I recently attended a reunion for Satellite Beach High School from which my wife and I graduated back in 1985. It was a lovely event that allowed me to reconnect with many old friends. I got to play bad golf with my old teammates from our bad golf team, hang out on the beach and of course reminisce about the old days.

My how things have changed. Some change is good. We are all grateful that the wardrobes and hairstyles of the mid-80s disappeared and, my goodness, we are thankful there isn’t any cell phone evidence of some of our displays of stupidity. We Scorpions laughed a lot over the weekend, but we also lamented other changes.

The list of departed classmates is longer. Staying up late takes a harsher toll. Several times, we found ourselves comparing medications and complaining about the government like a bunch of elderly curmudgeons. Sadly, almost everyone I talked to told a tale about the trial and tribulations of helping their parents or other older adult manage health issues.

Many of these stories will be familiar to financial planners reading this column.

Billy’s mom was hospitalized due to sepsis, a deadly blood infection. As is commonly the case, she had significant cognitive and physical impairments as a result of the infection and was sent to a rehab center to recover. Billy found he could not get his mom’s household bills paid because no one had authority to disburse money from her checking account other than her.  

Chris’s mom passed away in 2017, but Chris just now finished up the estate settlement despite the estate being relatively simple. The issues came about when the estate was probated. Chris’s “dad” tried to contest the will and claim some assets. The quotations are used here because he left Chris and her mom when Chris was in diapers. Chris has no relationship with him and hadn’t spoken to, heard from or even heard about the man since she was in college over 30 years ago.

Your head is probably going the same place mine did during these conversations. Both these situations were preventable with some planning and proper documentation. Billy’s mom could have put her accounts in a trust, executed a power of attorney, or added a joint owner. All of those options have pros and cons, of course, but all could have facilitated bill paying.

Fortunately, Billy’s mom recovered well and was able to get her documents squared away. A couple of years later she fell ill for an extended period and Billy was able to manage her affairs before her passing.

Chris’s plight may have been prevented if her mom hadn’t relied strictly upon a will for the asset transfers. The will turned out to be fine. It said what she wanted it to and was properly executed. In the end, the assets were eventually distributed as her mom wanted but between court costs, attorney’s fees, the seemingly endless delays, and the stress of the confrontation, the toll was significant.

Things would very likely have been different had Chris’s mom created and funded a garden variety living trust. When dad saw the obit, he could still have caused some trouble, but he would have found far less info in the public records, which is apparently what got him going down this path.

Those stories were frustrating for me to hear but even worse were the stories people told about care giving that even terrific documents do not really address.

The documents don’t help people deal with uncooperative seniors. This is a particularly difficult issue when cognitive decline is involved. In my own family, as my dad’s dementia got worse, he would not do many things he was supposed to do. For instance, when he passed, we found lots of pills he stashed in weird places rather than swallowing them.

My mom was his primary caregiver, and it took a toll on her. By the time dad died, she needed a new hip. It took two and a half years for her to get the surgery. Some of the delay was not her doing but much of it was because she was not doing things she needed to do. She did not want any of her children to go to some of her medical appointments and she often would deny she had any health issues or that she wasn’t following the doctor’s recommendations.

It can be extremely difficult to try to help someone that won’t help themselves. As I can attest, the helpers need help helping. When I was particularly frustrated, I reached out for some tips from my friend Carolyn McClanahan, MD, CFP, who has been on a mission to help financial planners help their clients with these matters for a couple of decades now. She regularly writes and speaks on the intersection of health and personal finance. You can find a compendium of her columns and more information at www.carolynmcclanahan.com

Carolyn started by imparting to me the importance of understanding what is actually going on medically and getting the information directly from the medical personnel involved is the best way to get good information. Patients don’t retain much of what they are told, it can be complicated and even those that try to convey information accurately can have trouble doing so.

Understanding why a care receiver might be uncooperative is helpful. The person that needs to address the underlying issue is the named health-care surrogate. If there is no surrogate, one needs to be put in place as soon as possible. This is usually a family member, typically one of the care receiver’s adult children.

With respect to not wanting anyone in medical appointments, a suggested approach for the surrogate is to basically say to the parent, “I really love you and want to make sure we all understand what is going on with your health care. In my experience, health-care conversations can be complicated, and by me being there, it reduces the chance of miscommunication. Can you please share with me why you don’t want me in all of your appointments?”

The surrogate should expect some common answers. For instance, some say they don’t want to burden their child. Others feel like the children will take over and others are embarrassed that they have problems they can’t fix or control. Often, if that reason is addressed, the care receiver will be more open to help, and the surrogate can get the information that is needed to better handle matters.

Carolyn offered a few examples:
“Mom, helping you isn’t a burden at all. It is a much bigger burden worrying about you and not knowing what is going on with you.”

“Mom, you are totally in charge of your health decisions. My bigger concern is understanding what is going on so I can help you if something ever happens where you can’t make decisions for yourself.”

“Mom, we all have our issues, and no one is perfect, especially when it comes to taking care of ourselves. There is no reason to be embarrassed and I promise I won’t share anything I hear with anyone else.”

If the attempt at those conversations doesn’t work, a properly named health-care surrogate can write a letter/email to the doctor stating the concerns. In that letter, they should note that they are the health-care surrogate, they love their parent, want to do a good job helping them, and that they are worried because the parent is not letting them be involved and know what is going on. The letter should express that privacy issues are known and understood and ask the doctor if they would please encourage the parent to involve the surrogate so the surrogate can be more prepared to take over in the event help is needed.

If the elder still refuses to let any of the children get involved, it is worth asking if a geriatric care manager could be hired. A third party who is more objective may be listened to when people close to the elder parent are dismissed by the parent.

What to do when none of that works?  McClanahan says, “If the situation gets dire and they are not doing well, ask the doctor to intervene directly. If that doesn’t work, and they won’t allow you to bring in a geriatric care manager, your next step would be to get help determining capacity.”

“Dire” is a good word here. In Florida, we have the Baker Act for such circumstances, but the bar is very high for the courts to invoke it. The best course is to create a plan, not just to get documents in place but to discuss health and quality of life situations when everyone is well. That won’t prevent all issues, but it can set the psychological tone for how people will act in the future.

Dan Moisand, CFP, has been featured as one of America’s top independent financial planners 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 [email protected].