As a new year begins, I’m delighted to join this community of bloggers who are committed to sharing information and exploring ideas in estate planning and the care of older people.
And what better theme than longevity to start the new year. People are living longer. Baby boomers are hitting retirement age in ever-increasing numbers and demanding changes in products and services to support them as they age. And centenarians are one of the fastest growing age cohorts in Canada. In addition to the longevity revolution, we are also seeing the largest transfer of wealth from one generation to the next. Societal factors have changed, with smaller families often living at a distance and fewer caregivers available. Families may not agree on how to care for a parent or stepparent, and grey divorce is on the rise. These are some of the factors having a profound impact on the increasingly complex world of estate planning.
As the founder of a professional services company focused on delivering planning and assistance services to older people, special needs people, and their families, caregivers, and advisors, I am often called upon to provide an independent assessment of a person’s care needs and wants. Recently, I have been encountering situations where the family disagrees about the level of a person’s cognitive and functional abilities as well as their capacity to make certain decisions. My job is made harder by the fact that the person’s health care and medical history is incomplete and specialist medical assessments have not been done.
Why is it important to determine a primary diagnosis and prognosis before assessing needs? Let’s get back to basics. If the dispute relates to the care of an elderly person, it is important to determine the person’s clinical baseline based on standardized assessments.
An example is a diagnosis of “dementia” by a family doctor with no referral to a specialist for further diagnosis.
- Dementia is an umbrella term for over 100 brain disorders that affect memory, thinking, behavior, and emotion.
- While Alzheimer’s is the most often diagnosed dementia, it can also be combined with other types of dementia resulting in a mixed diagnosis with different symptoms and behaviours.
- Geriatric medical specialists can complete a Comprehensive Geriatric Assessment (CGA) to help confirm the diagnosis of a specific brain disease with predicted symptoms that will need to be managed over time. The CGA may also determine if signs and symptoms of a disease can be managed differently with treatment.
- The CGA includes detailed histories regarding memory complaints, a functional baseline for Activities of Daily Living, and information on the patient’s current living arrangement and various screening assessments for items such as mood disorders, mobility issues or falls risk, etc. The physical assessments include such things as visual impairment, gait and balance abnormalities, cognitive impairment, assessment for depression, and attention to other organ systems predisposed to chronic conditions.*
Without a diagnosis and prognosis based on a thorough specialist assessment, it is very difficult to comprehensively identify a person’s care needs, determine possible treatments, or determine what those needs might be in the future. Without defined needs and care plans, it is then difficult to effectively plan for and cost out current and future care needs, and future accommodation needs.
We are in the midst of a longevity revolution and the landscape of aging is being transformed. Longer lifespans will change the way we live and offer new opportunities but it will also require us to delve into the complexities of how to effectively assess and plan for future needs. The first step is staying current with all medical appointments and referrals.
* Wong, Roger. (2017). Caring for older adults, Part 1: The value of geriatric assessment. British Columbia Medical Journal. 59. 90-92.