The New York Times had a recent article on money issues and Alzheimer’s disease.
New research shows that one of the first signs of impending dementia is an inability to understand money and credit, contracts and agreements. It is not just families who are affected — financial advisers and lawyers say they are finding themselves in a bind when their clients’ minds seem to be slipping….All too often, though, no one protects people who are losing their capacity to execute documents and their judgment about finances. Their stories of decisions gone awry tend to end badly.
The article goes on to talk about the difficulty financial firms have in determining if someone is still able to handle their finances and the problems faced by spouses who didn’t know their loved one was declining and losing control of money. It’s important for each spouse to know about money and accounts, even if that information isn’t shared with the children. For people without a spouse, make sure someone – friend, trust advisor, or attorney, knows where the account information is located.
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There was another New York Times article on hospice care for patients with dementia.
Medicare regulations require a physician to certify that a patient entering hospice is likely to die of his or her disease within six months. Doctors are more likely to do so when the disease is cancer or heart failure, which have more predictable trajectories.
That’s the major reason that dementia patients — who can benefit from the better pain control, fewer hospitalizations (so often associated with aggressive treatments that confer no measurable benefit) and greater family satisfaction that hospice has been shown to provide — are under-enrolled in hospice programs.
The article talks about the difficulty in certifying that a patient has a lifespan of less than 6 months, a requirement of most hospice programs, and then goes on to say:
Dr. Mitchell’s suggestion is to scrap the whole certification system for dementia patients, to allow them access to palliative care, or “comfort care,” without regard to their expected lifespans, since there’s no accurate way to estimate them.
Her message to Medicare: “If comfort care is the goal, patients should be able to access that whether they live a month or two months or six months.”
If a loved one has dementia, you may want to ask about hospice care for them. And when you are talking to your family about your end of life wishes, let them know what your wishes are about this so they can be educated if they need to communicate your wishes to your care providers.
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