One of the great benefits of a conference like FPA’s national gathering is that important but often overlooked issues get the attention they deserve, not just the arcane but even the quotidian. Like, say, death.
Doctors do a poor job of telling their patients that they’re dying, with serious repercussions for patients and their families. Advisors don’t do much better, despite the fact that terminally ill people’s biggest worries at the end of life tend to be financial ones. Those insights came on Sunday from two physicians — one who is also a certified financial planner — at the FPA Experience conference in Orlando, and the advisors in attendance were engaged throughout the hourlong early-morning session.
The session — “Communication During Advanced Illness: Addressing Client Needs” — was presented by Carolyn McClanahan, MD and CFP, and Anna Wright, also an MD (and a mentor of McClanahan, she revealed during the session). Among McClanahan’s points were the importance of advanced directives, the “beauty” of hospice care and that clients with terminal illness worry most about money. Specifically, they worry about how to finance their health care, how to keep the family’s finances from being devastated during that care, and how to manage their financial and other affairs as the illness progresses.
It turns out that physicians and financial planners are very much alike in one way: they tend to be problem solvers. So when a client tells an advisor that they have a terminal illness, the knee-jerk reaction might be to try to figure out how to prolong life—“Have you consulted a specialist?” or “Are you using the best hospital?” Instead, suggested Wright, allow your clients to “share the emotional aspects of the illness,” permitting them to voice their concerns. Only after doing so will the client be able to address the financial, tax planning or estate planning issues that should be taken care of before that terminally ill person is too sick to make decisions.
McClanahan said it was appropriate to ask clients what their plans are for treatment, since part of the advisor’s job is to help with cash-flow planning during illness. To do so, it’s important for the advisor to “understand the client’s health care mindset.”
That mindset is a measure of how the client wants to be treated medically, as either a “maximizer,” who wants every extraordinary measure taken to prolong life, or as a “minimizer,” who wants to be treated medically but not taken to extraordinary lengths to prolong a life that may be extremely painful. She suggested to the advisors in the audience that they read “Your Medical Mind,” by Drs. Jerome Groopman and Pamela Hartzband. McClanahan said that most physicians tend to be maximizers due to their training and their personalities, though that may be changing with younger doctors who now are trained in hospice care and geriatrics.
Regarding hospice, McClanahan noted that most insurers will pay for up to six months of hospice care — candidates for hospice are expected to live from as little as six months up to 12 — but that hospice is underused and often used very late: the average hospice stay, she said, is only 19 days.