I am very excited to introduce a new feature of the Life Transition Blog, interviews with leaders in fields serving those in transition. My hope is to help you get a better understanding of the many professions that are at your service and will help you feel less overwhelmed. If you know of a profession and/or professional you’d like to see interviewed for this feature, please be sure to be in touch.
Barbara Ringgold is a Geriatric Care Manager practicing in Naples, FL. I have been fortunate to share many clients with Barb and have learned so much from her, both about the role of the care manager as well as about how to best serve older adults and their family caregivers.
What is a Geriatric Care Manager (GCM)?
GCMs offer personalized services to older clients, helping to identify health related, psychosocial, financial or legal problems they may have. The care manager creates a care plan to solve the problems identified in the assessment and then takes the steps to implement a cost effective solution that takes into consideration the client and family wishes. Care managers are expected to be on call for their clients 24/7 although do not act as an emergency responder.
Who usually hires you?
Typically I am hired by a family member or the person serving as Power of Attorney.
Why are you usually hired?
I am usually hired to help find solutions to a presenting problem. Usually the family is at a loss how to handle Dad or they are too far away to be available to “really” know how their parent is doing much less help.
How are you different from other, similar professions?
GCMs focus on problems of aging helping to educate clients and families about options. Care Managers do not make decisions for clients, but respect the client’s autonomy and work to help their clients make sound, informed decisions about how they age. GCMs act as advocates ensuring their client’s best interest and wishes are served.
How did you get into this field? What is your story?
During the last 15 years of my nursing career I had focused on Geriatrics. During that time I witnessed countless families struggle with decisions for their parents about home vs. facility care, end of life decisions, caregivers, how to manage services to their parents once they left town to return to their homes. I saw the enormous anxiety and burden and knew there was a huge need to assist families in the community. I started my company out of a passion for helping older people, one family at a time.
What training, education and/or experience is required or helpful to do what you do?
Professional GCMs are typically educated in nursing, social work, gerontology, or health administration and certified by examination and work experience as Certified Care Managers.
Are there other special certifications? If so, what does obtaining them entail, and how important is it for a consumer to look for someone who possesses these credentials?
Certification begins with a qualifying bachelor’s degree or licensure in nursing, social work, gerontology, or health related field. One must work under supervision as a care manager for at least two years and have had at least two years’ experience in the human services field. The applicant must pass a certification exam and recertify every three years, documenting ongoing education and work experience.
How can a consumer find someone like you?
The NAPGCM National Association of Geriatric Care Managers maintains a website () with members listed by state and zip code for easy reference. Most members maintain their own websites as well.
What are the three most important questions to ask before hiring a GCM?
What is your educational background and work experience?
Are you certified, and by whom?
What professional licenses do you have?
What are your top tips for working with a GCM?
Hold nothing back. Communicate constraints on finances, long held fears, past health crises, and family disagreements on care. Care managers are skilled at helping but we need the right information to do so.
Please visit Barb’s website at http://www.seniorcarefamily.com.
My clients often ask me to recommend books, articles and other resources on a variety of topics. While I have developed a short list of go-to recommendations, I’ve decided to begin a regular new feature in the Life Transition Blog - - providing recommendations of specific resources. So, I spent my airplane flight this morning reading Charlie Hudson’s 2011 book Your Room at the End: Thoughts About Aging We’d Rather Avoid, a book that was recommended to me by a colleague and which has been sitting on my to-do pile.
Ms. Hudson’s approach to the topic of end-of-life issues is from personal experience, namely observing several people close to her arrive at the twilight of their days and serving as the primary caregiver for one of them. She writes of an intense emotional journey and a realization that she was uninformed and unprepared for it. Ms. Hudson’s goal for Your Room at the End is to help others be better prepared for life’s inevitable ending.
There are two central themes to Ms. Hudson’s work: first, she stresses the importance of planning ahead and communicating those plans. Those of you who are frequent readers of this blog know that is my soapbox too, so it should not be surprising to you that I applaud Ms. Hudson for helping to deliver this message in clear and concise terms. Ms. Hudson’s second core point is that articulating your personal definition of quality of life is something to do early. This enables you to develop a strategy for ensuring that you can achieve it and also to articulate your thoughts and feelings about this important topic to those who love you and will be your decision-makers and caregivers when the time comes.
While the first section of the book covers many important topics related to aging and death, it does so with broad strokes and a light touch. This section of the work will be helpful for “newbies”, those at the very beginning of their journey into caregiving or aging. Indeed, Ms. Hudson is clear that her objective is not to be comprehensive regarding these matters. If you are seeking an encyclopedic or even in-depth treatment of these types of issues you will be better served by the many other available resources.
The unique aspect of Your Room at the End is its second section which focuses on enhancing and sustaining quality of life. In this section, Ms. Hudson offers many innovative and creative ideas along with practical suggestions. I almost wish that she had spent more time on some of these areas and focused the book here, rather than including this section as only the last thirty pages for it is these thoughts that bring something entirely new to the conversation.
I particularly enjoyed the sections on building or reinventing your space and practical pets. These are topics that get relatively little coverage in compendiums on aging and end of life issues. While Ms. Hudson presents a number of helpful ideas, both of these sections would benefit from more specifics and suggestions of resources. For example, this would be a great place to introduce the National Association of Homebuilder’s Aging-in-Place certification program where general contractors can be trained and certified to recognize and offer solutions for common issues that prevent older adults from staying in their homes. Additionally, the idea of having a geriatric care manager come in to make an in-home assessment isn’t mentioned here, and this is a very valuable service and resource that many of my clients avail themselves of. In short, I loved the inclusion of these topics; I wish that the information provided was less general and overview in nature and that more guidance was provided related to implementing the suggestions.
I offer kudos to Charlie Hudson for sharing her experiences and insights. Both older adults and those caring for them will pick up an insight or two from this work, especially people who are just embarking on their journey.
I was at a women’s networking group meeting this morning and an attendee and after learning about my practice asked the following question:
What do you find is the hardest thing for adult children who are caring for their aging parents?
Here’s how I replied:
It seems that the most difficult thing for my clients who are adult children caring for aging parents is to understand that they “can’t fix it” and then learning to take charge (and not take over.) At first, the universal approach is to try to make everything “right” again. However, at this early stage in the caregiving process these adult children fail to realize that they can’t put Humpty Dumpty back together again. Rather, they struggle to stop the natural aging process they see before them in any way they can. For some this means honoring Mom or Dad’s desire to remain independent without help or support even if that’s not safe. I call this denial!
For others this means throwing help and support at the “problem” but it is often the wrong kind of help. For example, I have one client whose Mother could no longer handle her day-to-day affairs. Her son hired a companion to take her to the theatre and on outings but failed to recognize that it was the simple tasks like preparing a meal and paying bills that presented the most immediate need.
She went on to ask me for an alternative strategy.
I shared that often, adult children come to me exhausted, frustrated and overwhelmed. We work together to help them learn and then accept that their “job description” is to keep their parent safe, happy and as independent as possible for as long as possible, ideally in a way that is consistent with their parent’s wishes and resources. This is materially different from trying to fix everything.
As my conversation with the attendee at the networking breakfast continued, she told me what was going on with her parents. They are refusing to allow help at home and she’s worried that they aren’t truly safe and able to manage. She has been trying to “fix” the situation by insisting they accept a home healthcare worker a few days each week but they continue to refuse and it is causing fights between her and them. I asked this woman if her parents have a medical alert system and wear it faithfully. She said they do not. I suggested that she talk with Mom and Dad about how stressful it is for her to worry about them all of the time and for her to tell them that instead of a gift for her upcoming birthday she would like for them to agree to employ such a system and promise to use it. She will even offer to pay for her own “gift”. And in exchange, for now, she will tell them she won’t bug them about hiring a caregiver.
Coincidentally, when I returned to the office for my next client -- an adult child caring for her mother --the first thing she said to me when we started our session was, “I’m overwhelmed and frustrated.” When I asked for specifics, this woman shared that she couldn’t seem to get her Mom back to where she was before the recent decline. And so, I started the discussion about not being Ms. Fixit again.
During our first meeting, a recent client of mine shared her story:
My husband of 59 years died recently and I’m feeling overwhelmed by day-to-day decisions. I expected to feel the emotions associated with grief, but I never expected to feel helpless. My husband took care of our financial life and I’m really at a loss. I don’t want my children to know how much this confuses me and I certainly don’t want their help if that means they take over. I should be perfectly capable of handling my own affairs. How can I get on top of things so that I can manage on my own?
Her emotional challenge is common and the difficulties may be exacerbated by how the division of labor was handled between the partners during their marriage. Such a division of labor, for example, may have meant one spouse took care of the finances and the other took care of all the shopping and cooking. That was fine as long as both spouses were willing and able to do their jobs. However, if because of illness, attitude, capacity, or death, one of them can no longer hold up his or her end of the bargain, there is trouble brewing.
The best way to avoid this is through “cross training.” In this way, one partner teaches the other his or her system for accomplishing their job. If that’s not an option, then at least each should document the process and the facts of how they handle their tasks for the other. Each partner should be aware of where financial documents are kept, how to access the funds and what bills need paying. Both should have copies of supermarket/Costco or Sam’s Club cards and debit cards, know the nutritional needs (and food allergies) of the other and the contact information of the housekeeper, home aide, and other service providers.
However, what do you do if such cross training or documentation never happened?
The short answer is that it’s never too late to learn if you want to and don’t suffer from physical or cognitive complaints that make such learning too difficult. If you don’t want to or can’t learn, then you can hire someone to take over the tasks on your behalf.
There’s a middle ground, too. Maybe it is too overwhelming to step in and figure out how to do something you’ve never had to do before, but you’re not ready to completely outsource it either. In this case, you can bring in a professional daily money manager who can set up a system for you, teach you how to use it, and then check in with you periodically to make sure that you’re on track and answer any questions that might come up.
That’s exactly what my client did. She had me figure out her late husband’s financial system, bring it up to date, and then modify it until it made sense to her. Once we got to that point, it was easy for her to take over and maintain the process. At first we had a check-in meeting every other week, and then every month. At that point, I felt that she was ready for a quarterly meetings, but she liked the idea that I was looking over her shoulder, “just in case,” so we met more frequently.
As the months passed, new issues came up. For example, while the bill paying was well under control, when it came time to deal with the annual income tax return, my client became overwhelmed again. Then her car lease came to an end and she was having a tough time making a decision about whether to lease a new car, buy out her current car, or purchase a new one. We did the analysis together and I helped her negotiate her new arrangement.
Losing a life partner if tough is so many ways. It adds insult to injury to feel as though you can’t take care of yourself because of your loss. There’s help available, whether from family, friends, or qualified professionals. Don’t be afraid to ask for help. It is not a mark of weakness, but one of strength.
Advancing age is often frustrating as you face the new limitations age imposes on your body and mind, and turning over control of even little things to others might make you feel insecure. A loss of control is always frightening, but acknowledging that your situation is changing is not a loss of control … it is actually taking control of how things will go from now on. You can fight for your independence, but if such independence endangers you, what are you winning when you win that fight?
According to a study completed in 2009 by Home Instead Senior Care, more than half of older adults resist asking for help, even from their adult children, fearing it signals a neediness that could land them in a nursing home. Similarly, 51% of adult children caregivers surveyed across North America say their aging relatives can be so reluctant to accept help, they fear for their safety. Don’t let this be you; accept when you need help and learn to as for it.
In her classic book, “On Death and Dying”, Elizabeth Kubler-Ross put forth her now widely applied model for the grieving process. Since its publication, this model has been adapted to explain the feelings associated with many types of transition or personal loss. The stages include: denial, anger, bargaining, depression, and finally, acceptance. In my work, I have noticed that the individuals who seem to “age well” and capture the attention and admiration of others are those who reach the stage of acceptance long before the ravages of advancing age take over in a profound way.
Another way to look at aging is as a culmination of your unique self. Your life experiences, belief systems, and interpersonal style all combine to create your present self. Your hopes, desires, and goals all combine to define your future self. As you age, there is less and less time to define your future self and this can be experienced as a series of “mini deaths” along the journey. At each of these points there is the potential to get stuck at one of Kubler-Ross’ stages that come before “acceptance.”
If you can move past the earlier stages and reach acceptance things just seem to go more smoothly. Once you are able to accept that you are indeed getting older, admit the reality, be willing to ask for help, and evaluate and prioritize what you most need help with.
Admit that your body can’t – and never will again – perform like it did when you were younger. There are some things others can now do better than you but that doesn’t mean you are useless. You’ve got your brain, your wit and your experience (and it is age’s prerogative to give advice to the younger generations.) You need the help. People may notice you need the help but may be too fearful of injuring your pride to ask if they can help you. You need to ask them to do so. Be willing to ask for and accept help. Evaluate what type of help you need. Start with the basics. Do you need help paying your bills? Managing your medications? Could you use a hand with driving, shopping, fixing your meals, dressing, bathing? Are you spending too much time alone and could use a little companionship? Make a list and then prioritize it. Start with one thing at a time and ask for help.
You didn’t reach the age of silver hair without having been through some tough times and coming out the other side still standing. You have bucked up, knuckled down, pitched in, shut up, spoken your piece and maybe even said your prayers. What you probably haven’t done much of is ask for help.
Many older adults and their families find security and peace of mind by adding a medical alert system to their safety net. The basic idea is that if you are ill, injured, lost, or disoriented, you simply have to push the button on a transmitter device that you wear or carry with you at all times. The person receiving the transmission can then call emergency responders, a neighbor, or family member to come to your assistance. Many people supplement this system by putting a lockbox on their front door containing a house key. The person receiving the emergency transmission can then provide the lockbox code to the responder, avoiding the need to waste valuable time trying to get to the ill or injured person or having to break a lock or window to gain entry.
Medical alert systems typically consist of a receiver or base station which allows a central monitoring station to communicate with the client and a waterproof transmitter (typically on a wrist band or necklace) which allows the client to communicate with the monitoring station. The central station then maintains a call list indicting who should be called in the event of an emergency and in what order. Such systems are typically available for a monthly or annual rental fee or as a one-time purchase. Another choice is the “no fee” alert system which you can set up to call your friends or family instead of a monitoring service, thus avoiding the cost of monitoring. Some of the newest technology incorporates monitoring sensors that tell the central station whether the client has deviated from his or her normal schedule or forgotten to take medications that are stored in a special medication management container.
Some medical alert systems work only within a set distance of the base station (receiver) which is usually connected to a home’s telephone land line. This means that the system will work within the home and sometimes for a short distance outside, such as to the end of a driveway where the mailbox is located. Many newer systems work anywhere in the world through GPS technology and do not require a landline. Some systems are hybrid or dual systems, and work via a base station in your home and via a portable unit that you carry with you when you are out. So, the first choice you need to make is whether to obtain a home-based system or one that works wherever life takes you.
When selecting a medical alert system, be sure that you understand both the technology and the terms of the contract or service agreement. Also, be sure to compare carefully. For example, some systems come with only one transmitter while others provide a second one at no extra cost. Some provide assistance with setting up the system while others expect you to do it yourself. Finally, some providers include back up batteries for the parts of their system that require electricity to operate and others do not.
The most frequent objection that I hear from my clients regarding acquiring a medical alert system is, “I carry a cell phone. What do I need that for?” As I explain, a cell phone is terrific until it’s not. For example, if you have fallen and hit your head and are knocked out, you won’t be able to dial your phone. If you are confused or disoriented you might not remember the password on your phone or what number to dial in an emergency. What about if the person you called doesn’t answer? And finally, do you take your cell phone into the shower with you? The big advantage of a purpose built medical alert system is that it is designed to be with you all the time, 24 hours a day. That brings me to perhaps the most important point at all: your alert system only works if you remember to have the transmitter on your person all the time. I can’t tell you how many times I walk into a client’s home and see the neck pendant on the bedside table or the kitchen counter. It won’t do you any good at all in those locations!
Many of you are probably familiar with Dr. Gary Chapman’s timeless bestseller, “The 5 Love Languages”. Originally published in 1992 and updated many times since, Dr. Chapman’s premise is that couples who understand each other’s “love language” have a distinct advantage because they are able to effectively communicate with the people with whom they are in relationships, be it a spouse, child, boss, or business partner to name just a few. Over the past several years, I have applied Dr. Chapman’s approach in my family caregiver coaching and have seen tremendous benefits for my clients. As caregivers learn to identify their own caregiving language and that of their caregiving partners and care recipients, they are better able to navigate the inevitable challenges.
One of the most common frustrations I hear from caregivers is that they feel taken for granted, not so much by their care recipient, but by other family members who seem to expect them to just keep managing everything with little help or support. When I work with these caregivers to get underneath the surface of what is really going on, I often find that the caregiver has never explicitly asked his siblings for help, or if he does ask, makes a vague request like, “I wish you’d help out more with Dad.” When we unpack this frustration, I almost always find that the perceived disconnect is a (lack of) communication issue. Even if messages have been exchanged, the parties are speaking in two separate languages. This repeated observation got me to thinking about other types of relationships where communication issues are at the heart of so much distress and I took the time to review some of the major works on the topic and how it might apply to my clients. And that is what led me to Dr. Chapman’s work.
Since it is unusual that two individuals in a relationship (of any kind) will have exactly the same love language profile, Dr. Chapman counsels that it is imperative to make sure that you know not only what you need and communicate that to your partner, but also that you know what your partner needs because he or she has communicated that to you. Dr. Chapman identifies five distinct “love languages”: words of affirmation, quality time, receiving gifts, acts of service, and physical touch. I have found that these very same languages can be applied to caregiving relationships.
A caregiver whose “language” is words of affirmation is someone who thrives on verbal compliments or hearing encouraging words. If your sister, who is the primary caregiver for your Mom, is of this profile, taking the time to talk with her about how much you appreciate or how skilled she is at providing or organizing the care may be what she needs most to keep her going. On the other hand, if her primary language is “quality time” then she will value the fact that you come to visit and give her your undivided attention much more. Similarly, a caregiver who values receiving gifts will respond positively if you send a gift card for her to go get herself a massage, while the caregiver who values acts of service will be far more comfortable when you come and do the actual caregiving work for an afternoon. Finally, the caregiver who craves physical touch will just want to be held after a hard day with Dad. In this way, he or she will know that you are there and that you care.
I encourage my clients to identify their own caregiving language and then to effectively communicate that to their care recipients and caregiving partners. For example, one client learned to say, “You know, I can get through even the toughest day taking care of my husband when one of our children comes over or calls and asks me about what’s going on with me.” Can you guess which language this caregiver prefers? If you guessed “quality time” you are correct. This woman doesn’t need to be told she’s doing a wonderful job or sent a gift certificate for dinner and a movie. She doesn’t even really want you to take her husband to his doctor’s appointment or give her a hug. Now don’t get me wrong – this caregiver would WELCOME all of those gestures. But the thing she most craves? It is that you sit and really listen when she talks, that you pay real attention to what she is thinking and feeling.
If only family caregivers knew this important reality from the outset of their caregiving journey! The tricky part of all of this is something that I say often: the golden rule doesn’t work when it comes to caregiving. You don’t “do unto others as you would want”, but rather you “do unto the other as he or she wants”.
Overwhelmed. It is the most common word that I hear within the first sentence of nearly every telephone call that I receive from a prospective client. It is a loaded word – one filled with feeling, with emotion. When used in the context of talking with me, the word takes on a negative meaning, as in, “Caring for my ill spouse has left me feeling overwhelmed.” But this very same word is sometimes used in a positive way as in, “I was overwhelmed by the outpouring of love and support.” Or, “I was overwhelmed with joy when I held my son for the first time.” Feeling “overwhelmed” is the catalyst that leads so many to reach out for guidance, assistance, and reassurance. But what is this feeling? What is this word?
The dictionary definition of overwhelm is “to bury or drown beneath a huge mass” or “defeat completely” or to “subject to incapacitating emotional or mental stress.” Synonyms include “overpower” and “crush” to name just a few. The word is derived from Middle English over – whelm. In this context, over means “too much” and whelm means “submerge or engulf”. So it seems that the correct use of the term really is the negative, because after all, is it so terrible to have “too much” joy or to be “submerged or engulfed” by love?
So how do I help my clients get “over” being “whelmed”? Or, put another way, to feel less submerged by life?
The first step is to acknowledge and name what is going on. What are you engulfed by? Why do you feel defeated? What is overpowering you? Sometimes the answer is relatively clear, as in “I feel guilty that I can’t do more for my mom but I have my own life.” Sometimes, the answer is pragmatic, such as, “There are too many bills to pay and forms to be filled out.” Often, the root cause is that my client knows that they can’t change an inevitable outcome and feel sad and frustrated by this reality. Whatever the cause, the outcome, feeling overwhelmed, typically leads to inertia and profound stress.
Once the cause is named, I work with clients to define a successful outcome. My favorite powerful question is, “How will you define success?” I encourage my clients to give themselves permission to define success as working within the simplest parameters. For example, perhaps success will be defined as hiring someone to handle mom’s mail and bills. Or, perhaps it will be to make sure to exercise at least five times each week no matter what is going on with my ill wife. Typically, any given situation will call for multiple definitions of a successful outcome. The simpler the definition, the better it is.
We then work to create a plan to achieve those success milestones. I come to this with a bias, and that is that I see that life has a larger purpose, as something with meaning. I find that clients who share this view find it easier to deal with stress than those who believe that life is random chance. They seem better able to put events into perspective perhaps because they realize that there is more than just their own situation to think about. They believe that problems in life are challenges for our growth and development rather than a cause to feel overwhelmed. So we often need to spend time discovering their purpose and trying to understand how the immediate challenges fit in as a way to mitigate the stress they feel. What starts as a task oriented need like “Help me figure out whether my dad should go to an assisted living facility and how to pay for it” often becomes a transformational experience on the journey of life.
I was recently wearing my family transition coach hat in a case with a woman who was undergoing a series of significant life transitions all at once – physical symptoms including weight loss and musculoskeletal pain, a divorce, and loss of a job. As overwhelming as all of that sounds, and it was, perhaps the biggest challenge was that none of her doctors thought to look for an underlying physical condition. While working together to solve many day to day issues, I began to wonder if there wasn’t something more going on. As it turned out, this woman needlessly suffered great physical pain because her diverse symptoms were chalked up to “stress”.
While it is true that stress played an important role in the client’s distress, the fact is that she had a medical condition that, when treated, caused her situation to become manageable rather than hopeless. The eventual diagnosis came as a result of having a third party advocate involved. Specifically, an advocate can often bring a fresh set of eyes to a situation. In this case, I began to research possible causes of the constellation of symptoms other than the obvious one, stress. It immediately became clear to me that it was very possible that at least a portion of the symptoms could be explained by one or more medical conditions or an adverse reaction to prescribed medications. While I had no illusion that such a finding would explain everything, my hope was that finding and treating the condition would allow my client to get some relief from her many physical complaints, gain strength, and have the energy to focus on the hard work of dealing with the financial issues she faced.
My client’s physicians were skeptical and brushed aside our request for a thorough examination with an open mind. They felt that all of the symptoms were perfectly explained by stress. In their eyes, there was no need to look further. As an advocate, I was able to engineer a second opinion involving a thorough workup. In this case, that workup revealed a diagnosis for a treatable condition. My client is recovering well and in a much better place to tackle her many challenging life transitions.
In another recent case I became involved after the fact, wearing my medical billing advocate hat. In many medical billing cases, the simple act of sending a letter that begins, “we have been retained as Mr. Smith’s medical billing advocate” changes the dialogue. It seems that the mere idea of a third party’s involvement in the situation is enough to start a conversation where none seemed possible before.
While I realize that it doesn’t always turn out this way, often it does. A third party advocate has the benefit of looking at a situation with new and objective eyes. When those around you say “no”, an advocate can ask “why?” An advocate has the energy and expertise to push harder than you might be able to on your own. While this example focuses on the role of a patient advocate the concept can be applied to many types of advocacy. While advocates don’t carry a magic wand and can’t always get you the outcome you desire, we often can make an enormous difference, if not in the eventual outcome than in your experience as it unfolds.
How do you know that your finances (or those of a loved one) are off track? There are both obvious and more subtle signs. Let’s run through the top reasons that clients call me for help handling their day to day finances.
Piled up mail and being overwhelmed by it is the most common first sign of trouble in my experience. Once the mail pile gets too big, many people find that it is just easier not to open it. And once the mail isn’t opened you’re on the slippery slope to trouble. If this describes you, do yourself a favor and get help right away. It is much easier to get back on track when you don’t get too far off!
Unpaid bills are the second most common problem and often (but not always) results from the piled up mail. Sometimes I meet with people who have a very organized system for handling the incoming bills but then slip up with remembering to actually pay them. There is a relatively easy fix for many of these bills which is to set up automatic payments from your bank account or charges to a credit card, assuming that your cash flow permits this.
Late fees often result from unpaid bills and interest charges are typically piled on as well. So if you notice that more and more of your accounts have either of these added on, it is time to get back some control of the situation. Even worse are bouncing checks or excessive overdraft fees. Both of these are signs that you are not managing your cash flow well at all.
Mounting credit card debt can be a sign that you are living beyond your means and need to rein things in. If you are paying only your minimum balance every month (and especially if you are late making that minimum payment) then you are digging yourself deeper and deeper into a hole.
Sometimes a sign for older adults is a new habit of making frequent small charitable donations. Many charities have a strategy of mailing to older people very frequently and asking for small donations, hoping that they will get in the habit of writing those checks every few weeks. I had one client who was making thirty donations of $5 each every month to various organizations. He had no idea that he was spending $1800 every year on this hobby! If this was part of his philanthropic plan and he was doing this with intent then I’d have no issue with it (assuming that he could afford it) but in this case he could not afford it and didn’t realize the impact these seemingly small donations had on his finances.
A new habit of buying lottery tickets or participating in sweepstakes can be another warning sign, especially among older adults. They are often hoping to strike it rich to pay off their debts or leave money for their families and this is another scam that targets the elderly.
Calls from creditors are an obvious and late sign that your finances are in trouble. Do your best not to get to this point by getting some help early.