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When grandma fights back: the challenge of caring for combative dementia patients

When grandma fights back: the challenge of caring for combative dementia patients

It’s a treasured image: the loving grandparent with a soft smile, offering unconditional love and cookies to a bevy of grandchildren… until eventually she forgets their names and gently fades away. This scene of the aging grandparent often does happen, but sometimes there’s a dramatically different scenario that many of us may face at some point. Today, one in 10 people age 65 and older suffers from Alzheimer's dementia, and the number of new cases of Alzheimer's and other dementias is projected to soar[1]. On top of that, an unknown number of the nearly 6 million men and women with dementia will become violent at some point. When that happens, finding care can be incredibly challenging—whether it is for a grandparent, a parent, or a spouse.

Unfortunately, when a dementia patient becomes aggressive, combative, or otherwise non-compliant, their condition crosses into mental health territory. Similar to other mental health concerns, our health system is ill-equipped to handle the challenges. Despite the fact that as many as 1 in 10 Alzheimer’s patients lashes out physically, very few people talk about this issue. Perhaps it is the stigma of mental illness. Maybe we don’t want to admit to ourselves (much less our neighbors) that the people we love could become a physical threat, but the lack of care options for combative dementia patients seems to be the “dirty little secret” of elder care.


RELATED: Mental health, money, and breaking the silence


If you assume the issue is rare, think again. Here are just a few examples, and they paint a bleak picture:

  • When Randy’s wife Jean was diagnosed with dementia, he kept her condition a secret for almost two full years. He was embarrassed by the stigma of a mental health problem, but when Jean’s behavior changed, he couldn’t keep up the façade any longer. She refused to allow him to bathe her, fought him off when he tried to help her use the bathroom, and he couldn’t even coax her to bed at night. He had to get help. Sadly, Jean was just as uncooperative and aggressive with professional healthcare providers as she was with Randy. After three nights in a local nursing home, the facility called to tell him his wife would have to leave because she was “not manageable.” The next facility found her so difficult that they transferred her to a geriatric psych hospital where things got even worse. Two different memory care facilities refused her, and every time she was forced to leave another home, Randy was given a list of other facilities, a hasty “good luck!”, and little guidance.
     
  • Mia and Jon faced similar challenges.Jon had always been the decision-maker in the family, so when it was clear he could no longer keep up with the bills or manage their money, Mia didn’t know what to do. Even when Jon’s physician confirmed the early-stage dementia diagnosis, she felt stuck. Mia asked her adult son to help her talk to Jon about the necessary changes (beginning with taking away the car keys), but when they approached him about the issue, Jon was threatened, upset, and angry. Less than a year later, Mia and Jon moved into a continuing care community, but the transition proved too stressful. Within a week he was moved to the skilled nursing unit. When he became combative, he was transferred to the psych holding unit of the local ER for 24 hours. When he was released, Mia and her son were given a list of recommended facilities, but none of them would even consider accepting Jon because of his history of aggression. Four facilities later, an elder care placement worker urged Mia to consider a board-and-care home that specializes in combative dementia. It was there, says Mia, that Jon was saved by a caregiver who understood how to calm him and was able to give him the best quality of life he could have.
     
  • When my husband, Ed, suffered a debilitating strokeand became permanently disabled, he was only in his 50s, but we faced similar challenges. After a bad fall, Ed was placed in a medically induced coma to allow his body to heal. When he woke up, he was confused, angry, and combative. That didn’t change when he was placed in the best facility I could find—one where I knew they would not tie him to his bed. But after one violent episode, they transferred him to UCI without my permission, despite the fact that I had Power of Attorney at the time. Because there were no beds available in the psych unit, my husband was placed in the ER hallway (perhaps the worst possible place for someone suffering a psychotic break!) for more than a day. Finding any place that would accept him with that history was nearly impossible. The whole scenario was horrific.

Finding quality care for dementia patients who become non-compliant can be a nightmare for everyone involved. I wonder if the challenge lies not with the patients themselves, but with our society’s inability to accept mental illness—to give it a name, anticipate the possibility that this may become a reality in our own lives, and identify creative ways to help our aging population through the trauma and confusion of dementia.

To learn more, I recommend Esther Heerema’s article How to Respond to Combative Behavior in People with Dementia that looks at the daily challenges from the dementia patient’s point of view. She helps the reader understand what drives some of the anger and frustration that can result in combative behavior. If you do find yourself facing the challenges of caring for a combative family member, remember that dementia can take a devastating toll on caregivers. Find a local support group, join an online forum like Caring.com or the Alzheimer’s Association’s ALZconnected.com—get help wherever you can find it.

According to the Alzheimer’s Association, someone in the United States develops Alzheimer's dementia every 66 seconds. By 2050, that statistic is expected to jump to one new case every 33 seconds. By doing all we can now to help end the stigma of mental illness, perhaps we can help change the future for tomorrow’s dementia patients—ourselves and our families included—even when they become “non-manageable.”


Do you have an Incapacity Agreement?

To help our advisory clients anticipate dementia, we ask everyone 65 or older to sign an Incapacity Agreement. This agreement permits us to reach out to designated individuals if our client asks us to make changes to their investments or make withdrawal requests that are seriously inconsistent with their previously-stated life goals—something that we believe is an out-of-character request that could be due to physical or mental illness. Ask your advisor if he or she offers a similar agreement to help protect you and your assets in the case of age-related dementia.


 

[1]Source: Alzheimer’s Association Fact Sheet.

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Security vs. Freedom (and the magnificent merits of flying business class)

Security vs. Freedom (and the magnificent merits of flying business class)

I’m writing today swimming in jet lag after a week spent (literally) swimming with the fish in Fiji. And while it may be true that every vacation creates a mental shift of sorts (if for no other reason than that it takes us away from our daily routines), this particular trip was unprecedented in the impact of that shift. What was this dramatic change? After decades of helping others as a financial advisor, I’ve finally found my own internal abundance. I’ve finally been able to rise above the very basic need for financial security and embrace the ultimate goal: financial freedom.

Before you jump ahead and think I won the lottery during my travels (I didn’t!), let me take a step back to clarify.

Whenever I sit down with a client to begin the financial planning process, one of the first questions I ask is this: “What is important about money, to you?” In most cases, I receive one of two responses. The majority of people, regardless of income level or accumulated wealth, will begin with “security.” A small percentage (who admittedly tend to seem unusually at ease) will name “freedom” as their fundamental goal. For all the years I’ve been asking this question, I’ve always understood the need for security more. After all, who in her right mind wants to end up being a bag lady with no resources and no financial security to save her from the abyss?

I come to this scarcity perspective honestly. Raised by depression-era parents who saved everything from used tin foil to pennies, the fear of “not enough” was drilled into me from day one. Our family was frugal to a fault. Then, after becoming a single mother in my 20s, saving my pennies mattered more than ever. The responsibility to have enough to give my children was a heavy weight to bear. I expect this is why I was drawn to my career when I was. After all, the more I knew about money, the more security I could control, right? And though I’ve worked hard to have the skills and knowledge to help my clients plan for their financial security, I realize that I was never completely at ease with money myself. Did I have enough? Certainly. But whenever I saw friends spending on what seemed to be frivolous purchases, I caught myself asking, “How can you spend that money today when you might need it tomorrow?”

Fast-forward to two weeks ago when I boarded my flight to Fiji. For the first time, I had allowed myself to splurge on the luxury of a business-class ticket. Even as I walked onto the plane, I questioned what prompted me to spend a big chunk of my budget on a bit more leg room, a personal sleep kit (as if I don’t already have eye shades), and real food and drinks. But when I settled into my relatively monstrous seat, I had to confess it felt pretty darned good! When the flight attendant handed me a warm scented towel and invited me to “sit back, relax, and enjoy your flight,” I thought that, for once, I might actually do just that.

And I did. When we landed in Fiji more than 11 hours later, I was refreshed and ready to go. While I am sometimes apprehensive about meeting new people, especially an assigned roommate on a dive trip (Will I like her? Will she like me?), this time I felt light and almost giddy. More than anything, at the end of that flight, I felt empowered.

Once I settled in at the hotel, I learned that out of a group of ten, only three of us were planning to dive. The rest of our group were there to snorkel and enjoy the sights above sea level. So our band of three became fast and close friends, and in everything we did together, I felt more buoyant than ever—physically, mentally, and even spiritually—both in and out of the water. When we were diving, my buoyancy was amazing. I was breathing easily (not gulping air in fear of not having enough) and in my relaxed state, I found myself just hanging in the water—not sinking to the bottom or floating to the surface, but balanced and at ease. I was more present, more observant, and more at peace than I can remember. I felt completely free.

As I boarded my flight home on Saturday, I felt something that, until then, I’d only seen in others and never really understood. After years of careful planning and fearing scarcity, I was finally giving myself the freedom to overfill my glass a little. It felt fantastic.

The best part about financial freedom is that anyone can get it. Yes, as Jonathan Clements says, “Growing wealthy is embarrassingly simple: We save as much as we reasonably can, take on debt cautiously, limit our exposure to major financial risks, and try not to be too clever with our investing.” (Read my blog Money really can buy happiness for more on that great topic.) That’s why having a solid financial plan is vital for anyone. There’s no doubt that there’s a fine balance between knowing that you’ve planned to achieve abundance and trusting your plan will deliver what you need for the future. But achieving financial freedom—that buoyancy that enables you to trust in your own abundance—is as much about a mindset as it is about finance.

For years I’ve preached the value of striving for financial freedom to anyone who would listen. Today I can say I finally have that freedom myself. In the ocean, I now trust that I have enough air to sustain me for the duration of my dive. Back on land (or up in the air in business-class!), I now trust that I have enough resources to sustain me for the rest of my life—even if I allow myself to overfill my glass now and then. That is true financial freedom. I hope you can meet me there!

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New parents: Know the true costs before choosing to stay at home

New parents: Know the true costs before choosing to stay at home

Gail Hicks is a senior financial advisor at Klein Financial Advisors. She is this week’s guest blogger while Lauren is away on vacation.


It’s a question almost every soon-to-be parent ponders: should I stay at home after the baby is born? And if so, for how long? Even for the most career-driven parent, it can be a very emotional decision. To come up with the right answer for you, step beyond a basic pros-and-cons list. Be certain you’re considering every piece of the puzzle before making a choice—and do all you can to be sure that choice balances your emotions with what’s best for the long-term financial stability of your family.

If you think that puzzle is a simple one, think again. It’s easy to look at the high cost of childcare and assume that those costs, combined with the savings on everything from dry cleaning to taxes to eating out after a long day at the office, make staying at home the most cost-effective option. That’s rarely the case.The truth is in the data. According to a recent study by the think tank Center for American Progress (CAP), the average 26-year-old woman who takes a 5-year break from her career will lose much more than five years of her salary. In fact, when considering lost income, wage growth, and retirement assets and benefits during just five years, she’ll lose a whopping $467,000 over her lifetime. A man of the same age will lose even more: just under $600,000. To make those numbers more personal (especially knowing that Orange County is one of the most expensive places to live in the US) assume that staying at home will cost up to five times your annual salary for every year you’re out of the workforce. According to the latest U.S. Department of Agriculture’s Expenditures on Children by Families report, households with income over $105,000 should be prepared to spend at least $400,000 to raise a child to age 18. With that price tag in mind, it’s a challenge to make staying at home an affordable option!

Of course for some parents, the math isn’t enough to sway the emotional desire to stay home with children. For others, there are family and cultural biases that strongly influence the decision. But it’s vital to look closely at the reality of your choice before opting to leave the workforce. As someone who has been there myself, I know the real-world challenges all too well.

When my husband and I were contemplating expanding our family from one child to two, we remembered the toll my job took on my health during my first pregnancy, including a very frightening pre-term labor that resulted in being put on bed rest at seven months. The high cost of childcare and the fact that we had no family in the area to help out were also factors to consider as we considered our options. We did the math (it’s what I do, after all!), and determined that with our savings and the extra income from my husband’s side business, we could make it work. We knew there would be sacrifices, but it was an important—and yes, emotional—decision for us both. So I walked away from a high-paying corporate job and walked into stay-at-home parenthood.

Unfortunately, the decision didn’t play out in real life as well as it had on paper. First, our second son was born with a mild disability. That alone tipped the financial and emotional scales. Jumping through hoops to get a diagnosis and then therapy two or three times a week was hard. Soon afterward, the recession hit, and with it came the end of the consulting income we had counted on to help replace my salary. Even worse, my husband didn’t want to add any more stress to an already high-stress situation, so he postponed admitting that his side business had completely dried up. Our plan of just breaking even quickly turned into the reality of taking on debt. Now the numbers didn’t make sense. How could I go back to work when my younger son needed me at home and my older son had grown accustomed to having me at home with him too?

At the same time, I was in a world of the unknown. I’d been a businesswoman my entire life. I was home with a special-needs child, I knew only a handful of my neighbors, and the few stay-at-home moms I was able to meet had never worked, so our experiences were completely different. I felt isolated and alone. And while it was a difficult choice to go back to work, money was just one piece of the equation. I was confident my choice would be best for our whole family, and it truly was. Within months of going back to work, I felt we had found balance again. Yes, I missed the time with my sons, but I knew I was a better mother when we were together as I watched the financial and emotional stresses wash away.

Everyone’s situation is different. The key to making the best choice for you is to understand the true financial impact of staying at home, and then to decide what makes sense for you and your family—both today and over the long term. How can you be sure your emotions aren’t overriding your common sense? Work with a professional advisor to help you crunch the numbers and be sure you’re really considering every piece of the puzzle.


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Ready to retire? Consider taking the road less traveled

Ready to retire? Consider taking the road less traveled

It’s inevitable. You tell your friends you’re retiring and the first question out of their mouths is, “What are your plans?” Question number two: “Where are you going?” It seems the connection between travel and retirement has become an obsession in our society. And while it may conjure up images of tropical destinations and “once in a lifetime” adventures, the dream doesn’t always reflect the reality.

My friend Joyce is a perfect example. After working in corporate healthcare for decades, ten years ago she was finally ready to call an end to her career. Of course, the questions and suggestions began immediately: “Where are you off to? Have you thought about a cruise?” “You should go on a safari! It’s the trip of a lifetime!” “We loved Capri! You just have to go!” “You’ve never been to Paris?” Joyce had already traveled a fair amount in her life, for work and pleasure, so the idea of planning a big retirement trip wasn’t even on her radar. Suddenly the pressure was on. She started to feel like she had to travel—it was, after all, what retirees are expected to do.

When we met for coffee a week after her retirement party, she was restless. “I don’t even know where I want to go, but I feel like I should figure it out soon. I’m already bored with my routine!”

It’s a dilemma I see all the time. As retirement looms, people are so focused on closing the door on their careers that they don’t take the time to think about what’s next. They know they’re not ready to settle into a rocking chair, but they have no idea how they want to spend their days.

To help guide Joyce, I posed a question that was much different than, “What’s your travel destination?” Instead, I asked, “What do you want to do in your second half of life?” Joyce looked like a deer in the headlights. I took a sip of my coffee and continued. “Is there anything you’ve dreamed of doing, but have simply never had the time—not including traveling?” We sat quietly for a few minutes, and I could see the wheels turning in her mind. When she did speak, she seemed almost embarrassed, as though she was confessing a dark secret. “Paint,” she said. “I’d love to paint.”

Joyce’s vision was no standard image of an elderly gentlewoman quietly painting landscapes on a sunny hillside. Her dream was to paint large, bold canvasses that would take people’s breath away. I could already picture her in paint-covered overalls tossing paint onto the canvas like a modern-day Helen Frankenthaler. She didn’t know her next step, but she now had a vision in her mind, and it had nothing to do with jumping on a retiree-filled cruise ship.

Don’t go me wrong. I’ve recently discovered my love for travel, and I get that, at least for some people, travel is a retirement dream come true. Even then, I’ve seen peer pressure turn what should be a time of financial freedom into a whole new level of stress and anxiety. Travel anxiety can be especially challenging for anyone who lives in an affluent area, and even more so for affluent couples who set out on their travels together. Suddenly, what could have been a modest, budget-conscious Alaskan cruise morphs into a five-star, luxury journey on the Crystal line—for five times the original cost. The pressure to overspend can come from relatives as well. Knowing that memories are important, it’s all the rage right now for grandma and grandpa to treat the entire family to an all-expenses-paid family vacation, yet few retirees can afford this level of extravagance. I’m all for spending money on experiences instead of “things,” but it’s important to be realistic. If a trip is beyond your budget, that’s the moment you need to stop and ask yourself: whose dream am I living? Mine—or my neighbor’s? Peer pressure can be tremendous, but swallow your ego and make choices that align with your dreams and your budget.

Joyce’s story has a wonderful outcome. After our talk that morning, she decided to make her dream come true. She signed up for classes at Otis College of Art and Design, studied with master teachers, and earned a certificate in Fine Arts. She’s been painting ever since, and though I have yet to see her in overalls (I guess that’s my version of her dream, not hers!), she’s happier than I’ve ever seen her. She does travel a bit, but mostly to New York City on artist trips. By focusing on what she truly wanted, she took the road less traveled (pun intended!) and painted a beautiful “retirement” that even she never saw coming.

If you’re on the cusp of retirement—or even already there—take some time today to brainstorm how you want to spend the next decade of your life. Build a vision board. Journal. And don’t let anyone else’s expectations stand in your way. Once you have some ideas, I recommend sitting down with your financial advisor to figure out a realistic budget, and then take it from there. By charting a path based on your dreams and your finances, you can paint your own picture of a wonderfully fulfilling retirement that’s free of financial anxiety. That’s what I call the “golden years”!

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Rethinking retirement in the “gig economy”

Rethinking retirement in the “gig economy”

There’s a movement going on in America, and it’s something retirees, and those even close to retirement, should start studying—hard. It’s called the “gig economy,” and it’s changing how people think about almost everything. Work. Play. And even the fine line in between the two. It’s changing how we pay and get paid for both, and it’s transforming how people look for work and how the work itself is getting done. Whether you’re looking for extra income to help fund your retirement, or you simply want to work to keep your mind and body active in your later years, understanding the gig economy and how it functions is vital to rethinking your retirement.

Anyone who has been forced to look for work recently can tell you firsthand how the gig economy has flipped the traditional work landscape on its head. Old-fashioned resumes have been replaced by LinkedIn profiles, and even the idea of finding a conventional “job” is fast becoming a thing of the past. Companies like Uber, Lyft, and Airbnb have provided a way for almost anyone to earn an income, as well as a whole new way for consumers to find and pay for services.

These companies aren’t alone. Today, there’s a website or an app that offers on-demand services of almost any kind imaginable. DoorDash delivers breakfast, lunch, or dinner from your favorite restaurant to your door at the click of a button. TaskRabbit lets you order up a “trusted and local handyman” within an hour. Dogvacay gives pet owners online access to 5-star pet sitters and dog walkers. And there are just as many services for professional freelancers. Upwork helps companies hire web developers, writers, accountants, and virtual assistants. Guru is the place to find professionals in management and finance, engineering and architecture, and sales and marketing. And UpCounsel is the go-to site for legal services.

Of course, every one of these services requires individuals to provide skills. Whether they are driving for Uber or DoorDash, putting together IKEA furniture, or helping a business crunch the numbers, these workers make up a growing workforce that is already in place. That means that if you thought serving up lattes at your local Starbucks was the only job in town for anyone “post-career,” you’re happily mistaken. The gig economy is taking over, and that’s good news—at least for those who get it and can adapt to this new reality.

The business school at UCI certainly gets it. My friend Howard Mirowitz is on the advisory board at the school’s new Beall Center for Innovation and Entrepreneurship. The center is devoted entirely to inspiring innovation and entrepreneurship in the 21st century. Here students learn both why it’s important to become an entrepreneur, as well as the processes and tools to help turn that dream into a reality. The center fills a need that’s positively exploding. While being an entrepreneur may have sounded like a lofty dream a decade ago, it’s fast becoming mandatory for anyone hoping to succeed in an environment where it’s predicted that 43-50% of workers in the US will be freelancers by 2020. Let me repeat that: 43% to 50% of workers will be freelancers. Whatever your age, if you’re looking for work today, you are part of that statistic. Which means that now is the time to figure out what you have to offer the world and how that fits into what the world needs from you, and then begin to create your opportunities as part of this new, dynamic workforce.

For those of us who grew up in a business world where “climbing the corporate ladder” was the norm and playing by the rules led to a coveted lifetime pension, this new era can be pretty daunting. It requires flexibility and agility, not to mention a good dose of personal marketing savvy and technology know-how as well. So where do you start? It may be a moving target, but these five steps can help you take those first important steps:

  • Start to think differently.Rather than thinking about getting a “job,” make a list of all of your skills—both skills you learned in the traditional workplace and those you learned in life. Next, examine your list and circle the things you would like to continue doing and what someone else wants enough to pay you for. One of these skills may very well be your next “gig.”
     
  • Get a mentor.There’s no doubt about it: millennials have the gig economy down pat. To them, it’s just the way the world works now. If you need help figuring out how you can offer your skills, or even what skills people might be looking for, ask someone younger to serve as your mentor. You’ll be amazed at the knowledge they can offer.
     
  • Market yourself. Create a great LinkedIn profile that uses keywords that match your skill set to be sure people can find you online (learn all about LinkedIn keywords here). No, you don’t need to include dates that might “age” you or list every job you’ve ever had. Focus on what’s relevant to what you’re marketing today. If there’s already an on-demand service that matches your skills (think Upwork and Guru), explore how to get listed. There are even services which provide that service, helping to market everything from your Airbnb rental to your skills in human resources or healthcare.
     
  • Save madly.While there are many upsides to the gig economy, the downside is that it isn’t always consistent. Even if you do find the perfect niche, there may be off times when your services aren’t needed, or the need may change entirely, causing you to have to rethink your focus once again. Having a sizeable emergency fund can help offset potential gaps in income.
     
  • Be flexible.When I left my own corporate career, I realized there was a whole set of skills I needed to learn to succeed at my new goal. If you have some but not all of the skills you need for your new “job,” don’t let that scare you away. And if your interests change, know you have the freedom to change your work focus as well.

The gig economy may be replacing the traditional workplace, but what powers it are three things that will never be replaced: people, knowledge, and skills. By taking a look at the knowledge and skills you bring to the table, you may find that working in the gig economy can help your golden years shine that much brighter. How fun is that?!

 

 

 

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All written content on this site is for information purposes only. Opinions expressed herein are solely those of Lauren S. Klein, President, Klein Financial Advisors, Inc. Material presented is believed to be from reliable sources and we make no representations as to its accuracy or completeness. Read More >