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Carolyn McClanahan

Practice Management > Marketing and Communications

How Advisors Can Help Clients With a Terminal Illness

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Many of the best advisors tend to have relationships with their clients that can last for decades. As a result, it’s inevitable that advisors will eventually arrive at a time when a client is diagnosed with a terminal illness.

It is, of course, important for advisors to review cash flow, estate planning, insurance and other areas of clients’ portfolios with their terminal illness in mind.

But even more important is how to best communicate and interact with a client whose thoughts are consumed by their terminal illness, according to Carolyn McClanahan, a certified financial planner and physician who is founder of Life Planning Partners in Jacksonville, Florida.

After all, if an advisor isn’t aware of the strategies for working with such a client, all the best financial plans may become useless.

Also important is how to guide clients through the planning process when they don’t feel well.

Below are 13 pieces of advice that McClanahan discussed Tuesday during the Kitces.com webinar “Helping Clients Facing A Terminal Illness: Planning Strategies & Talking Points.”

1. ‘Shut up and listen.’

McClanahan suggests first asking a terminal client to tell you more about what’s going on.

“And then just shut up and listen,” she advised, noting “doctors are notorious for interrupting people, and it’s really important to just let the client say everything they’re going to say.”

When the client is done talking, “then you start asking questions,” she said. One smart thing for the advisor to say is: “Tell me how you’re handling it.”

Then ask what their treatment plan is, she added.

2. Take advantage of the ‘golden window’ to get things done.

There are “usually a couple weeks before they either have to have surgery or chemotherapy,” she said. “That’s a golden window to get very important things done.”

After all, she noted, “you don’t know if that person’s going to do well with the surgery or [if] they could die at any moment.”

Another important reason to try to get as much done during that window as possible is that the client is not yet clouded by treatment such as chemo, she pointed out.

3. Make sure to balance the client’s concerns with your concerns.

“You have to address … the concerns that they’ve shared with you,” she said. “But then you have to plant seeds about your concerns. Often there are things like the estate planning [and] tax planning that the client has no clue about, where you can save them a lot of angst and a lot of money just by being proactive throughout their illness.”

McClanahan likes to create a “triage” list of all the competing concerns, she said.

“First, you’ve got to address those client concerns and their three big concerns are usually: Do they have the finances to pay for care, especially if it’s going to be a long drawn-out illness, especially if they’re in the working phase of life and they still haven’t saved enough money,” will this decimate the family’s finances, and how will affairs be managed as the illness progresses and after death, she said.

The advisor, meanwhile, should have three top concerns: how the client can meet his or her cash flow needs, tax planning and estate plan “cleanup.”

From there, “it’s great to make sure clients have done their advanced directives,” she noted. Some people also like to do “ethical wills, where they leave their goals and dreams and have a record of their life for their family,” so that’s another potential issue to raise with clients. Last: “Have they done funeral preparations. And that’s a big area that people fight over.”

4. You may have to approach some discussions differently.

“You have to realize … that the ‘sick’ brain works differently. So when people are ill, you have to approach things in a different manner,” she explained.

This is not the time to say that clients got cancer because they smoked or agree with them that they are to blame as they beat themselves up for causing their illness, she cautioned.

“You’ve just got to tell them, ‘stop that,’” in a nice way and “be more supportive of them and say, ‘Gosh, there’s so many different things that cause this. Don’t beat yourself up. Let’s do what we can to help you move forward so that you can get through this.’”

5. Try enlisting the client’s family members to help you.

“If you have a client who is seeming depressed and you can’t get them to work through their items, make sure you enlist other family members to help,” she said.

You can also suggest that the client talk to their doctor about how they’re feeling,” she said, noting, “sometimes that little nudge will be what it takes to get the client” out of that funk.

6. Have early meetings with clients.

“People are usually fresher earlier in the day so meet early in the day,” she suggested.

But, “sometimes when you have people that have trouble sleeping,” that time may not be good for them, so suggest an alternate time to do it, she noted.

7. Go to the client’s house for meetings.

“If you actually have to go to their house, go to their house,” she said. “Sometimes you can learn a wealth of information by just taking that time to meet them in their place.”

This also “helps their energy because they didn’t have to come in” to your office, she pointed out.

Also, a “second brain is always invaluable to help them retain information and provide clarity after the meeting’s over,” she said, adding advisors should keep meetings “simple, focused and short.”

8. Enter the meeting with a clear plan.

Start a client meeting with the important things, “repeat the details and make sure you provide written materials behind it,” she advised. “What I’ll do in a meeting like this is I’ll create a little agenda that I’ll provide to the client when we go in. It’s not going to have all the details on that agenda because sometimes you don’t know exactly what’s going to transpire,” she said.

Have your “triage” list with you and “check off what you get through,” she added.

9. Provide follow-up materials.

“After the meeting’s over, provide follow-up materials” to the client, she suggested. “I usually send a summary email. I create a task list of what we get done of what we need to do and what the client does. And our client service person is just fantastic. If something needs to get done with a client, she will work with a client to get it done.”

10. Make sure to take frequent breaks during meetings if needed.

“If people have like gastrointestinal disease or urinary tract disease, sometimes they have to go to the bathroom a lot,” she said. So “make sure you take frequent comfort breaks,” she suggested.

11. Use a calm, quiet and soft voice.

Although it may be hard for some advisors, she suggested they “project a calm, quiet and soft voice” with terminal clients.

“I have never been calm, quiet or soft in my life,” she admitted. “But I’ve learned how you just keep your voice low [and] try not to get excited and just make sure that you’re being aware of how you’re being perceived.”

12. Avoid distractions.

“Don’t take your cell phone” into a meeting with the client, she suggested. Also, “if you have a conference phone in your room, turn that phone off. Make sure that you’re not going to be disturbed.”

Another suggestion: “If you see the client fading and you’re not getting things done, just end the meeting. Just say, ‘Hey, we’ve got through these one or two things. We’ve got more to go, but it seems like you might be having some issues. And I want to make sure that you’re OK.”

Then point out there will need to be another meeting or follow up with them in their home or through Zoom, she said. “Thank goodness” we have the latter now, she added.

13. Ask clients, carefully, about hidden wealth.

Along with discussing the obvious financial concerns including cash flow, she suggested bringing up subjects that include hidden wealth.

“I have clients who might have hidden gold or they have things in lock boxes,” she noted. It’s, therefore, important to ask if the client has anything hidden that he or she doesn’t want people to know about, she said.

But “you have to stress confidentiality,” she cautioned. What may work is “if you stress to them that you’re doing it to help because if they have important assets that they’re not telling anybody about, things like bitcoin, then you can’t help them.”

On a related note, she said it’s also important that family members or others handling a terminal client’s finances know how to access their accounts and have been given the proper authorizations for transferring responsibilities.

(Pictured: Carolyn McClanahan)