Have You Attended a Death Cafe?

At a Death Cafe people, often strangers, gather to eat cake, drink tea and discuss death.

Their objective is ‘to increase awareness of death with a view to helping people make the most of their (finite) lives’.

A Death Cafe is a group directed discussion of death with no agenda, objectives or themes. It is a discussion group rather than a grief support or counseling session.

Death Cafes are always offered:

– On a not for profit basis
– In an accessible, respectful and confidential space
– With no intention of leading people to any conclusion, product or course of action
– Alongside refreshing drinks and nourishing food – and cake!

Death Cafe is a ‘social franchise’. This means that people who sign up to the guide and principles can use the name Death Cafe, post events to the Death Café Website (www.deathcafe.com) and talk to the press as an affiliate of Death Cafe.

Death Cafes have spread quickly across Europe, North America and Australia. As of today, 803 Death Cafes have been offered since September 2011.

The Death Cafe model was developed by Jon Underwood and Sue Barsky Reid, based on the ideas of Bernard Crettaz.

Death Cafe has no staff and is run on a voluntary basis by Jon Underwood in Hackney, East London. Also Lizzy Miles who ran the first Death Cafe in the U.S. and Megan Mooney who runs the Death Cafe Facebook page have played a significant role in Death Cafe’s development.

People often ask why the Death Cafes are so popular. Everyone has their own reasons for getting involved in Death Cafe. – See more at: http://deathcafe.com/what/#sthash.eYN3ZxOa.dpuf

Join the War Against Alzheimer’s

losing one’s memory

Nearly half of all seniors who need some form of long term care, from help at home to institutional care, have dementia. That’s from the World Alzheimer Report which came out a few weeks ago.

The report further states that cognitive impairment is the strongest predictor of who will move into a care facility in the next two years. That is 7.5 times greater than people stricken with cancer, heart disease or other chronic ailments.

More than 35 million people worldwide, including 5 million in the U.S., are estimated to have Alzheimer’s. Unless some miracle cure is found these numbers are expected to double by the year 2050.

Unfortunately the U.S. is investing only $400 million a year in Alzheimer’s research. But the disease’s financial toll is estimated to be $200 billion per year. Compare that to the budget of the National Cancer Institute, part of the Department of Health and Human Services. For the last 6 years it has had a budget of $4.9 billion per year.

It’s time for caregivers, advocates and families stricken by Alzhemier’s to come to together to demand a push to end this brain disease. The world’s governments and researchers came together to turn the AIDS virus from a death sentence to a chronic disease and the same force of will can turn Alzheimer’s around.

If you want to get a clear picture of what Alzhemier’s is like from the patient’s perspective I suggest you read Lisa Genova’s book, “Still Alice” or read Dr. David Hilfiker’s blog, “Watching the Lights Go Out.” He is a retired physician who was diagnosed with Alzheimer’s in September, 2012, Lisa Genova’s book is fictional but was based on her experiences working with support groups for people who contracted the disease.

During my 33 years as a financial advisor I met with many couples and strongly recommended that they put together a long term care plan while they were healthy. I was emphatic when I suggested that they consider buying long term care insurance to protect themselves. Most people don’t realize that medicare will not cover the custodial care that an Alzheimer’s patient will require. It is only available for up to 100 days if a person is expected to recover from an illness or injury.

Long term care insurance covers cognitive impairment from Alzhemier’s or other forms of dementia. Time and time again people told me that long term care insurance was too expensive. But all they had to do was to talk to a few of my clients who discovered that the cost of care was much more expensive! Here in New England care in a residence that focused on those with mental impairment averages more than $8000 per month and in some cases is over $10,000 a  month.

How to Be At Your Aging Parent’s Bedside When They Are Very Sick

When one of your parents is very sick, you may not know what to do or expect. The time you spend with them by their bedside is very important. It is time that you will never forget. You may find it very difficult and very uncomfortable to be there but you will be glad you did it when it is over.

People are very different in how they handle serious illness. You are just going to have to let them deal with it in their own way. They may just act the way you have always known them or they may seem like a totally different person to you. A lot depends on the type of illness they have and whether or not recovery is possible.

Your loved one may be afraid of dying, tired all the time, confused, unwilling to have visitors, afraid to be alone, not wanting to talk, restless, depressed, or wanting to talk all the time. None of these actions are unusual. The best thing you can do is to be prepared for the unexpected. Your primary goal should be to make them as comfortable as possible.

Just being there with your parent is the most important thing you can do. Do not worry about saying the right thing. You may even admit, “Mom, Dad, I don’t know what is the right thing to say to you. I just know that I want to be with you and I am happy to be here.”

If your parent is sick they may want you to hold their hand, softly stroke their hair, read to them, play some music for them, show them photographs, tell them family stories, listen to them, pray with them or just sit quietly with them. Try not to upset them and assure them that they aren’t a burden to you.

Be conscious of how long you stay. After awhile you will get a sense of how long is appropriate. If you notice them starting to close their eyes or lose concentration, it’s time to go. In most cases I would suggest not staying longer than an hour. Frequent visits are much more important than long visits. Don’t be offended if they tell you they want to be alone. Having family members visit you requires a lot of energy and can be very draining to those who are ill.

As difficult as it may seem, imagine that this is the last conversation you may have with them. This will help you say everything you need to say.

Important Information You Must Save for Your Elderly Parents

Every time I speak before groups of babyboomers and their elderly parents I remind them of the importance of getting all their critical information down on paper or in a computer file that can be accessed by the family if there is an emergency.

What kind of information do you need close at hand? Copies of wills and trusts, durable powers of attorney, health care proxies and living wills should all be readily available. In addition the names and contact information for any family advisers(attorney, doctor, minister, banker etc.) should also be accessible.

Financial information such as the name and account numbers for bank and investment accounts should be listed. In addition the beneficiary statements for IRA’s, annuities and life insurance policies should be close at hand. Make sure these are up to date, and the beneficiary has not already passed on. Also make sure there are contingent beneficiaries listed if the primary beneficiary is deceased when the funds are released.

Last and perhaps more important than ever before. Make sure the internet addresses, usernames and passwords for any online financial accounts are readily available. When one of my clients passed away, his wife did not know the internet accounts he had utilized to manage his investments. The institutions would not give her any information about the accounts. She eventually had to hire an IT specialist to hack into his accounts and it took months!

A Guide for Babyboomers helping their elderly parents

Save info on important documents for your parents.There are a few ways to store all this information. One is a simple three ring binder. If you purchase my book “Can We Talk, A Financial Guide for Babyboomers Assisting Their Elderly Parents.” there is a section at the end of the book called the Lifefolio that has forms available for everything I have mentioned above. You can either tear those pages out or copy them and put them in the binder.

Another approach is to copy all the information digitally into a cloud system such as Dropbox or Google Documents. Then all family members who are authorized can access the information from any computer or tablet connected to the internet.

Whichever way you do it, do it now. You never know when there might be an emergency and you will need to access critical information for your parents.

8 Steps to Having a Successful Family Meeting with Your Elderly Parents

A Family Meeting is an excellent way to get the family together to discuss important issues especially those that involve elderly parents. It is very useful to help Mom and Dad decide where they want to live, how to manage their future health care needs, their financial needs and their estate plan.

The meeting should include all of the adult children and both parents if possible. It is important to have a facilitator for the meeting that has no emotional attachment to any decisions which will be made. The Family Meeting is one of the most important steps in parent care planning.

Here are Eight Steps Necessary to have a Successful Family Meeting:



The adult child who is considered the “Alpha Child” or “Family Champion” should enroll everyone in the family to understand the importance of the meeting and secure their promise to be there.



The Facilitator should contact each member of the family in advance to  get to know them and hear their concerns and ideas for the meeting.



The Facilitator, based on conversations with each family member should construct an agenda and distribute it to each of them well in advance of the meeting to get their feedback and help them prepare for the meeting.

Parents should understand that their children are providing ideas and sharing their concerns and not trying to control them. When decisions are made the parents wishes take priority.



Family members should treat each other with respect and compassion. The meeting should be held in the context that the family members love and care for each other.



A family member should be assigned as the scribe, to record important decisions, open items and action items that must be completed.



At the end of the meeting open items and action items should be reviewed and assigned to a family member to be followed up. These tasks should be distributed amongst family members and not lie with just one or two people.

A plan for communication between family members should be established. This method of communication should be used to keep everyone up to date on the status of open items and action items.  

It’s Time to Talk Turkey With Your Aging Parents!

Have you had a conversation with your parents regarding what they want to do if one of them needs extended care? Will they stay at home? Who will take care of them? I know it may be difficult to ask these difficult questions but the holidays may be good time to begin the conversation. You don’t want to wait until they have a medical crisis before you start planning. No one makes good decisions when they are under a lot of stress.

So how do you begin the process? Here are my suggestions to get the ball rolling:

Go to the website www.agingwithdignity.org

Download a copy of the Five Wishes Document.

Complete the document for yourself. It will force you to make a lot of decisions regarding how you want to be treated if you become critically ill.

Sign the Five Wishes document and have two witnesses sign it. If you are in one of 42 states this now becomes a legal health care proxy and living will. (Check the website for those states where the form is not legal.)

Make several copies of the document and save the original in a protected place.

Share the document with your spouse and children and make sure they know where the original is.

When you visit with your parents over the holidays share your completed Five Wishes document with them. Tell them what the experience was like filling it out.

Leave blank copies of the Five Wishes for each of your parents and suggest that they might want to complete them.

Check in with you parent a few weeks later to see if they have completed the forms. If not set up a time to review the forms with them and help them fill it out.

This process is a painless way to open up the conversation regarding your parents’ wishes for their care. You don’t have to ask them the questions directly. The form provides you with the tools to gather the important information. You just ask your parents to read the questions on their own and answer them privately when they are ready. And the process of planning their future care has begun!

Are You a Likely Candidate for Alzheimer’s?

I recently had the opportunity to participate in a radio series focusing on Alzheimer’s caregivers. My mom and I were interviewed by Sean Corcoran of WCAI radio, the NPR station on Cape Cod. The series was divided into five parts which were played on five different days. Sean did an outstanding job of illustrating many different family situations with a family member who has the disease. He has won many awards for his work and I am sure this series will be another award winner.

Here is a link to the series: www.wgbh.org/wcai/alz2.cfm

The research has shown that there are no specific strategies anyone can take to avoid the disease. No amount of crossword puzzles, brain teasers or mental exercises can protect your brain from Alzheimer’s. But according to Lisa Genova, author of “Still Alice” the most incredible book I’ve ever read about an Alzheimer’s patient, early detection is valuable.

Lisa states that “Awareness leading to earlier diagnosis is important. Although the current drugs available for treating Alzheimer’s do not change the ultimate course of the disease, they can stave off its progression for a significant amount of time, allowing the person with Alzheimer’s to live on sort of a plateau, to enjoy the capabilities they still have for a longer time”

Research has also shown that 50% of the children of Alzheimer’s patients will get the disease themselves. I am a child of an Alzheimer’s patient. Should I be tested to determine if I am likely to get the disease? Recent advances in testing can indicate if you have a very high likelihood of getting the disease but can’t tell you for sure if you will. So does it make sense to have the tests done or just let life take it’s course?

At this point I have decided not to be tested but to live my life to the fullest and be conscious of the occurrence of symptoms. I checked with the Alzheimer’s Association at their website http://www.alz.org/alzheimers_disease_10_signs_of_alzheimers.asp and learned that there are ten indicators to be conscious of . If you have any of these ( or if a loved one does) check with your doctor:

Memory loss that disrupts daily life.
Challenges in planning or solving problems
Difficulty completing familiar tasks at home, work or at leisure
Confusion with time or place
Trouble understanding visual images and spatial relationships
New problems with words in speaking or writing
Misplacing things and losing the ability to retrace your steps
Decreased or poor judgement
Withdrawal from work or social activities
Changes in mood or personality

Do Not Resuscitate?

Many of us mistakenly believe that if we have gone to the trouble of having our parents complete a living will and have had an attorney prepare an advance directive identifying a health care proxy for them we have covered all the bases. But this is not the case!

Advance Directives and living wills are not accepted by Emergency Medical Services (EMS) as legally valid forms. If a patient has a living will that states that they do not wish to be resuscitated but does not have an appropriately filled out state sponsored form that is co-signed by a physician, the Emergency Medical Technician (EMT) will attempt resuscitation. This is a little known fact to many patients and primary care physicians that can cause patients to be resuscitated even if their family has given instructions not to do so. Although this law is currently being evaluated for a constitutional challenge it is still in place.

A do not resuscitate document is a binding legal document that states resuscitation should not be attempted if a person suffers cardiac or respiratory arrest. A DNR does not affect any treatment other than that which would require intubation or CPR. Patients who are DNR can continue to get chemotherapy, antibiotics, dialysis, or any other appropriate treatment.

The DNR documentation is especially complicated since each state has its own specific approved form. The DNR form for residents of the State of Arizona is required to be printed on orange paper or it is not valid.  The Massachusetts form can be obtained from the Department of Emergency Services and can be downloaded from the site: www.mass.gov/Eeohhs2/docs/dph/emergency_services/comfort_care_bracelet.pdf  It provides for a bracelet to be applied to the patient’s wrist.

It is imperative that you contact your state health and human services department to determine what form is approved in your state. The form must be signed by the health care proxy ( sometimes called the health care agent) or a durable power of attorney and cosigned by a physician. It is recommended that the original DNR form be kept in safe place, and that copies be kept in places that will be readily available to EMS personnel

How to talk with Mom and Dad

Opening up a conversation with your elderly parents about important issues can often be a very stressful and difficult task. You know there are certain things you need to talk to them about but you often fear that they might speculate what your motives are. So how do you open up those conversations without embarrassing yourself and upsetting your parents?

First you must remember that one of their primary concerns ( according to David Solie in hs book, “How to Say it to Seniors” )is maintaining control of their lives. They don’t want to be told that they can’t drive anymore or that they have to move out of their house into a retirement community. Even if these choices are in their best interest they will be very reluctant to comply if they don’t feel that they have made the decision.

But you also need to know that you don’t want to wait until its a crisis to approach your parents. In my 30 years as a financial adviser to hundreds of families, I never saw things go well when families tried to make decisions after a loved one was already in trouble. These situations are fraught with emotion and people don’t often think very clearly when things are unraveling.

Now, while your parents are still healthy ( hopefully) plan out what issues you need to discuss with them before you approach them. Try writing them a letter expressing your concerns and thoughts. Don’t give them the letter but use it as tool to explore your own emotions. Narrow down your concerns to be as specific as possible. What are you anxious about? Enroll the ear of a friend or spouse and read your letter to them. Do they think your concerns are legitimate and worth discussing? Finally, listen to the letter as if you were your parents. Where do you think there will be resistance or stubbornness?

Once you know the focus of your conversation develop an ice breaking phrase that you can use  with your parents. Make sure your questions are open ended and leave room for them to express their opinions. For example,” Mom, recently one of my friends told me her mom was having difficulty keeping up with all the chores around the house. What do you think she should do?” Or, “Dad, can I get your opinion on a couple of things?” Or as simply as “Mom, can we talk?” One of my favorites was “ Dad, how are you enjoying those golden years?”

Your parents probably want to talk about the same concerns you have, but they just don’t want to upset you or mention things that are uncomfortable. They certainly don’’t want to be told what to do. But by easing into the conversation and creating an environment that is safe, you can eliminate a lot of stress for them and yourself. You’ll also give them the opportunity to age with dignity and peace of mind.

Radio Interview on NPR

This past week I had the privilege of being interviewed by Mindy Todd on WCAI, the Cape and Islands NPR station. We talked about the importance of baby boomers establishing a dialogue with their parents about financial and legal issues that will affect them and the whole family. Click here to listen: http://streams.wgbh.org/online/cape2/thepoint/point_120810.mp3