The Alzheimer's Association announced in mid-March that more than five million American's have Alzheimer's disease, a 10% increase from the last official tally five years ago. The Association predicts that without a cure, the number of those affected by the disease will to triple by 2050. What's more alarming is that the cost of care for a patient with dementia is three times as much as care for an average beneficiary--$13,207 a year vs. $2,454. Furthermore, overall dementia Medicare costs are expected to more than double, to $189 billion by 2015, according to research by the Rush Alzheimer's Disease Center in Chicago. The primary risk factor for Alzheimer's disease is age, and with the majority of planners' clientele growing older due to the baby boomers, it's best that advisors become familiar with a different side of the financial planning business--gerontology. Someone who is way beyond the familiarity stage is Rosanne Grande, managing director at R.W. Rog?(C) & Company, Inc. in Bohemia, New York.
"Our services are not strictly financial," notes Grande in describing her work and that of her colleagues when it comes to planning for elderly clients. "We'll go to the attorney with them, find adult daycare centers, etc.--it's just a matter of the level of care that the person needs." Grande knows about the care people need first hand. While taking care of her sick mother for more than ten years, Grande entered the financial world with a job on Wall Street, and later took a job in the financial services office at an insurance company on Long Island, where her interest in elder care increased. The long-term care policies that the company sold interested Grande--if her mother had one, she reasoned, she would have been eligible for an aide to help care for her at home. Grande soon took an interest in gerontology, as well as in the two related professional designations--certified senior advisor from the CSA Board and registered financial gerontologist from the American Institute of Financial Gerontologists. She began working as a paraplanner for Rog?(C) & Company in 1995 and, more than 10 years later, has carved out a niche working with elderly clients in helping them plan long-term care and showing middle-aged clients how to help their parents do the same. Staff Editor Kara Stapleton spoke with Grande in late March.
When dealing with a client caring for someone with dementia, how is the financial planning process affected?
With any type of long-term disease, especially those that are degenerative and progressive, such as Alzheimer's, the family really has to sit back and take notice of the stages of the dementia. First, does the person live at home alone, or with a family member or spouse? If the person lives in the home with a family member or spouse, can they take care of them? That's a key question because someone taking care of a person in their home causes the caregiver to lose 5 years of their lifespan. The person has to be physically and mentally fit, and they shouldn't neglect themselves, since they are the central component of the family's financial equation. Second, see if the client is in a position where they have sufficient funds--if they can have someone come in and provide daycare to give the client a rest, or if there's an adult daycare facility where the Alzheimer's patient is eligible to go and participate. If they're not eligible and the family is pretty tight on funds they really have to see an estate-planning attorney to make sure they can be eligible for Medicaid. With all the new laws, it's gotten really tight, but they cannot turn an Alzheimer's person away--there's no precondition.
How have the laws gotten tighter?
Before the new Medicaid law passed in 2006, a person could apply for Medicaid before going into a nursing home and you had three years for assets that were transferred outside of a trust and five years for assets transferred inside a trust. Now it's five years no matter what. And, you can't apply for Medicaid until the person is in the actual facility. There's not really much maneuverability as far as trying to get someone taken care of. This makes it hard for the family. It's emotionally taxing to place someone in one of these nursing facilities. However, there is an upside to it also. If they can get into one of these new facilities that are becoming popular--continuing care retirement communities--where if one of the parties of a married couple is independent and well and the other party has been diagnosed with the early stages of dementia, the facility, which is expensive, will continue the care from independent living to assisted living to the nursing home. These places are wonderful because it's really a quality of life that these people have. And their families see that they have a quality of life and see the care they are given. It really helps the family cope with it. If they know when they leave there, that their parent, spouse, or sibling is being taken care of--they're clean, they're fed--it gives them a sense of relief.
What are the typical steps an advisor should be taking in these delicate situations?
The family member of the diagnosed person is usually the client. We, here at Rog?(C), have started to incorporate gerontology as part of our service. When we do an initial meeting with a client, we always ask them how old their parents are. In more cases than not, their parents are in their high nineties. I'll ask if they're physically fit, if they're well, and if there are any cognitive problems. A prospect will usually open up about that. Usually, with existing clients, we will get a phone call from the client telling us that their parent has been diagnosed with a disease and asking us what they should do. Then, we start to get them into a process where, if they need it, they can begin to get the diagnosed eligible for Medicaid. We'll get them someone who can help them--an estate-planning attorney or a firm that can prepare the Medicaid paperwork, because it's extremely onerous. Then, we get the family thinking if, financially, they can help them out. Many of the clients we have are already retired. So, they just have enough money that they saved for their retirement and now they're going to have a parent that's dependent on them and may have to move back in with them. The client may have to renovate their home to make it handicap accessible, and then have a stranger come into their house everyday to take care of the patient, with is another emotionally taxing thing. So, we try to get them on track financially and emotionally. I will go with them to the estate-planning attorney, if necessary. I will make the connections for them with the firm that can prepare the paperwork. We try to make it as human as possible and let them know that there is someone in the firm who is compassionate, and will care, and will help.
Do you have employees that specialize in gerontology?
I have a registered financial gerontologist designation and I'm also a certified senior advisor, in addition to being a CFP.
How do you and your colleagues educate yourselves on matters that deal with Alzheimer's, dementia, and similar diseases?
I go to continuing education classes every year. I am going to a 4-day continuing education seminar in early May that has classes on dementia and Alzheimer's and what to look for, and it really does help. There are so many advances that can take place overnight. They do a good job of keeping us up-to-date on that. I do a lot of reading because we have some clients that had spouses that have passed away after having Alzheimer's or dementia and they constantly ask questions about whether or not they could have done something different. You have to tell them that they did the best they could and in that situation, they took great care of them. Whatever the situation is, I keep trying to make them aware that no matter what they did, they did the best they could.
The Alzheimer's Association offers special help to people whose family members have been diagnosed with the disease. There's such a great resource of places to go, especially on the internet if you need to be educated or if you need a facility that specializes in the disease your loved on was diagnosed with. They just changed Medicaid laws in 2006. All of the CFPs in the firm are up-to-date on it, but we also each have a specialty. Usually, I'll go and attend a class and disseminate the information throughout the office.
Is there an extra charge for this service?
No, it is part of our comprehensive financial planning. We take care of all of that.
How does long- and short-term care insurance play into the equation?
The long-term care insurance does cover, if a person is placed in a facility or needs daycare. The policies have become more patient-friendly. The John Hancock policy revised in New York State has been tremendous in getting people the care they need. The short-term is really out-of-pocket, until the patient can be placed somewhere, which could take anywhere form six months up to a year, depending on how much in assets they've given away. That's the penalty period. It's financially devastating if it's not prepared for in advance.
How can a client prepare for this in advance?
We always recommend long-term care insurance, especially if they are young. We try to put that into their expenses, because at some point these facilities aren't going to be able to hold everybody.
On estate planning...
A typical example is if a parent is going into a home. We'll make sure our client goes to an asset protection attorney and look at the assets. No matter what, any income that is generated from that portfolio goes to that person's care. The principle is what really needs to be preserved to keep the income coming in, so the patient can stay in the facility if they aren't Medicaid eligible. Estate planning is so specific and laws change so quickly, that you need an attorney who knows what they're doing. It can't be a real estate attorney or the person who put together the wills. This is especially important if you want to have a life estate, in which the person can stay in their home until they pass away. The title of the home is passed on to a child or sibling, but the Medicaid cannot come after the home while the person is alive and living there. Individuals who would like to do Medicaid planning for a spouse, sibling or child should use the services of an Elder Law Attorney. They specialize in Medicaid planning. The estate-planning attorney would draw up wills, powers of attorney, health proxies, etc.
How early in advance do you have to do this?
You have to do it five years in advance. It's best to set this up as soon after the diagnosis as possible. These types of diseases are progressive, and you have to hope it takes a slow, rather than a fast turn.
What are some methods you use to make dealing with end of life issues easier?
You have to have an extreme amount of compassion. People have to know that you're here for them, whether it's a physical, emotional, or financial. Go with them if they need to put someone in a home or make a trip to an attorney. Be the middleman and give them direction. And be a wealth of knowledge. Know the best facilities and attorneys so that they can come just to you and you can point them in the direction they need to go in. A lot of people will turn to an advisor first.