 |
Daniel Reingold, President & CEO-
Hebrew Home in
Riverdale, N.Y. |
MIDWAY
through the film “Still Alice,” which tracks the growing grip of
Alzheimer’s on a 50-something Columbia University professor, that
professor, played by Julianne Moore, stands at a lectern to address an
Alzheimer’s conference. She is holding a yellow highlighter and a copy
of her speech.
She
proceeds to talk about her struggles with the disease and how she never
knows what will vanish from her memory and when. It’s a lucid,
affecting talk, and the viewer would be hard pressed to know anything
was wrong with her, if not for the highlighter. She uses it to track her
every word so she doesn’t read the same sentence over and over again.
For
anyone who has ever watched a family member disappear into Alzheimer’s,
Ms. Moore’s performance is gripping, particularly as her tricks to
stall her decline inevitably fail and the later stages of the disease
consume her.
Yet
the movie is also a great vessel to explore many of the financial
issues that families need to address when someone is diagnosed with
Alzheimer’s or any other disease that causes cognitive impairment.
Ms.
Moore’s character has one big advantage over many people who get
Alzheimer’s. She and her husband, played by Alec Baldwin, are affluent.
They teach at Columbia and have raised three children in what looks like
a brownstone near campus. One child is in medical school, another in
law school and a third, to the chagrin of her mother, has moved to Los
Angeles to become an actress.
When
she grows concerned over her own forgetfulness, she has the wherewithal
to be seen by a top neurologist. She thinks she has a brain tumor;
after a series of tests she finds out it’s Alzheimer’s — a diagnosis she
hears about in her husband’s presence.
But stories from
financial advisers indicate other families are not so fortunate.
Thomas
Mingone, managing partner at Capital Management Group of New York, said
he had clients whose mental slide had been apparent to the advisers,
accountants and lawyers in the room but not to the client. Since
advisers are bound by a fiduciary duty to protect their clients’
privacy, Mr. Mingone said he can’t simply call up their children to let
them know.
With
a client who seems to be slipping but lives alone and sees family
members infrequently, Mr. Mingone said he suggests a family meeting,
which allows him to connect with his client’s children. Other times, he
said, just asking clients how they are doing brings the problem out.
“Sometimes when you bring this up with clients, it’s a relief to them,” he said.
Once
the family is brought in — if there is a family — legal documents can
be tended to and the family’s ability to manage Alzheimer’s care can be
assessed.
In
the film, Ms. Moore’s character gets bad reviews for her teaching and
is confronted by her department chairman. She tells him she has
Alzheimer’s; a few scenes later, she and her husband are on a beach and
she appears to be receiving disability payments.
It’s not always this easy. Not everyone has disability or long-term care
insurance; even those who do may not have enough. Advisers encourage people to buy it, but it costs thousands of dollars a year.
Short
of having that coverage, an up-to-date estate plan with a durable power
of attorney and relevant health care documents is essential. “It’s not
that people don’t have an estate plan,” said Richard A. Behrendt,
director of
estate planning
at Annex Wealth Management. “It’s that it’s a will that was done 20
years ago when their kids were 3 and 5. It’s not about who’s going to
get your stuff. It’s ‘If I can’t communicate it’s going to be tough to
make decisions with my health care providers.’”
And
part of that conversation, Mr. Behrendt said, should be pointing out
that nursing home care for an Alzheimer’s patient can run around $80,000
a year and last for a decade or more, depending on the person’s age.
“You can have someone with a pretty sizable
retirement
account that just gets wiped out by an illness like this,” he said.
“Less than 10 percent of adult Americans have some long-term care
insurance.”
Then
there are the family dynamics. Daniel Reingold, president and chief
executive of the Hebrew Home in Riverdale, N.Y., said of his three
brothers: “Each of us has different parents. They happen to be the same
people — unless we describe them.”
That
dynamic is on display in “Still Alice”: The daughter in law school is
married and has twins after struggling to conceive; the son is in
medical school; the daughter acting in Los Angeles keeps her distance
from both and seems to get along best with her father.
Of
course, that siblings fight and harbor grudges from childhood is news
to no one. But those adult children also don’t always respect their
parents’ wishes. Consider when a person with Alzheimer’s wants to have a
say in when he or she dies.
 |
| In "Still Alice," Julianne Moore |
Ms.
Moore’s character makes a video instructing her future debilitated self
on how to take pills hidden in her drawer to commit suicide. The
carefully detailed plan is the product of a lucid mind, something she no
longer possesses when she later finds the video. Her effort fails when
she is interrupted and forgets what she was doing.
William
Zabel, a leading trusts and estates lawyer and a founding partner of
the law firm Schulte Roth & Zabel, said it was difficult for people
in the United States to chose dignified death on their terms. One of his
clients wanted him to be with her when she took her own life at the
Carlyle Hotel in Manhattan, he said. But doing so would have led to his
disbarment.
But
after the request, a lawyer at his firm put together a 21-page memo on
right-to-die laws around the world. It is a difficult subject, and not
just because of the moral issues. There are the logistics beyond the
actual act. How, for example, would someone with Alzheimer’s get to a
country that allows assisted suicide when he or she has only moments of
lucidity, or find a doctor in the United States who might administer a
strong dose of morphine?
His
firm’s memo includes a “dementia provision,” where people can elect
that a list of life-sustaining treatments be withheld and ask that their
wishes regarding the end of their lives be upheld. It’s a strongly
worded statement, but Mr. Zabel said it might not hold up in court,
particularly in states like New York where withholding food and water
from a person is illegal.
“In
one case, I filmed the decedent about why he wanted to die in a
dignified way,” Mr. Zabel said. “Just writing a letter is not the same
as seeing it on film, particularly where there are family members who
particularly religious and particularly not. You get into this moral
quandary of assisted suicide versus dignified death.”
Just
as vexing is the abuse of someone with Alzheimer’s by a family member,
caregiver or grifter. Hebrew Home established the first shelter for
abused elderly people in 2005, and Mr. Reingold said about 60 percent of
its clients suffered from some form of dementia.
“There
is almost always an underlying financial issue — Mom didn’t give me the
money so I pushed her down the stairs,” Mr. Reingold said. “Each case
is different, but what’s typical is there is always coercion and
control.”
Red
flags include an elderly relative suddenly spending time with a new,
younger friend — or an adult child or distant relative moving in.
Putting good checks in place is not hard but it requires foresight:
regular visits by someone who is trusted to monitor someone’s
appearance, automated deposits and bill payments, and conversations with
bank tellers or doormen who know the elderly person’s patterns.
For
people who are alone and have to rely on a durable power of attorney,
Mr. Reingold said having two was a good check, one for the person and
one for the property.
Here
was where the professor in “Still Alice” was fortunate: Her family put
aside their differences and together figured out a way to care for her.
It’s a good Hollywood ending.
Full Article & Source:
In Alzheimer’s Cases, Financial Ruin and Abuse Are Always Lurking
