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 "Money Woes Can Be An Early Clue to Alzheimer's" 
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Joined: Fri Aug 11, 2006 1:46 pm
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Post "Money Woes Can Be An Early Clue to Alzheimer's"
We've certainly see the inability to manage one's bills as a sign of Lewy Body Dementia as well.


http://www.nytimes.com/2010/10/31/healt ... ances.html

October 30, 2010
Money Woes Can Be Early Clue to Alzheimer’s
By Gina Kolata
New York Times

Renee Packel used to have a typical suburban life. Her husband, Arthur, was a lawyer and also sold insurance. They lived in a town house just outside Philadelphia, and Mrs. Packel took care of their home and family.

One day, it all came crashing down. The homeowners’ association called asking for their fees. To Mrs. Packel’s surprise, her husband had simply stopped paying them. Then she learned he had stopped writing checks to his creditors, too.

It turned out that Mr. Packel was developing Alzheimer’s disease and had forgotten how to handle money. When she tried to pay their bills, Mrs. Packel, who enlisted the help of a forensic accountant, could not find most of the couple’s money.

“It just disappeared,” she said.

What happened to the Packels is all too common, Alzheimer’s experts say. 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.

The Financial Industry Regulatory Authority, the largest nongovernmental regulator for securities firms doing business in the United States, recently met with individual financial services companies and the Alzheimer’s Association to formulate guidelines on how to deal with clients who have trouble remembering and reasoning, a problem that is not new but is increasing as the population ages.

The issue is far from simple. Dr. Jason Karlawish, an associate professor of medicine and medical ethics at the University of Pennsylvania, says it is generally agreed that decisions by a competent adult should be respected.

But, he said, “What do we mean when we say someone has enough decision-making capacity to be ‘competent’? The law, psychology and finance are all waking up to issue of decision-making capacity.”

The issue promises to become even more complicated as researchers and doctors diagnose Alzheimer’s earlier and earlier. If new brain scans and other methods show signs that a person is developing dementia, does that mean the patient should be watched, or that there should be limits on his or her abilities to make financial or legal decisions?

Financial firms are in “a dicey situation” if they have to decide whether a client can make major decisions about finances or future plans, said John M. Gannon, senior vice president for investor education with the financial regulatory agency. “Even doctors can have trouble figuring that out,” he said.

And yet, according to research by Daniel C. Marson, a neuropsychologist at the University of Alabama, Birmingham, confusion over money and finances is perhaps the most important and most predictable early functional change as people descend into dementia.

For lawyers, the main question is at what point a client lacks the capacity to execute a will or other document, and who decides when that point has been reached. And if a lawyer lets a client go ahead, will the document be challenged?

Lawyers have guidelines, published in 2005, that include warning signs of diminished capacity, like memory loss and problems communicating and doing calculations. The guidelines instruct lawyers to look at the legal requirements for capacity in specific situations, like making a gift. But many questions remain, said Charles P. Sabatino, who leads the American Bar Association’s Commission on Law and Aging.

“Courts are always struggling to come up with principles and definitions of capacity,” Mr. Sabatino said. Definitions of capacity vary among the states.

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.

Mrs. Packel had to close her husband’s business and sell their house to pay lawyers and creditors. Now they live in a one-bedroom apartment in Philadelphia. Mrs. Packel, who is 75, supports herself and her husband by working as a receptionist. He goes to adult day care.

“It’s such a complete turnaround,” Mrs. Packel said. “Arthur was a very, very bright man.”

Spotting the Problem

Last year, Fidelity Investments surveyed 350 investment advisers. The advisers were asked if they suspected that any of their clients had Alzheimer’s or were developing it, and what they did about it. The advisers also were asked if they had mentioned the problem to their clients.

Most — 84 percent — said they thought they had had clients with Alzheimer’s or symptoms indicating that they were developing it. And 96 percent said they did not feel prepared to deal with those clients. Half said they were not comfortable even raising the subject of dementia. They worried that they might be wrong about a client’s mental capacity, and even if they were right, they did not know what they were supposed to do about it or where to refer the client for assessment and help.

The survey was an impetus for this year’s meeting involving investment advisers, the Alzheimer’s Association and the financial regulatory agency, said David Canter, an executive vice president at Fidelity.

‘Protect Your Client’

Lawyers see another side of the dementia problem. They too can end up in situations with no clear resolutions.

Robert Grant, a lawyer in Palo Alto, Calif., explained what happens in California.

“Your first duty is to your client,” Mr. Grant said. “You have a duty to protect your client. Often there will be discussions with the family about whether your client is capable of handling things. But you are prohibited from disclosing information about your client without the client’s permission.”

And clients — suspicious, forgetful, disturbed by or denying their impending dementia — may not want their lawyer to discuss their behavior with their families.

“In one sense it is straightforward,” Mr. Grant said. “You have a bunch of rules out there.”

For example, a lawyer has to make an independent determination that the client is competent. If the lawyer determines the client is incompetent but the client insists on executing a document, the rules say the lawyer should withdraw representation. However, Mr. Grant said, “one can question whether withdrawal from representation of an incompetent client is actually in the client’s best interest.”

Bruce Wampler of Glenwood Springs, Colo., said the law was of limited help in dealing with his father, who lived alone in Casper, Wyo., and, in his dementia, had forbidden his son to visit him.

Concerned about his father’s capacity to make decisions, Mr. Wampler went to court and won guardianship, angering his father so much that he refused to speak to Mr. Wampler for nearly a year.

Meanwhile, a neighbor who believed that the elderly Mr. Wampler was being ignored by his family found a lawyer who arranged to have the guardianship rescinded. The neighbor also encouraged the father to change his will, leaving much of his money to organizations he had never supported, his son said. At the same time, the elder Mr. Wampler was sending substantial amounts to lottery schemes.

The bar association’s handbook for lawyers, written with the American Psychological Association, tries to provide some guidance. But the handbook acknowledges that it may not be easy to determine a client’s capacity to sign a will, execute a contract or transfer property.

“The law wants a yes-or-no answer,” Mr. Sabatino said.

But medical evaluations come in shades of gray, discussing strengths and weakness in reasoning and mental abilities. The assessments place patients on a continuum. “They don’t like to give a yes-or-no answer,” Mr. Sabatino said.

And persuading clients to have medical evaluations can be difficult, as the law association’s handbook acknowledges.

“A referral to a clinician requires client consent, and can be quite traumatic for the client, as well as unsettling for the lawyer-client relationship,” the handbook states, adding, “Also, it is expensive.”

Losing Everything

Dr. Max Gomez had problems with both finances and legal documents. And by the time his son found out, Dr. Gomez had lost everything.

Dr. Gomez, an obstetrician-gynecologist, lived alone in Miami and worked at a nearby general medical clinic where he was the director. His son, who is also named Max, is the medical correspondent for CBS News and lives in New York.

Dr. Gomez was no longer seeing patients, his son said. The clinic, he explained, “was basically a place that gave him somewhere to go and something to do.” It operated under Dr. Gomez’s license.

It turned out that Dr. Gomez actually was the medical director for as many as five or six clinics, his son said, adding, “Whether he realized that and signed on or whether someone put papers in front of him and said, ‘Here, sign this and you’ll be medical director’ is not really clear.”

At least one of the clinics also appropriated Dr. Gomez’s identification number for Medicare and Medicaid, using it to fraudulently bill for several million dollars worth of goods and services, as Dr. Gomez’s son learned from the Federal Bureau of Investigation.

Then Dr. Gomez’s son got a call from his father’s condominium association. His fees were not being paid. The clinic was supposed to have been paying but had stopped.

The clinic had closed, but Dr. Gomez did not realize that. When he drove there and the doors were locked he would think it was a weekend and drive home, his son said.

The clinic had also stopped paying Dr. Gomez’s mortgage. Dr. Gomez thought the clinic was buying the apartment and allowing him to live there. Instead, it turned out that Dr. Gomez was the owner. His son later learned that, at closing, the clinic also took out a second mortgage on the apartment in Dr. Gomez’s name. He was responsible for both mortgages. The bank foreclosed.

As Dr. Gomez’s son tried untangling the mess, he discovered his father’s bank account had been plundered by a woman who talked him out of his savings. There was check after check written to the woman, signed by Dr. Gomez but made out in someone else’s handwriting.

Only his Social Security payments were left. They were being deposited in a bank account that Dr. Gomez had forgotten about. The complications mushroomed. Dr. Gomez’s son received a letter from a bank saying his father owed about $50,000. It turned out that Dr. Gomez was listed as an officer of the clinic and a personal guarantor on a loan. “I talked to attorneys, and they said, ‘That’s crazy, no one signs to be a personal guarantor on a commercial loan,’ ” his son said.

Dr. Gomez’s creditors could not collect, though. His assets were gone.

He now lives in an assisted-living facility in New York and seems content, his son said. He seems to have forgotten most of his experiences in Miami.

But every now and then, Dr. Gomez will be troubled.

“He will see me filling out papers for Medicaid,” his son says. “He says, ‘Medicaid? But I have money.’ ”

“He’s a proud man,” Dr. Gomez’s son said. “He is used to giving orders rather than taking them.

“It’s a sad story. But I’m afraid it’s not an uncommon one.”


Sat Oct 30, 2010 11:54 pm
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Post Re: "Money Woes Can Be An Early Clue to Alzheimer's"
Reading this was like seeing my own situation of 2008 in print! Dale is also a retired attorney and we owned an insurance brokerage. He completely lost track of our business and I had to pick up the pieces.

In a moment of awareness, he finally came to me, literally on bended knee, to apologize and turn it over to me. He was aware of what he had done and failed to do.

In his case, it was total confusion in decision making rather than a failure of memory. I think there is a distinction between the two. The fact that he apologized means that he didn't just 'forget.'

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Leone Carroll (75); wife of Dale (75) who passed away March 23, 2011


Sun Oct 31, 2010 6:11 am
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Post Re: "Money Woes Can Be An Early Clue to Alzheimer's"
I had nothing as tramatic as above but my husband just stopped paying our car insurance, he forgot ! I recieved a letter some 3 months later because one of the cars had a loan on it and at that point I discovered what had happened, we went from paying about 1000.00 per yr to about 4500.00 because of being uninsured for 3 months. I called our insuance broker and was told they can no longer tell you when your car insurance is in arrears, this was in the State of FL.

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Irene Selak


Sun Oct 31, 2010 9:14 am
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Post Re: "Money Woes Can Be An Early Clue to Alzheimer's"
I'm very thankful that I have always handled our financial accounts and paid the bills, etc. He has always been hopelessly careless about such things. When I first met him, he had a cardboard box full of unopened bills. :shock: He never balanced his checkbook. After we married, he was content to let me take care of it. I would present him with a printed financial statement once a year and that was about the extent of his interest. [He was a research scientist/manager and didn't have to deal with financial matters except annual and quarterly budget proposals, etc. I have no idea how successful he was with those.]

When he began showing early symptoms of Lewy [I now recognize] he became paranoid and suspicious of my handling of the finances. One year [around 2002, I believe] he insisted on doing the taxes, which he messed up dreadfully and I had to re-file with the IRS. He later thought I was conspiring with my daughter and her husband to give them our house. I really feel sorry for those of you whose LOs have been mishandling your finances. It must be a nightmare!

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Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Sun Oct 31, 2010 9:19 am
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Post "Money Woes" Irene S - cut
Are you still in Florida, Irene? Thankfully, we have a competent insurance firm that handles all our insurance payments. They have been friends for several years.

However, I sympathize with the cost of 'picking up the pieces' when things fall through the cracks. The cost of repairing the damage Dale had done to our business by failing to keep on top of it was at least $40,000. Fortunately, we had the money. I am far from homeless.

The result for him is that he is extremely paranoid about the insurance we carry to cover the mistakes made by insurance agents. He regularly asks me if we have 'E & O coverage.' (That's 'errors and omissions.') He almost cries when I assure him that we do. It is a continuing thought in his nightmares and delusions, and has been since he retired more than two years ago.

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Leone Carroll (75); wife of Dale (75) who passed away March 23, 2011


Mon Nov 01, 2010 10:33 am
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Post Re: "Money Woes Can Be An Early Clue to Alzheimer's"
Leone,
No I am not in FL anymore, I moved close to 3 yrs ago but we had the same insurance co for over 15 yrs and when I called them to ask why they never contacted us they said it is a law that they can't anymore, its just another tactic to catch people off guard and charge them more!

But anyway I loved in the Tampa Bay area and still miss it Its too cold in SC for me !

If memory serves me correctly you are in Ocala ??

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Irene Selak


Mon Nov 01, 2010 6:45 pm
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Post Re: "Money Woes" Irene S. - cut
Yes, Ocala... where the median home price was once about $150,000. but where last year saw the greatest dip in home values in the nation: 24% There are few jobs available. We see businesses fail every week. The young people are moving away.

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Leone Carroll (75); wife of Dale (75) who passed away March 23, 2011


Mon Nov 01, 2010 7:09 pm
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Post Re: "Money Woes Can Be An Early Clue to Alzheimer's"
I may have mentioned before that my writing has helped me through this past year since Mr Bobby is gone and I never saw a reason to share it before. This is the way it happened with us:

On closing a life ~~~~~~~~~~~ January 25, 2010

The pride is there
Concise bookkeeping,
Numbers on the page
All speak to his identity

He paid his bills and kept
His checkbook up to date
The bills came first
He owed not any man

Until one day he could not see

He tried to add
And then subtract
The numbers changed
Their place and shape.

The bank kept records too.
But they were not the same.

I wrote the checks for him to sign
In pain I watched his name
Start on the mark to end up high
rise upward to the end

I asked the bank to add my name
My name to the account.
He signed the card and
Trusted me to always pay,,,
Our bills… upfront on time

Tonight I stored the final stubs
Of that long lived account.
They rest inside a plastic sleeve
Keep safe for seven years.

I placed new clean unwritten sheets
Within the binder; snapped it shut.
My name alone appears, not ours.
He taught me well.
I’ll keep his book,
I’m closing down his life.

Dorthea

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"See this lady she's 85 but she's nice", This is the way my husband, Mr B., introduced me in 2006 to the people only he knew. Death due to pneumonia. Lewy Body Dementia diagnosed post mortem at Mayo Clinic in Jacksonville Florida.


Mon Nov 01, 2010 10:03 pm
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Post Re: "Money Woes Can Be An Early Clue to Alzheimer's"
Dorthea, that's beautiful! Thank you for sharing it. Hugs!--Pat

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Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Mon Nov 01, 2010 10:10 pm
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Location: SF Bay Area (Northern CA)
Post Re: "Money Woes Can Be An Early Clue to Alzheimer's"
DrP,
Lovely but sad. Another online friend who lost her husband also emailed me recently to say that she's in the process of changing all the acct ownerships to one name. It's a sad milestone.
Robin


Tue Nov 02, 2010 1:22 am
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Post Re: "Money Woes Can Be An Early Clue to Alzheimer's"
Dorthea, We can all relate, thank you, and stay well. I always look forward to your postings.
Take Care, Gerry

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Gerry 67, cared for Frank 71, married 49 yrs; dx 2004, passed away October 26, 2011.


Tue Nov 02, 2010 5:40 am
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Post Re: "Money Woes Can Be An Early Clue to Alzheimer's"
Dorthea,
Yet another lovely poem of yours, thank you for sharing ! When you mentioned the handwriting, it brought back memories of our life too!

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Irene Selak


Tue Nov 02, 2010 7:54 am
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Post Re: "Money Woes Can Be An Early Clue to Alzheimer's"
Dorothea....
I'm new to your poems so reading this one was a happy surprise. Thank you for sharing your obvious talent!

I haven't removed Dale's name from any accounts but he has nothing to do with them anymore. Thankfully, he is fully cooperative on such things.

A few days ago, when he was studying a bank statement for a couple of hours, he asked, "Where did all this money come from?" I smiled but didn't respond. It's too complicated for him.

Hugs from your house to ours,


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Leone Carroll (75); wife of Dale (75) who passed away March 23, 2011


Tue Nov 02, 2010 9:10 am
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Post Re: "Money Woes" Dorothea
:oops: I meant 'from our house to yours' .... but your poem was certainly a hug from you to us. ::::smile::::: Thanks again.

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Leone Carroll (75); wife of Dale (75) who passed away March 23, 2011


Tue Nov 02, 2010 9:33 am
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