The Investment Management Consultants Association prides itself on the educational rigor of its conferences, such as the current IMCA national conference in Boston, featuring economists and statisticians and academics who take deep dives into sometimes arcane subjects, with attendees happily going along for the ride.
So what to make of the fact that the highest rated speaker at IMCA’s 2013 annual conference was Amy Florian, the CEO of Chicago-based Corgenius? Rather than discussing asset allocation or inverted yield curves, Florian talks about death and dying, about dementia and Alzheimer’s. If you’ve heard Florian speak, you wouldn’t be surprised at her high ratings, even though she speaks directly, sometimes toughly but always with a leavening pinch of humor, about topics that too many of us would prefer to avoid.
Her words and suggestions are valuable to advisors in helping clients and their families deal with emotionally fraught, legally murky and potentially money-draining issues around aging clients. Beyond providing tips on the legal, emotional and intrafamily dynamics of death and dying and dementia, she also lays out how advisors can use their knowledge and insights into those issues to help build their businesses.
Worried about how to attract the next generation of clients? You could do much worse than to demonstrate to your current clients’ children how valuable your services are, how you’re ready to go the extra mile for clients in the most practical of ways by quarterbacking the diagnosis and treatment of dementia in an aging parent. Want to get more referrals? Imagine how the friends and acquaintances of an aging client would feel when they see how you’ve covered every legal and financial base to ensure that said client’s wishes about the end of life are followed. Worried about the rise of the robo-advisors who can provide financial planning at 25 basis points? Then show the value of your advice by supporting clients through the biggest challenges they’ll ever face in life.
The need is great, the opportunities clear. In her presentation Monday at the IMCA annual conference, Florian began by asking attendees if they prepare carefully for a visit from an SEC or FINRA examiner. She asked if attendees plan their vacations in detail. “We prepare for what’s inevitable,” she said, so why don’t we (including clients, of course) prepare for aging and death?
“We’re all terminal,” she said with a smile, though most of us don’t know when we will die, and too many of us prefer not to think of death and dying. Her suggestion: “Help your clients prepare for the inevitable.”
The statistics prove the need: only 50% of baby boomers have a will, Florian reported, and among working women, 72% do not have a will. One in eight people over the age of 65 have dementia, and 22% of people over 71 have some form of MCI, or mild cognitive impairment. Florian also dispelled some common myths about aging, dementia and dying. “Dementia is not normal,” she said, but rather is caused by one of 18 different diseases to which we are more susceptible as we age. Dementia is not what she called “regular forgetfulness,” which is common in most people, but which can also be exacerbated by medications, by drug interactions or by other diseases.
She defines demenia as a “severe loss of thinking, memory and reasoning skills, such that the person’s ability” to carry out the activities of daily living (ADLs) “is compromised or destroyed.” While she thinks living wills can be a good document to create, she stressed that they are “not a legal document,” but rather are “imperfect but best ways to put into writing what you want” as you age. (A recent poll showed that 64% of boomers don’t have living wills or any other form of health care directive.) A living will is not, she said, “a way to pull the plug on Grandma; she can get any treatment she wants.”
Moreover, there is a legal hierarchy among documents dealing with health care, and the legality of those documents varies widely from state to state: there are no federal living will documents, or a document called the Five Wishes, which Florian “highly recommends,” or POLST (Physician’s Order of Life Sustaining Treatment). Think that checking a box on your driver’s license will ensure your organs will be donated? Think again, she said, because “the family can override” that directive. Instead, sign a state’s organ donor registry. Have you noticed how in the movies and on TV people who are given CPR usually recover? It ain’t so: only about 25% of the time does such resuscitation work, and when applied to the elderly or frail, CPR only works about 10% of the time.
Speaking of Do Not Resuscitate/Do Not Intubate (DRN/DNI) documents, she said that the default procedure followed by EMTs and other medical professionals is to attempt to resuscitate a person in cardiac arrest absent the presence of a document to the contrary. A tip on DNR documents: most EMTs, Florian said, will look in a patient’s refrigerator freezer for such a document before attempting to resuscitate a patient at their home, since that is considered the safest place in the house for important documents.
Back to the business. It’s when you are working with clients on these health care and end-of-life issues that you will be introduced to the client’s “inner circle” of friends and next generation of family, Florian says. Those are the people, she suggested, that you meet over coffee to explain what you’ve done for the client. “Don’t do business” at those meetings, she urged, but instead ask about them and their interests and remain in touch, lightly. Florian is quick to point out that she is not an attorney (though she is a thanatologist; look it up) and that advisors should be sure to work with a client’s attorney on all legal matters. She also suggests that when an advisor works with a client on documents like the Five Wishes, living wills or health care proxies that the advisor have the client sign a separate document that lists those documents the client has signed and which they have declined to sign, which can be helpful should family members threaten legal action after a client’s fall into dementia or death.
Florian’s website, provides more information on the resources her firm offers. Like advisors, she’s passionate about her work, but also practical. If you get a chance to hear her speak or take advantage of her classes, grab that chance. You’ll help build your practice, get closer to clients and be providing an important humanitarian service.