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Alzheimer's, Can It Wreak Havoc on Family Finances ; Debbie Gilbert ; Marcy Ages ; Dr. A. Claudio Cuello
http://www.radio-shalom.ca/mp3/Programs/1042/2012-05-30-alzheimer.mp3
INTRODUCTION
Alzheimer's is a progressive, fatal disease that eventually affects most if not all of the brain's functions. It is this progression through the brain, following virtually the same path in everyone afflicted, that causes the stages of Alzheimer's disease. The disease kills brain cells, beginning in the hypothalamus and steadily advancing into other areas of the brain. As different areas of the brain are affected, different brain functions are lost or impaired.
Alzheimer's may be present in the brain for years before it is diagnosed. The time frame, from earliest recognition of symptoms to ultimate death, can range from three to ten or even twenty years. Not all of the symptoms are present in every case, and there are individual differences in the speed that the disease advances from early to later stages.
It is not easy to accept the possibility that you or a loved one is experiencing symptoms of Alzheimer's disease, but an early diagnosis can be important. The sooner you know, the sooner you can start planning for the future, and the sooner you can begin exploring treatment options.
Just as there is no cure, no magic bullet exists to prevent Alzheimer's disease. On the other hand, there is compelling evidence that we can do certain things to delay the onset of the disease and even slow its progression. If we follow enough of this advice, we might be able to avoid it altogether.
It is becoming evident that lifestyle plays a big role in many diseases. What we eat, where we live, what we do with our leisure time: all of these are now known to play a very significant role in how likely we are to get cancer, heart disease, diabetes, and other of our most feared diseases. The same is true of for preventing Alzheimer's. Our genetics may be a big factor in whether or not we will eventually be affected by it, but our lifestyle and other environmental factors, factors we can control, are also contributors. There is less evidence in the professional literature that these steps will prevent dementia, but environment and lifestyle are probably factors in almost all forms of dementia.Today live from Toronto to talk about Alzheimer’s and its affect on the family finances is Marcy Ages ; Marcy is Senior Consultant & Certified Professional Consultant on Aging for T.E.WEALTH ; Debbie Gilbert is a Certified Professional Consultant on Aging in private practice and the Founder of Generations. Based in Toronto, she works with individuals and families across Canada facing their own care journeys and we will also talk Dr. Cuella a world renowned expert and scientist on Alzheimer disease he is currently the holder of the Charles E. Frosst/Merck endowed Chair in Pharmacology of the Department of Pharmacology and Therapeutics at McGill University, Montreal, we will discuss with him How Alzheimer’s Affects the Brain and the misinformation that some of the pharmaceutical companies are telling us..
http://www.tewealth.com/experts/samuel-ezerzer-b-sc/
My name is Samuel Ezerzer, your host to the Money & Business show on Radio Shalom, CJRS 1650 AM. Thank you for tuning in live on the Money & Business show, with our Business studios headquarters in Montreal, the financial capital and the home to the greatest hockey team, the Montreal Canadians. We have another great show for you today and as always, you can call if you have any questions, comments, or criticisms on today's topic. Please call us direct at 514 738 4100 ext 200 or email me at moneyandbusinessshow@gmail.com if you have any inquiries. You can also visit our website at http://www.radio-shalom.ca/ – all our shows are archived there.I work as Financial Consultant for T.E MIRADOR or TE WEALTH. TE MIRADOR has been providing Corporate Executives , CEO 'S , families ,employers and employee with independent wealth management and Financial education services since 1972. You can visit our website for my contact information at http://www.temirador.com/,
Biography: Marcy Ages
Marcy is Senior Consultant & Certified Professional Consultant on Aging for T.E, She has a degree in Mathematics rounded out Marcy’s financial education and for the past fourteen years she has been helping clients at T.E. Wealth look after their own personal finances. Along the way, Marcy has acquired industry accreditation in investment management and financial planning. She has also received the Certified Professional Consultant on Aging designation.
As a long-time supporter of the Daily Bread Food Bank, United Way and the United Jewish Appeal, Marcy takes great pleasure in helping clients further their own philanthropic interests. And not surprisingly, given her own experience, Marcy is passionate about helping other women, especially those who are widowed or divorced, become financially literate and self-sufficient.
Biography: Debbie Gilbert
Debbie Gilbert is a Certified Professional Consultant on Aging in private practice and the Founder of Generations. Based in Toronto, she works with individuals and families across Canada facing their own care journeys.
A graduate of University of Toronto’s Department of Rehabilitation Medicine, Debbie draws upon 25 years of experience as an occupational therapist and rehabilitation consultant in community and hospital settings. In 2009, she received her designation as a Certified Professional Consultant on Aging from the Canadian Academy of Senior Advisors with a focus on aging from medical, legal and financial perspectives.
In addition to working individually with clients and their families, Debbie is an industry recognized public speaker, workshop designer and facilitator. As a result of her own 10-year caregiving journey with her mother, Debbie gained important insights into the complicated issues that families face as our population ages.
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Maurice cousinau
Marcy is Senior Consultant & Certified Professional Consultant on Aging for T.E.WEALTH and has acquired industry accreditation in investment management and financial planning.
Debbie Gilbert is a Certified Professional Consultant on Aging in private practice and the Founder of Generations. Based in Toronto, she works with individuals and families across Canada facing their own care journeys.
Questions for Debbie Gilbert:
Question (for Debbie): We hear Alzheimer’s Disease spoken about more and more frequently. What does it actually mean?
Answer;
Alzheimer's disease is the most common cause of dementia. It’s a progressive disease, which means it gets worse over time. Brain cells degenerate and die, causing a steady decline in memory and mental function. As Alzheimer's disease progresses, brain changes begin to affect physical functions such as balance, swallowing, bladder and bowel control.
People with Alzheimer's Disease experience:
Memory loss: They don’t just forget people’s names but how they are in relationship with them. They might forget what they are doing, lose or misplace things.
The person can become disoriented. We think of disoriented meaning getting lost. But it can also mean not recognizing the time of day such as morning versus night or seasons of the year.
A person will have increasing trouble finding the right words to express themselves. Over time, they lose their ability to read and write and may lose their ability to speak altogether.
People eventually have difficulty concentrating and thinking, especially about abstract concepts like numbers.
Judgment, insight and decision-making become impaired which can put them and loved ones at risk. Eventually they will require others to make care and financial decisions on their behalf.
Planning and performing familiar tasks become increasingly difficult. Eventually, people with advanced Alzheimer's Disease forget how to do basic tasks such as dressing, bathing and feeding themselves.
There can be changes in personality and behaviour.
(Debbie):
- Question Answer
- Question
- Since we are talking about finances, what type of care costs do people with Alzheimer’s Disease face?
- Question
- How can a financial planner help an individual to plan for these types of expenses?
You lose the ability to understand numbers: my mom, a former bookkeeper, who lived with Alzheimer’s Disease for her final 10 years of life, could not tell the difference between 5¢, $5 and $500. They all have the number "5". Dollars and cents were concepts that held no meaning and the cost of various goods and services no longer held meaning either.
Combine not understanding numbers and the meaning of money with impaired judgment. Going shopping can be a very challenging and potentially risky activity.
Paying bills, writing cheques or doing on-line banking, managing investments, preparing and filing Income Tax Returns eventually becomes too difficult.
Think about writing a cheque. It requires a series of seemingly simple steps but for a person with dementia, it is very complicated.
When a person with Alzheimer’s Disease does not understand the concept of money, does not know appropriate from inappropriate requests for money, they are vulnerable to potential financial abuse. The person may not recognize the abuse or be able to respond to it appropriately.
Answer (Debbie): Initially, assistance needed may be minimal during which time a person with Alzheimer’s Disease can remain quite independent even if they live alone, with strategies put in place. As the disease progresses, increasing care will be required. Although the provincial governments provide some degree of home care, this is usually not sufficient as the disease advances. Average care costs from an agency are $22 - $25 per hour. Privately hired caregivers who are qualified to work with the elderly, bill on average $15 - $17 per hour. Costs for live-in care vary greatly. A person with Alzheimer’s Disease will eventually require 24-hour care, as they cannot be left alone in the home. It is a combination of hands-on care and supervision. Managing mid to end stages of Alzheimer’s Disease at home becomes very difficult, as the person will require more specialized care. It is a huge physical and emotional strain on caregivers who are at risk for injury and illness. Assisted living becomes an important care option. There are 2 main options: retirement homes and long term care homes. Retirement homes are not government subsidized. Amenities and services vary and may or may not be able to manage mid – advanced stages of Alzheimer’s Disease. Costs for retirement homes range in price across Canada and on average start at $4,000 per month with additional care billed on average at $25 per hour. Care costs can be as high as $8,000.00 and up per month.
Long Term Care homes are also known as nursing homes. The majority of homes are public rather than private, which means provincial governments subsidize them. Co-payment costs for these homes are determined by provincial governments and vary across Canada. For example, in Quebec, resident co-payment costs range from $1368.00 - $1637.00 per month. In Ontario, they range from $1620.00 - $2166.00 per month. Private caregivers are often hired by families to provide additional care and companionship.
Question (for Marcy): How can a financial planner help an individual to plan for these types of expenses?
Initially, assistance needed may be minimal during which time a person with Alzheimer’s Disease can remain quite independent even if they live alone, with strategies put in place.
As the disease progresses, increasing care will be required. Although the provincial governments provide some degree of home care, this is usually not sufficient as the disease advances. Average care costs from an agency are $22 - $25 per hour. Privately hired caregivers who are qualified to work with the elderly, bill on average $15 - $17 per hour. Costs for live-in care vary greatly.
A person with Alzheimer’s Disease will eventually require 24-hour care, as they cannot be left alone in the home. It is a combination of hands-on care and supervision.
Managing mid to end stages of Alzheimer’s Disease at home becomes very difficult, as the person will require more specialized care. It is a huge physical and emotional strain on caregivers who are at risk for injury and illness.
Assisted living becomes an important care option.
There are 2 main options: retirement homes and long term care homes.
Retirement homes are not government subsidized. Amenities and services vary and may or may not be able to manage mid – advanced stages of Alzheimer’s Disease.
Costs for retirement homes range in price across Canada and on average start at $4,000 per month with additional care billed on average at $25 per hour. Care costs can be as high as $8,000.00 and up per month.
Long Term Care homes are also known as nursing homes. The majority of homes are public rather than private, which means provincial governments subsidize them. Co-payment costs for these homes are determined by provincial governments and vary across Canada. For example, in Quebec, resident co-payment costs range from $1368.00 - $1637.00 per month. In Ontario, they range from $1620.00 - $2166.00 per month. Private caregivers are often hired by families to provide additional care and companionship.
Answer
A Financial Planner can run projections which incorporate the different costs of care. There are many different scenarios that can occur. For example, one scenario may be that the individual with Alzheimer’s stays at home with attendant care at first but then moves into an assisted living facility later on. Another scenario could be that a person moves into an assisted living facility immediately. We can run projections for each type of care, from public to more expensive private.
We typically use a life expectancy of age 90 unless there is a specific reason for using a different age, such as family health history. We would also take into account the fact that both partners may need care, either at the same time or one after the other. We want to make sure that there are enough funds left over for care after the first spouse dies.
The projection will make assumptions about items such as inflation, rates of return and savings rates. And we can run different scenarios where we change these assumptions.(for Marcy):
Question (for Marcy): How do Powers of Attorney come in, in the event of a person being diagnosed with Alzheimer’s.?
These projections can be a real eye opener for some people. When many people see these projections they find out that they can’t even retire when they want to in a healthy state. So there is no way that they will be able to retire and pay for the additional costs that come with Alzheimer’s. A common misconception that people have is that when they need to go into an assisted living facility they will sell their home and use the proceeds to fund the costs of the assisted living facility. However, this may not provide them with enough funds. Also if you choose to stay at home with attendant care there will be no house proceeds to use.
If a projection shows that there are insufficient funds then we look at what the person can change now to better their financial position. We look at things like savings rates before retirement, taking more risk in the investment portfolio to get possibly higher returns (if they are comfortable with this) or more tax efficient investing which will increase after tax returns.
If there are not a lot of changes that can be made to the portfolio then another option is to purchase insurance. One can purchase Critical Illness insurance or Long Term Care insurance. Critical Illness insurance provides a lump sum amount in the event of an Alzheimer’s diagnosis. The payment is tax free and the funds can be used for anything. With Long Term Care insurance you can either choose to have your expenses reimbursed or you can choose to receive a payment of a fixed monthly amount. These payments are also tax-free. There are many versions of these products so it is best to speak to an insurance broker to get all of the details. One can also purchase a first to die life insurance policy that will pay out when the first person dies. This would leave funds for the surviving spouse to use for care. It is always best to purchase these policies when you are young. However in certain situations it can still be worth the cost when you are older if you end up using the insurance.
(for Marcy):
How do Powers of Attorney come in, in the event of a person being diagnosed with Alzheimer’s.
You should make sure that at all times you have both a Power of Attorney for Property and a Power of Attorney for Health Care. Some people think that if they have a Will they don’t need Powers of Attorney. This is not correct. A Will deals with your estate only after you die. While you are alive your Will has no standing. You need Powers of Attorney. Then if you or a family member are diagnosed with Alzheimer’s there will be someone who can act on your behalf with regard to financial and health care matters. Do not wait until a person is diagnosed with the disease. It may then be too late for them to appoint a representative because of their mental incapacity.
Also, keep in mind that some financial institutions will only accept their own Powers of Attorney. You should check with your financial institution if this is the case and then complete one of theirs if necessary. They may even ask you to come in and sign and have the document witnessed in their presence.
In addition, some financial institutions who may accept your own Power of Attorney may still ask for proof of capacity when the document was signed if it is an old document. You should therefore make sure that you have up to date documents.
Questions for Debbie Gilbert:
Question (for Debbie): This disease is heartbreaking. What additional perspectives can you offer to help families or people living with this disease cope?
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A. Claudio Cuello, M.D., D.Sc., FRSC
A. Claudio Cuello obtained his degree in Medicine from Buenos Aires University (UBA) and started his research career while a medical undergraduate. He was trained initially in
Argentina at the De Robertis Institute for Cell Biology UBA and at the Institute of Neurobiology. Later, he accepted an NIH International Postdoctoral position in the Department of Physiology of the University of California, San Francisco (USA) and later another in the Department of Pharmacology at Cambridge University (England). After a brief stint as Assistant Professor at the Faculty of Biochemistry and Pharmacy, UBA, Argentina, he was recruited in 1975 as Staff Scientist of the MRC‐Neurochemical Pharmacology Unit, Cambridge, England and was invited in 1978 to take an academic position at Oxford University in the Department of Pharmacology. While in Oxford he was also appointed as the E.P. Abraham Senior Research Fellow and Medical Tutor of Lincoln College (founded in 1427). He remained there until 1985 when he was invited to McGill University to Chair the Department of Pharmacology and Therapeutics.
In Canada, Dr. Cuello transformed the McGill Department of Pharmacology and Therapeutics during his three consecutive appointments from 1985 to 2000. Under his leadership the Pharmacology Graduate Program grew steadily for 15 years to graduate some 5% of all the PhDs in Pharmacology in North America. The scientific profile and productivity of the Department increased significantly to reach some 100 papers per year in high impact journals. During his tenure as Chair outstanding young scientists were recruited who went on to become leaders in their fields. He brought a plethora of outstanding lecturers to McGill, including 5 Nobel Laureates. Dr Cuello established liaisons and academic and research cooperation with the Canadian pharmaceutical industry and played a key role in bringing the Canadian International Congress of Pharmacology (IUPHAR) to Montreal in 1994. During his chairmanship he created valuable endowments, prizes, lectureships and fellowships honouring distinguished McGill and Canadian scientists such as Theodore Sourkes, Mark Nickerson, Frank "Hank" MacIntosh, James E. Frosst and Charles E. Frosst.
Many of his past trainees are presently occupying leading positions in academia (e.g. Head of Cell Biology, London University; Professorships at Harvard, UCLA, McGill and others), industry (e.g. current Director of Global Research Neurology, Pfizer) and medicine (e.g. Head of the Cleveland ALS Clinic) A. Claudio Cuello is currently the holder of the Charles E. Frosst/Merck endowed Chair in Pharmacology of the Department of Pharmacology and Therapeutics at McGill University,Montreal, Canada. He leads a successful multidisciplinary research group which maintains a number of international collaborations. His major area of interest, for which he is recognized nationally and internationally, is in cellular and molecular aspects of degenerative/ regenerative diseases of the central nervous system with special emphasis in aging and Alzheimer’s disease. His publications have brought him recognition as a "Highly Cited Neuroscientist" by the US Institute of Scientific Information (ISI). At McGill University,
he was recognized with appointment to the Charles E. Frosst/Merck Chair in Pharmacology. In addition to his more than 300 peer reviewed scientific publications he has edited several books in his field and is on the editorial boards of over ten prestigious journals in the neurosciences.
In 1986 he was granted the degree of Doctor of Sciences by an international panel and Oxford University for his outstanding contributions to neuroscience. He is also recipient of numerous national and international distinctions; he has been named Honorary Professor at the School of Biochemistry and Pharmacy, Buenos Aires University and received an Honorary Doctorate in Sciences from the University of Ceara, Brazil and an Honorary Doctorate in Medicine from Kuopio University, Finland. He was elected Fellow of the Royal Society of Canada and has received the Novartis Senior Award of the Pharmacological Society of Canada, the H. Lehman Award from the Canadian College of Neuropsychopharmacology. Dr. Cuello is listed in several international Who’s Who volumes and he has recently been recognized with an Honorary Visiting Professorship from Oxford University, a Visiting Fellowship from Oxford London College and a position as Adjunct Professorship in Neuropharmacology at the Scripps Research Institute, La Jolla, California. Finally, his accomplishments in science have merited his entry in the "History of Neuroscience in Autobiographies" (Academic Press, NY 2000), a publication sponsored by the Society for Neuroscience (USA).
His friend and collaborator, Cesar Milstein highlighted Dr. Cuello’s contributions to the development of hybridoma technology (e.g. bispecific monoclonal antibodies) in his 1984 Nobel address. On the death of Prof Milstein, Dr. Cuello was invited by Oxford University to Chair the appeal for the creation and endowment of the Cesar Milstein Chair in Molecular Cancer. The Committee organized by Dr. Cuello attracted prominent scientific leaders from the University of Oxford, London and Cambridge and generated 3.0 million pounds sterling for the Chair which was recently inaugurated at the Oxford Sir William Florey School of Pathology, where penicillin was isolated by Florey’s team.
In addition to his academic activities in Canada, he translated his pioneering contributions in the development of monoclonal antibodies and founded three active biotechnology oriented companies in Montreal, which for the last 23 years have generated employment for some 20 technically qualified people. He has several patents issued or under review. On a personal note, Dr. Cuello is married to Martha Kacs and has two married daughters, Paula and Karina, presently residing in Washington DC and Zurich Switzerland respectively,as well as six grandchildren. He is an avid reader of classical history and a collector of antiquities.
Question #2
Any of us could unknowingly be in the silent stages of the disease. Is there anything we can do to remain in this stage for as long as possible while scientists are working to find biomarkers and treatment?
Question #3
If my parent or sibling has Alzheimer's Disease, does this mean that I will likely get it? Question #4
This was improvised on air but went something to the effect of: why research is so important.
Question #5For Baby Boomers and older seniors, what message of hope would you give us in terms of Alzheimer's Disease?
(Debbie):
Question (for Debbie): Since we are talking about finances, what type of care costs do people with Alzheimer’s Disease face?
Question (for Debbie): You mentioned that Alzheimer’s Disease gets worse over time and that it impacts a person’s ability to manage their daily activities. Can you give some examples of how it could impact a person’s abilities to manage their finances? ------------------------------------------------
Question #1:
If you find these biomarkers, what would this mean for a person in the silent stages of this disease who today, looks totally normal and healthy? (for Debbie): You mentioned that Alzheimer’s Disease gets worse over time and that it impacts a person’s ability to manage their daily activities. Can you give some examples of how it could impact a person’s abilities to manage their finances? Answer
Sam, Alzheimer’s Disease is heartbreaking. There are so many losses – for the person living with the disease and their family. It is important to approach these challenging care years with compassion and help ensure that the person living with Alzheimer’s Disease has his or her voice heard. Although cognitive and function declines, there are other aspects of a person – call it their core being, their soul or their essence that needs to be acknowledged and listened to. Although a person’s abilities to participate in daily activities significantly declines over time, where they are able to make decisions or voice opinions whether on care options, clothes they wish to wear or food they wish to eat, they have the right to do so and be listened to.
I challenge the notion that we experience role reversals and that with Alzheimer’s Disease, our parents become our children. I believe that we experience evolving roles. As multiple adult generations, we need to stretch beyond our comfort zone and learn how to be in relationship with a loved one with Alzheimer’s Disease or other dementias and becomes dependent on us for care – whether we are their spouses, adult sons and daughters or adult grandchildren. We need to develop our own compassion and help ensure that a vulnerable person’s dignity is kept in tact and that they receive the respect and care they need and have a right to have.
Caregivers and the person living with Alzheimer’s Disease all need tremendous practical, emotional and spiritual support on a very difficult care journey.
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