Ham or turkey, mashed potatoes and pie — that’s many people's idea of a great holiday meal. Discussions about cognitive decline? Not so much. But maybe this year, that's exactly what you should be adding to your family get-together.
For many families, the holidays are the rare occasion when the entire clan gathers under one roof, making it a great opportunity to delve into important family matters. As a financial planner, I've seen my fair share of heart-wrenching situations stemming from a lack of planning for cognitive decline. It ranges from an older woman found wandering her neighborhood late at night to a grandfather whose driving posed significant risk. Confronting these events can throw families into crisis, forcing them to make critical life decisions in a matter of days. Regrettably, hurried decisions rarely make for thoughtful evaluation.
And yet, cognitive decline is more common than you might realize, which should make it a top priority for every family. Consider this: Roughly two out of three people experience some level of cognitive decline by the time they reach 70. And the number of new dementia diagnoses is expected to double by 2050, according to the Alzheimer's Association.
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Against this backdrop, it's imperative that families make plans, not only to safeguard the well-being of their elders, but also to provide adult children with a roadmap for handling the illness. Without your explicit guidance, your children may find themselves second-guessing their decisions and potentially making choices that contradict your wishes.
Tread gently
Cognitive decline is a touchy subject for everyone. Your spouse may not want to think about becoming mentally incapacitated. And your adult children may have a hard time coming to terms with their parents' aging. Don't be surprised if your desire for a candid conversation isn't greeted with open arms.
That said, there are ways to ease into the topic. For instance, give your family fair warning before they arrive that you'd like to start focusing on the possibility of cognitive impairment. The last thing you want to do is catch everyone off guard just as they're digging into their holiday meals. Reassure your loved ones that you're not expecting to make major decisions at the table.
Give them some options for when they'd like to have the conversation. Would they like to take a walk while the ham is roasting to bounce a few ideas around? Would they like to do some journaling around the topic beforehand and share their thoughts? Would they prefer to work with an elder care specialist who can guide your family through all the different aspects that cognitive impairment could entail?
This way, you'll be able to start the conversation you want to have, but still give your family some agency in how they want to proceed.
Take baby steps
It's unrealistic to expect that you'll finalize all your major decisions during this holiday visit. Instead, use this time to talk about the big picture.
Explain what type of care you'd like to have if you're no longer able to care for yourself. Do you want to stay at home? Are you open to moving to an assisted care facility that can provide additional support? Or do you hope to move in with one of your children?
Additionally, let your children know about any financial arrangements you've made for your care, such as savings, a long-term care insurance policy, an annuity or a reverse mortgage. The total lifetime cost of caring for someone with dementia is $392,874, according to the Alzheimer's Association, so your family will need to understand how what money will be available.
You can also talk about what the triggers might be that will necessitate your children stepping in. Many people start displaying signs of cognitive impairment well before they have a formal diagnosis. These early signs take many different forms, from making poor financial decisions to neglecting personal hygiene or becoming disoriented in unfamiliar situations.
Plan before you need it
In the best of circumstances, your holiday conversation will be a springboard for further action. Over the next few months, take steps to put in place important legal documents (if you don't already have them) that can help protect your health and finances if, and when, you need it.
These are the documents you should consider:
- Durable power of attorney. This empowers someone you trust to act on your behalf in financial and legal matters. It's important the power of attorney document be “durable," making it valid even after the person becomes incapacitated and can no longer make legal decisions. A note of caution on powers of attorney that are “springing," which take effect only once there is a medical diagnosis of dementia. These require two doctors to sign off on the diagnosis, which can take up valuable time when important decisions need to be made.
- Power of attorney for health care. You can empower someone else to make medical decisions on your behalf if you are unable to. This includes making decisions around doctors, treatments, where to receive care and end-of-life decisions in the event that you are incapacitated.
- Living will. A living will allows you to spell out the type of care you want in the event that you are incapacitated and unable to communicate your wishes.
- Standard will. This is a basic estate planning document that lays out what should happen with your assets once you die. You must choose an executor (the person who will manage the estate and carry out your wishes) and beneficiaries (the people who will receive the assets once your estate is settled). A standard will is only effective upon death.
It's essential to create these documents while you are still competent and capable of making informed decisions. Once you experience cognitive decline, you may lose the legal capacity to establish or modify these documents. Consult with an attorney who specializes in estate planning and elder law to create documents that are legally valid and aligned with your specific needs and circumstances.
Find your people
Another important component of your plan is to assign roles for carrying out the different aspects of your care. Choosing roles for adult children can be complex and can stir up old family dynamics. What's more, it also involves careful consideration of your children's abilities and circumstances.
A child who is good with numbers might be a good fit to make financial decisions, while a child who displays deep reserves of emotional intelligence might make the most sound medical decisions on your behalf. But it's also possible that none of your children has the right skills or the ability to take on these roles.
If that's the case, consider working with a corporate trustee who can handle the business side of your care. That can relieve your family members from the burden of managing those aspects, so they are free to give you their emotional support and love.
Bottom line
While your family may be looking forward to the holidays for a chance to relax, eat good food and be together, use this precious time to also initiate important family conversations about cognitive decline. It may feel awkward to broach this topic during a festive time, but cognitive decline is a common issue, and planning for it is essential. By addressing it openly and proactively this holiday season, you can enjoy future holiday celebrations without having it hanging over you.
Securities offered through Cetera Advisor Networks LLC, Member FINRA/SIPC. Investment advisory services offered through CWM, LLC, an SEC Registered Investment Advisor. Cetera Advisor Networks LLC is under separate ownership from any other named entity. Carson Partners, a division of CWM, LLC, is a nationwide partnership of advisors, address 14600 Branch St. Omaha, NE 68154. Erin is a non-registered associate of Cetera Advisor Networks LLC.
The opinions contained in this material are those of the author, and not a recommendation or solicitation to buy or sell investment products. This information is from sources believed to be reliable, but Cetera Advisor Networks LLC cannot guarantee or represent that it is accurate or complete.
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