Helping Advisors Deal With the Uncomfortable but Inevitable

The statistics prove the need: only 50% of baby boomers have a will, Florian reported, and among working women, 72% do not have a will. One in eight people over the age of 65 have dementia, and 22% of people over 71 have some form of MCI, or mild cognitive impairment. Florian also dispelled some common myths about aging, dementia and dying. "Dementia is not normal," she said, but rather is caused by one of 18 different diseases to which we are more susceptible as we age. Dementia is not what she called "regular forgetfulness," which is common in most people, but which can also be exacerbated by medications, by drug interactions or by other diseases.

She defines demenia as a "severe loss of thinking, memory and reasoning skills, such that the person's ability" to carry out the activities of daily living (ADLs) "is compromised or destroyed." While she thinks living wills can be a good document to create, she stressed that they are "not a legal document," but rather are "imperfect but best ways to put into writing what you want" as you age. (A recent poll showed that 64% of boomers don't have living wills or any other form of health care directive.) A living will is not, she said, "a way to pull the plug on Grandma; she can get any treatment she wants."

Moreover, there is a legal hierarchy among documents dealing with health care, and the legality of those documents varies widely from state to state: there are no federal living will documents, or a document called the Five Wishes, which Florian "highly recommends," or POLST (Physician's Order of Life Sustaining Treatment). Think that checking a box on your driver's license will ensure your organs will be donated? Think again, she said, because "the family can override" that directive. Instead, sign a state's organ donor registry. Have you noticed how in the movies and on TV people who are given CPR usually recover? It ain't so: only about 25% of the time does such resuscitation work, and when applied to the elderly or frail, CPR only works about 10% of the time.

Speaking of Do Not Resuscitate/Do Not Intubate (DRN/DNI) documents, she said that the default procedure followed by EMTs and other medical professionals is to attempt to resuscitate a person in cardiac arrest absent the presence of a document to the contrary. A tip on DNR documents: most EMTs, Florian said, will look in a patient's refrigerator freezer for such a document before attempting to resuscitate a patient at their home, since that is considered the safest place in the house for important documents.

Back to the business. It's when you are working with clients on these health care and end-of-life issues that you will be introduced to the client's "inner circle" of friends and next generation of family, Florian says. Those are the people, she suggested, that you meet over coffee to explain what you've done for the client. "Don't do business" at those meetings, she urged, but instead ask about them and their interests and remain in touch, lightly. Florian is quick to point out that she is not an attorney (though she is a thanatologist; look it up) and that advisors should be sure to work with a client's attorney on all legal matters. She also suggests that when an advisor works with a client on documents like the Five Wishes, living wills or health care proxies that the advisor have the client sign a separate document that lists those documents the client has signed and which they have declined to sign, which can be helpful should family members threaten legal action after a client's fall into dementia or death.

Florian's website, provides more information on the resources her firm offers. Like advisors, she's passionate about her work, but also practical. If you get a chance to hear her speak or take advantage of her classes, grab that chance. You'll help build your practice, get closer to clients and be providing an important humanitarian service.