conversations about death and dying is desirable. What do you think? Do you think it is best when doctors are direct and honest with their terminal patients, or does this take something away from them? Read the article and share your thoughts.