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.