By: Kevin Doll, CFP®
Watching family members age is never easy but helping them with Alzheimer’s and dementia can be especially challenging financially and emotionally. The relationship and conversations will likely be changed forever and unfortunately you may be the only one who realizes it. It can be hard to maintain a tender relationship given the struggles and ever-changing circumstances as the disease progresses, but hopefully the below can provide some ideas to help navigate this journey.
Alzheimer’s is a specific disease and the most common cause of dementia. The earliest signs of Alzheimer’s are trouble remembering new information. Dementia is a blanket term used to describe various disorders of the brain, all of which result in impairment of intellect, memory and personality. This is usually accompanied by changes in behavior and the gradual loss of the skills required to cope with the activities of daily living.
There are several financial considerations to consider as you begin noticing a decline in memory or other signs of dementia. Some of these should be dealt with as part of their estate planning and ahead of any memory issues because implementing changes after the fact can be difficult. The below is not an exhaustive list and there is certainly more to examine about each. Consider discussing the following points with family, a financial planner, your family’s accountant and estate attorney.
- Make sure your loved one has updated estate documents including a Will, health care power of attorney and living will. In some cases, a revocable or irrevocable trust can make sense.
- The most important document will likely be the Power of Attorney naming one or more trusted friends or family members who can transact business and pay bills once an issue arises.
- Implement the Power of Attorney when you are no longer confident in their financial decision making.
- Reduce the number of credit cards and/or bank accounts to one or two.
- Consider imposing an upper limit on transaction amounts or requiring two signatures for transactions over a certain amount if your loved one will maintain access to accounts.
- When bills start to be missed or unusual transactions start to be made, consider removing or limiting access to bank accounts and/or credit cards.
- Automate transactions to be deposited and withdrawn on the same day every month.
- Change the settings on their cell phone to permit calls only from their contact list to limit fraud or being persuaded by robocalls and telemarketers.
- Be mindful of the rules your preferred nursing home has regarding assets and income. For example, some require proof of at least 3 years of care to guarantee a Medicaid bed should they run out of assets.
- Be vigilant in reviewing all of their financial accounts.
- Make sure required distributions from retirement accounts are made.
- Have a trusted accountant prepare their tax returns and be sure to provide any costs of care that may be deductible.
Moving a family member to an assisted living, skilled nursing, or memory care facility is often the most contentious step of this process. Understandably, most people want to spend their final years in a place they know where they feel a sense of independence. It is common to feel a sense of guilt which may only increase if your family member has a hard time adjusting to their new environment. It is important to understand these feelings are natural and you are doing what is in the best interest of your loved one to keep them safe.
- Consider furnishing their new home with familiar furniture, a favorite chair, photos, books, and other items that make them feel home.
- Provide caretakers with highlights of their life including their interests and hobbies to help them make your loved one feel more welcome and engaged.
- Ask the staff to comment on the above.
Visiting loved ones can be hard. I remember feeling guilty I didn’t spend more time with my grandfather because it was hard to see him like that and I felt like he wouldn’t know who I was anyway. But it is just as important for you to see them as it is for them to see you. It’s definitely hard to watch and you may have a hard time coping, but coming to terms with these changes and offering your time, companionship, and support will be an important part of both your journeys. Know every visit will be different and some will be harder than others. Try to appreciate the small wins like a smile, laugh, joke, or even just their eyes in that moment they recognize you. While they may not recognize you at times, people always appreciate having visitors and if nothing else, you can provide your loved one with pleasure and joy while you’re there.
Try some of these tips during your visit.
- Keep your loved one informed about family news.
- Bring pictures or scrapbooks and converse about good times and significant events.
- Sit outside on the patio.
- Bring a game they may have enjoyed in the past.
- Bring other family members and friends to visit.
- Hold their hand, paint their nails, style their hair.
- Watch a favorite movie or share videos of your family.
- Listen to their favorite music – research shows music transcends people unlike anything else.
Losing their independence is probably the hardest part for dementia patients to cope with. Not being able to cook the meals they like, spend money in ways they prefer, lock their door, drive to the grocery store or come and go as they please is tough to accept and adjust to. This is made worse when you start treating them like a child telling them what to do and when to do it. Demanding they sit or eat or use their cane can highlight their loss of independence and while your instructions may be in their best interest, asking questions can give them more sense of control. Try asking questions instead. Would you like to use your walker? Can I get you some juice? Would you like to go to the patio? How you communicate is also important, especially as your loved one loses their ability to talk. Research suggests 55% of communication is visual, 38% tone (this one can be hard at times, so try to maintain a calm demeaner) and only 7% verbal. Try these suggestions to improve communication.
- Use simple language and avoid the use of jargon, complicated words and long explanations.
- Avoid asking why questions as the reasoning needed to answer them may be difficult and agitate them when they don’t have an answer.
- Listen (we’re all really good at this right?). Keep your cell phones off and give them your full attention.
- Try not to finish their sentences, talk down to them or patronize them by using childish language.
- Talk at a slower pace.
- Most important, do not get upset or angry with them and maintain a calm presence and tone.
That last point is worth repeating. The changes in your parent or loved one can be shocking and emotionally hard to adapt to. Perhaps they no longer want to bathe, brush their teeth, clean their house or take their medicine. This can be difficult to understand, especially if these were activities they did consistently before. Shaming them doesn’t change their decision and may eventually make you feel guilty for trying to influence a behavior through shaming. It’s important to realize they aren’t trying to be difficult or combative, but rather they do not understand what you’re asking of them or why you are asking.
For anyone going through this or preparing to go through this with your loved one, my heart goes out to you. It is a long and sometimes difficult road, but I hope something above can make it a little easier. I wish for peace to you and your family and feel welcome to reach out if I can provide assistance as you navigate this terrible disease.
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