Supporting clients with dementia, and their caregivers

Over the course of a 40-minute meeting with her financial advisor, Colleen Dolce’s 79-year-old mother tends to repeat herself.

“She asks about [the advisor’s] family every five minutes, and expresses her utter delight at how well they’re doing, every time,” Dolce says. “She’ll leave that meeting and an hour later not remember she ever had it.”

And still, says Dolce, whose mom was diagnosed with dementia a couple of years ago, her mom’s advisor always speaks directly to his client, and not to Colleen or her siblings, who drive their mom to her appointments from her home in an assisted-living centre in Thunder Bay, Ont., and sit in on them.

“I really appreciate that,” she says. “In the present moment, my mother has the wherewithal to be hurt or insulted that we’re talking over her or behind her back. You hear about dementia patients acting paranoid—well, I can’t think of a better reason to act paranoid than feeling like people are talking about you or over you.”

Read: Managing assets for a parent with Alzheimer’s

According to the Alzheimer Society of Canada, more than half a million Canadians are living with dementia, and that number will rise to close to 1 million within 15 years. That means advisors will increasingly serve clients whose capacity to understand and make financial decisions is deteriorating. And while advisors may be comfortable navigating the financial, ethical and administrative tasks associated with dementia—including powers of attorney, joint accounts, wills, permissions, watching for signs of undue influence—the interpersonal sphere also requires managing.

Dementia is an overarching term for a set of symptoms—memory loss, confusion and disorientation, difficulty performing familiar tasks, impaired judgment, personality changes and sometimes distressful behaviours like aggression, wandering or agitation—that can be caused by a variety of brain disorders, including Alzheimer’s and Parkinson’s diseases. It is a progressive condition with no cure.

There’s a tremendous amount of stigma surrounding dementia, says Mary Schulz, director of education at the Alzheimer Society of Canada. “People see it as a personal failing, and may not want to talk about it.”

Still, advisors are obligated to acknowledge the dementia elephant in the room. That’s a conversation that requires both delicacy and directness, says Schulz.

Read: Help clients design end-of-life plans

If a client seems to be struggling to understand, or is making decisions that seem at odds with their risk tolerance or personality, gently acknowledge the situation: “You know, I’m noticing that you’re having more trouble with our conversations than you have in the past.” Or, “I’m a bit concerned because you’ve asked me to withdraw money that we had agreed you weren’t going to touch.”

Those statements open the door, says Schulz, to asking what a client needs and how you can be most helpful. “Is there anything that you want to tell me about how things are going? Is there anything you’re scared of? How can I make things easier for you?”

As a client’s condition worsens, substitute decision-makers will take an increasingly active role in meetings. That doesn’t mean ignoring a client who still wants to be involved or gets satisfaction from these interactions, says Schulz. Like Dolce’s mother’s advisor, it’s important to address clients directly about their finances, asking them questions and making eye contact—even if the attorney is the one ultimately making the decisions.

Advisors should also remember for whom they’re making decisions, says Paul Bourbonniere, an investment advisor with Polson Bourbonniere Derby Wealth Management, HollisWealth, a division of Industrial Alliance Securities Inc. in Markham, Ont. “If the attorney is younger and loves equities and mom is 92 and very conservative, then you need to remember that it’s mom’s portfolio and make decisions accordingly.”

Advisors, he says, have both the obligation and the authority to refuse any trade instructions they deem unsuitable for the client. That might mean that an advisor needs to educate the attorney about the portfolio.

“Just because somebody has POA for finances, that doesn’t mean that they have experience making financial decisions,” says Bourbonniere. “So we can provide some education on the background and philosophy of the portfolio, and coaching so that the attorney understands that they are acting on the client’s behalf rather than according to their personal appetite for risk. That can be very helpful.”

Managing a meeting

For a client with dementia who repeats a question over and over, try to answer in a few different ways, says Schulz, and then do your best to redirect: “You know, I’ve answered that question a few times, and we still have a couple more things to talk about. If you’re still worried about that when we’re done, let’s come back to it at the end of the meeting.”

Sometimes, a client with dementia may make assertions that seem untrue or outright bizarre. Don’t discount these assertions—“The neighbour is stealing all my money!”—outright, says Pat Irwin, president of Elder Care Canada, which provides advice and action consulting for adult children of aging parents. Maybe the neighbour (or a spouse, child, or caretaker) is stealing the client’s money; certainly, people with dementia are highly vulnerable to financial abuse and undue influence. Do your best to investigate those kinds of claims before ruling them out.

If a client’s assertions are obviously out of line with reality—perhaps a person who is very financially well off is convinced it’s the Great Depression and she doesn’t have enough money to buy food—you could gently correct her. If she stays on her version of the facts, though, don’t argue or ask questions like, “Don’t you remember?” That line of conversation, says Irwin, “demeans both of you. It serves no purpose. And any correction that you make will be forgotten almost immediately.”

Instead, suggests Schulz, enter into the person’s reality, and engage with the feelings rather than the facts: “‘OK, it’s the Depression. What are you worried about? Why are you telling me you have no money?’ Maybe she’ll tell you that every time she looks in her purse there’s no money in it. And then you can brainstorm solutions”—like ensuring she always has a few loonies, or even some play money, in her bag. Depending on the client’s capacity, a bank card with access to an account with limited funds and withdrawals for occasional spending may be appropriate.

It can also mean providing emotional support, information, and referrals to government and community organizations, like the Alzheimer Society, that can help provide assistance and social services like Meals on Wheels, dementia daycare programs, or occupational therapy. “We say to caregivers, ‘This is not the time for stiff upper lips,” says Schulz. “We tell them that it’s actually a sign of strength to say that you need help. Why not say to a client, ‘Let’s call together and set up that appointment right now?’”

Some advisors choose to maintain relationships with long-time clients, even when dementia has progressed to the point where they may no longer speak much, or even recognize the advisor.

Bourbonniere recalls a recent visit to an elderly client with advanced dementia, who now lives in a nursing home. “I went in, and there was a glimmer of recognition. He said a couple of things that indicated that he absolutely remembered who I was and what I did. His son was there, and he was very, very grateful to be able to see that Dad had had a good day, that he did remember, that his father still had meaningful relationships.”

Read: Does your elderly client need dispute resolution?

Tips to make your practice friendly for clients with dementia

• Send a courtesy reminder with a checklist of what to bring to a meeting; follow up by phone when possible
• Tactfully ask if your client has made travel arrangements for the meeting
• Sending documents for signature to the client in advance of the appointment can be helpful (printed in large font in some cases)
• Encourage your client to take notes if they are able to without getting frustrated
• After the meeting, supply a brief, simple written summary of what was discussed. For example: It was a pleasure meeting with you on Tuesday, May 8, 2018. We reviewed your accounts and decided to transfer the funds from your savings account to your chequing account and to then close your savings account.
• Take notes about your interactions after the meeting.

Source: The Alzheimer Society of British Columbia