When Betty took her mom to the doctor, she had no idea it would mark a turning point in their relationship. Up to that point, 87-year-old Louise had been showing signs of cognitive decline, but the signs were never anything terribly worrisome.

On this day, when Betty went to the reception desk to turn in the usual array of forms, Louise proceeded to take her blouse off and ask the other people in the waiting room where the gowns were hidden.

Louise’s brain was recalling what she had been told in the past at one of her doctor’s appointments, but it wasn’t recognizing that her current environment and situation were not that environment and situation.

Just like that, Betty went from being a daughter trying to help out to a “caregiver”. Betty laughs about it, now.

Sometimes that is all you can do. When an elderly family member of mine told me she dated Douglas MacArthur, all I could do was smile and tell her that must have been very interesting. By that point, she had such significant cognitive issues, no one tried to correct her anymore. As long as she was happy with her false memories, we were happy that she was happy.

One of the most difficult situations to address in my work as a financial planner is seeing decline in my clients’ mental and physical abilities. I work on the Space Cost of Florida. Some of my clients are or were rocket scientists. The decline can be spectacular in its extent and speed. It can be heartbreaking to see someone with a high level of mental acuity, lose it.

But as tough as it is for me, it is impossible to forget that it is far worse for the client’s family. The journey from forgetful to “gone” is never smooth.

If you spend a lot of time with someone, you will hear the same story from them on multiple occasions. That’s normal. So is misplacing things, forgetting names and failing to recall dates or other details. It is when the stories are retold too frequently or with little recognition that the story could have been told previously that people start to get concerned.

Ideally, of course, before the need arises, we discuss with clients how they want things handled. We put a plan in place that typically involves documentation of who should be responsible for different things should the client be unable to continue to take care of things themselves. 

These trust, powers of attorney and other documents also describe when such control provisions take effect. What has to happen for a successor trustee to take over? The documents can sound simple enough but determining competence is often not so simple. That’s a discussion for another day, perhaps.

In practice, documents are essential but do little to minimize the trauma caused by the decline of a patriarch or matriarch. 

Cognitive decline is messy.

What often reveals itself with minor forgetfulness issues can quickly turn to something more serious. In Betty and Louise’s case, there was some embarrassment but no real harm. In a way, they were lucky that the switch to serious caregiving was triggered in such a benign way.

It isn’t always so. Leave the stove on and the danger to people and property is substantial. Mess up the medications and the error can be fatal.

Those situations represent a clear danger to self and others so decisions about what needs to be done are often clear as well.

What seems to be more challenging from the perspective of determining what level of care is needed are incidents that can arise via normal day to day activity before there are serious physical dangers.

Intelligent people like to solve problems and part of that process is examining possible solutions and eliminating ones that fail to meet certain standards. Smart people have natural skepticism. 

One thing we see often with those in decline is their “BS detector” doesn’t function at a high enough level. Often they will respond to junk mail offers that would have gone straight to the trash. They open new credit card accounts without considering what that does to their credit ratings. They will sign up for newsletters covering topics that may or may not have ever been of interest to them in the past. 

“Sign up for a 30-day free trial. If you like it, for your convenience, we’ll simply bill your credit card. Cancel at any time.” Except, they don’t remember signing up. Their spouse has to get on the phone with the card company and get everything stopped.

The Internet has made this worse. Many perfectly legitimate services are sold with the “try it free” pitch, but the Net and email are also the preferred hunting ground of scam artists. “Mrs. Smith” sent me a link to an options trading program “Mr. Smith” signed up for. She got the credit card bill, found the email he responded to their deleted file, and since she knows little about options, markets or investments in general, sought my opinion on the matter.

When I looked at the site, it had a ticker in the upper right corner counting down the number of openings available in this “exclusive” program. As the pitch went on the number of openings dropped, building a sense of urgency. “Hurry, act now!” The whole site and pitch was so cheesy, I chuckled to myself and checked on one thing I suspected.

Sure enough, every time anyone goes to the site the same countdown begins anew. Mrs. Smith may not know anything about investments, but she is no dummy. This feature was enough to assure her that her instincts were correct.

There is no way Mr. Smith would have given the initial email even a moment of his attention just a few months earlier.

Spam filters and browser controls similar to blocking kids from porn sites (common among elderly too) can help. We have also had client’s put spending limits on the cards used so excessive spending is contained.

Limits on credit cards is another example of something that sounds good until it doesn’t work. One client got stranded at a gas station because he had hit his limit. His poor wife had to drive 40 miles to buy him some gas. Which leads us to another sticky situation, getting the car keys.

I was at a shopping plaza the other day and twice almost got hit. When do fender benders represent a real safety issue? I have found that most people think they drive better than they do. Seniors are notorious for refusing to give up their keys. I can’t say I blame them. It represents a loss of freedom and autonomy. It also means someone else will have to transport them.

In many states, if the doctor agrees it is necessary, they can contact the DMV and the patient will have to requalify to keep their license. Sometimes, the revocation of the license is enough to keep the patient from driving. Sometimes not. The end of driving can elicit some strong reactions

Seniors often display uncharacteristically terrible behavior for less significant issues like simply being reminded to take food out of the freezer to thaw. Their frustration at not being able to recall things can lead to some downright hateful, paranoid and sometimes even violent interactions with those around them.

There is no document that can help a person when their spouse of 55 years tells them they hate them, wishes they were dead and pushes them into the wall. On an intellectual basis, the husband in this case knew his wife didn’t really mean those things but that hasn’t stopped him from having the image of the “fire in her eyes” as vivid now, 9 years after she passed away, as it was when she shoved him. Those weren’t the sweet baby blues he fell in love with, and it hurts to think about it.

These issues can be emotionally brutal, and it is easy to forget that there are literally millions of others who have gone through or are going through similar challenges. A great source of free yet substantial support can be found at churches and other faith-based organizations. Many communities also have programs offering care to the elderly or respite to their caregivers.

Financial planners surely need to be up to speed on the documents our clients should have, but I think we have an opportunity to help in areas where it can have a very profound personal impact. Take some time to get out in your community and meet people providing services to seniors and caregivers. Someone will need them soon. 

Dan Moisand, CFP, has been featured as one of America’s top independent financial advisors by Financial Planning, Financial Advisor, Investment Advisor, Investment News, Journal of Financial Planning, Accounting Today, Research, Wealth Manager, and Worth magazines. He practices in Melbourne, Fla. You can reach him at www.moisandfitzgerald.com.