Financial elder abuse is much more common than most of us wish to think. Some believe that it will be the greatest crime of the 21st Century. This abuse doesn't always come from 'scammers' outside the house or on the phone. Often, sadly, it comes from relatives of the elder. When you add dementia to the mix, it's a terrible problem.
Please join us in San Mateo on Thursday, September 11th for an important talk about early dementia and financial challenges. How would dementia affect your family’s wealth? What happens if an elder starts giving money away to anyone who asks? What if they start gambling and can’t seem to stop? What are the risk factors in not planning financial safeguards? How does elder financial abuse happen- and how prevalent is it? These and many other questions will be discussed with Dr. Landsverk and Certified Financial Planner Ben Pettigrew in an interactive discussion.• 12:00-2:00 • Lunch provided by Les Koonce and Ben Pettigrew of LPL Financial -Contact Adrienne Galvez at (650) 321-6068 or Adrienne.firstname.lastname@example.org
Location: Franklin Templeton Investment Headquarters at One Franklin Parkway, San Mateo, Building 920, First Floor, H.L. Jamison Auditorium
This is the first question I ask of the patients I see as a geriatrician doing house calls in the San Francisco Bay Area. So often, I consult with the children of patients who are incredibly worried about their parents. They want their parents to be safe. They don’t want predators to steal all their parents’ assets. They want to be sensible. They have the best of intentions. But they forget to ask, what does Mom, or Dad, really enjoy? What were they priorities before the dementia set in?
A few years ago, I treated one patient who was relatively young, only 68 years old. He suffered from alcoholic dementia. After his wife’s death, he began drinking even more heavily. His behavior and anger became erratic. Twice, he ended up in the hospital with alcohol-related illnesses. Finally, his family placed him in a dementia facility filled with patients 15 to 20 years older.
The patient balked. He refused to participate in the life of the facility, shunning group activities. He voted with his feet; and he voted “No.” While impaired, this man still saw himself as active and independent, an avid biker. “I only want to get on my bike and go down the coast,” he said. “I like fast cars and fast women.”
A year passed. The man became increasingly unhappy, angry and aggressive.
The man’s sons found themselves at a loss. Finally, they balanced the risks of a motorbike against their Dad’s quality of life. They decided to ask their father if he would like a dirt bike. He said he would.
Actually, this patient never ended up doing the physical therapy necessary to become strong enough to ride a motorcycle again. But his sons’ act of taking his preferences seriously turned the corner for this man. He began to go golfing and his agitation decreased as he became busy with outings and things that he enjoyed.
I’m not saying that impaired elders should do whatever they want. I am saying that it’s our duty as medical caregivers, and as family members to honor dementia patients. What did they like to do in the past? What do they want to do now? Remember that, while impaired, dementia patients still have personalities and preferences. There’s a person in there.
Always try to take personality and preference into account when you’re making decisions for your elder. Does your parent adamantly want to stay at home? If they have the resources to do that safely, let them. Does your elder have a fear and loathing of hospitals? Then try to arrange for care at home. In addition to house call docs like me, you can arrange for all kinds of care at home: x-rays, podiatry, dentistry, nursing check-ups. Does your Dad insist on staying in control of his finances? Maybe you can get by with the half-step of hiring a bill payer to keep things organized while Dad still maintains a feeling of control by signing the checks.
The answers will be different for each family: Maybe Mom wants to buy yet another knitting kit, to join the 24 stacked in the hall. Maybe Dad no longer can drive safely, but would enjoy rides with a hired driver.
Just remember to ask the question: What makes life worth living? Your elders will be happier if you do.
Wishing you and yours a happy, healthy Thanksgiving celebration. Elizabeth Landsverk, M.D. Specialist in Geriatrics
I was recently corresponding with David Tate, a San Francisco Attorney who specializes in estates, trusts and elder/disability litigation. He told me that he’s seeing more cases of conservators having to justify the need for dementia care, and also the kind of dementia care being provided. Here are some of the questions that conservators may be called upon to answer by a Probate Court:
• The nature of the medical condition which requires treatment.
• The recommended course of medical treatment which is considered to be medically appropriate.
• The threat to the health of the conservatee if authorization to the consent of the recommended course of treatment is delayed or denied by the Court.
• The predictable or probable outcome of the recommended course of treatment.
• The medically available alternatives, if any, to the course of treatment recommended.
• Efforts made to obtain an informed consent from the conservatee.
Honestly, it’s a good idea to ask these sorts of questions no matter what medical condition you’re facing. But families and elder care specialists should remember to ask these kinds of questions when they’re planning a course of treatment for dementia.
Money poses one of the most difficult issues for patients with dementia and the people who love them. I’ve met families in which one person has helped manage the elder’s finances for a reasonable fee. In other cases, families hire a “fiduciary,” a licensed professional who can help manage an elders bills and bank accounts. Too often, unfortunately, it’s just not that easy. Older people with early stage dementia may resist all attempts at help with money management. They may feel that their relatives are trying to take over, or steal from them. Paranoia is a common symptom of dementia.
Some families just throw up their hands. They become convinced of the idea that nothing can be done. They wait for the big crisis, a hospitalization, or a clear and catastrophic decline of mental ability.
I urge all families to try to face the difficult issue of money as soon as they suspect that an elder has a problem. Primary care doctors, attorneys and social workers may find the diagnosis of dementia difficult, but I can tell you from experience that scammers are very, very good at spotting an elder whose judgment has begun to falter. I’ve seen cases where elders with early dementia sell their house for pennies on the dollar to a scammer, or let their caregivers sell all the furniture out of their house, or write six-figure checks to people they barely know.
Don’t let this happen to your elder. The early stages of dementia, when things aren’t exactly clear, may be the most financially dangerous for elders. Get help as soon as you think there’s a problem.