Why It’s Okay to Fire Your Doctor

Finding a primary care doctor who makes you feel heard, responds to your questions and understands your concerns is not easy. And if you’re lucky enough to find a physician who suits your needs, it’s not always guaranteed that the doctor will do so as long as you need.

When a doctor stops meeting your standards of care, the conundrum becomes: Do I wait it out, avoid hard feelings and give it a chance, potentially wasting time, money and effort? Or do I move on and see if I can find better care from another doctor?

Fire Your Doctor? Many Do

Former health care journalist Bob Brody grappled with this challenge in a recent New York Times piece. Brody wrote that his trusted doctor of more than 20 years became less thorough in his questioning and examinations and began looking at his computer screen far more than Brody during appointments. Brody said the physician gave increasingly more referrals out to other doctors, more dense medical articles for him to read and more prescriptions without evidence showing the need.

Brody was left feeling unheard, and he’s not alone. In his article, he pointed to a 2001 Journal of Family Practice study showing that one-fifth of patients left their primary care doctors voluntarily over a three-year period.

Dr. Danielle Ofri, an associate professor of medicine at NYU,  told Brody that in an attempt to avoid medical risks, it’s on trend for doctors to prescribe medications and refer patients to specialists by default. And Dr. Russell Phillips, director of the Center for Primary Care at Harvard Medical School, validated Brody’s qualm that doctors are spending more time looking at screens than their patients — a topic Next Avenue has previously explored.

Brody’s tough decision was ultimately made simple when he learned that his doctor retired. He had no choice but to seek out a new physician. Not everyone has that fortune.

Putting You First

In thinking about whether to start seeing a new doctor, ask yourself if your physician listens to you and understands what you want. If you’re consistently feeling ignored or misunderstood, allow yourself to prioritize your health above your doctor’s feelings and consider making a change.

To start off on the right foot with a new doctor, read up on getting more time with your physician, standing up for yourself at a doctor’s appointment and steering your health care in the right direction.

By Grace Birnstengel

The Biggest Estate Planning Mistake People Make

If you are like most people, when you hear the words “estate planning,” you probably think of writing a will, to explain who will get what you own when you die. The problem is, a will has little or nothing to do with you. It’s all about planning for someone else. In reality, estate planning is about much more than writing a will; it’s also about taking care of you while you are alive, should you become incapacitated and unable to make your own decisions.

What follows is a rundown of the key disability documents to complete as part of your estate planning, even before writing a will. Although their names vary from state-to-state, the following are essential “me first” documents.

An Advanced Health Care Directive, sometimes called a Medical Power of Attorney  This document lets you choose who will make decisions about your health care if you become too ill or injured to make them yourself. This person is referred to as your health care agent.

Living Will  A living will spells out the kinds of medical care and treatment you do and don’t want to receive if you are close to death and there is no hope of your recovery. Your health care agent will have the power to make sure your wishes are complied with. In some states, a living will is part of an Advanced Health Care Directive; in others, they are two separate documents.

A living will also spares your family members from having to second guess your desires and can help avoid emotionally difficult fights among your loved ones over what to do (or not do). Worst case scenario: Without a living will (and a Medical Power of Attorney), decisions about your end-of-life care could end up in the hands of a judge who knows nothing about you, and your loved ones could be completely shut out of the judge’s deliberations.

A Durable Power of Attorney If you become incapacitated, your bills still must be paid, your investments managed and so on. A Durable Power of Attorney helps ensure that during your incapacitation there will be someone to manage your finances. This individual, your agent, will be able to write checks, deposit and withdraw money from your accounts on your behalf and speak with your financial advisers, among other things. Be sure to pick as your financial agent someone you trust and who will act in your best financial interest.

Don’t confuse a Durable Power of Attorney with a Power of Attorney. The latter ceases to be legally valid as soon as you become incapacitated. You need a Durable Power of Attorney

A caveat: Despite the importance of a Durable Power of Attorney, many financial institutions and real estate title companies don’t like them. They worry the document may have been revoked by its creator and replaced with a different one and that the individual claiming to be your financial agent may be trying to steal money from you. So it may be difficult for your financial agent to use your Durable Power of Attorney.

The more recent the power of attorney, the more likely it will be honored, but this varies from state-to-state. Also, financial institutions and title companies have their own criteria for when they will accept a Power of Attorney document.

Before you prepare yours, find out the criteria of your financial institutions and real estate title companies. Also, check with the companies that hold your retirement accounts to see if they have their own Power of Attorney forms; aif they do, use theirs.

A Revocable Living Trust To avoid problems with Powers of Attorney, some people set up a revocable living trust, which essentially acts like a super power of attorney. Financial institutions are legally obligated to comply with their terms. Generally,a revocable living trust is most appropriate for estates worth more than $1 million.

When you set up a revocable living trust, you transfer your assets to the trust and designate yourself as trustee. This way, you can continue to manage and benefit from those assets as you did before they were in the trust. If you can no longer act as the trustee because you become incapacitated, the individual you designated as your successor trustee manages the trust. Most people choose their spouse or partner, a close relative or a trusted friend.

A living trust doesn’t eliminate the need for a Durable Power of Attorney, however. You’ll still need that document to identify the person you want to manage your retirement accounts, like your 401(k) and your IRAs, because these kinds of accounts cannot be transferred into a living trust.

A HIPAA Release HIPAA is the acronym for the federal Health Insurance Portability and Accountability Act. Doctors may prefer, or require, you to give them written permission to share or discuss your health information with family members and friends involved in your care or payment for your care. But HIPAA does not require you give your health provider written permission; you may want to ask about your provider’s requirements, says the federal Office of Civil Rights.

An Organ Donation Authorization You may want to donate your organs when you die so someone can benefit from them. If so, make your wishes known on your driver’s license or register with an organ bank or with your hospital. Be sure to make your family and your health care agent aware of your wishes.

By Brad Wiewel

Brad Wiewel is a Texas estate planning attorney who teaches in the University of Texas CFP training program, and has taught continuing education classes to CPAs at St. Edward’s University
This post was published on Next Avenue

10 scary scams targeting seniors and how to avoid them

By Clark.com staff, July 4, 2017
Crimes against the elderly continue to skyrocket each year, as criminals continue to find more ways to carry out both new and old scams.

In fact, seniors lose billions of dollars a year to home repair scams, investment scams, IRS scams and various other cons targeting older people.

Elderly people are targets for criminals for a variety reasons, and as their family members and friends, it’s our job to help protect them from potential scams.

So in order to help you protect your loved ones, here’s what you need to know about some of the most common types of scams targeting seniors and how to avoid them.

Who criminals are targeting

Con artists are particularly fond of elderly widows. The scam is to find those who may be lonely or infirm, and slowly shower them with attention and small gifts in order to gain their confidence.

How you can help protect older people in your life

If you have elderly friends or relatives, you need to stay involved in their lives. Be nosy! Visit them. To someone who is alone a lot, just your presence brings them joy. It may seem dull at times, but never forget, someday you will be in their shoes.

With families together during the holidays, it’s a great time to check in on what’s going on in a parent or other older family member or friend’s life, including their finances.

Do you have siblings? Some families find it’s a good plan to divide up responsibilities when you have elderly parents — one kid takes them shopping, another entertains them, and a third handles money issues. Regardless of how it’s handled, be aware and be present in the financial lives of your elders.

That can mean being a second signature on a checkbook, or an authorized person on a checking account. Know about the investments they have. Remember, be nosy! You don’t want to find out your parents are destitute because you were looking the other way.

As you monitor your parent or other older person’s financial life, it’s important to be aware of some common scams and to talk to your loved ones about how they can avoid being scammed.

According to the National Council on Aging (NCOA), here are the top 10 financial scams that are wreaking havoc in the lives of seniors.

Top 10 financial scams targeting seniors

1. Medicare/health insurance fraud

PROBLEM: Scammers have targeted seniors for numerous ripoffs surrounding the Affordable Care Act and Medicare enrollment. Since every U.S. citizen over the age of 65 qualifies for Medicare benefits, seniors are an easy target for medical scams, because criminals don’t have to do any research around their insurance provider.

Many of these scams operate via door-to-door or over-the-phone solicitations by someone claiming to be a Medicare representative. Here are some ways to spot a medical scam targeting a senior:

Being told you need a new Medicare card and have to divulge your Social Security number.
Being told you need new supplemental policies.
Being asked to pay a $100 fee for help navigating the new Obamacare landscape.
SOLUTION: When in doubt, just hang up the phone or shut the door on the person trying to get money from you.

2. Counterfeit prescription drugs

PROBLEM: Many older people may be looking for cheaper drug alternatives as a way to save money on a fixed income. The problem is that scammers prey on this vulnerability of wanting to save.

The Internet is the most common way criminals operate these scams — offering ‘better prices’ on specialized medication, which can not only be fake, but also end up being harmful to the person if they take an unknown substance.

SOLUTION: Be very cautious when ordering medication online and make sure to talk to your loved ones about the dangers of doing so. Here are more tips about what to look for when buying medications online. Also, check out these 4 ways to save money on prescriptions.

3. Funeral & cemetery scams

PROBLEM: Funeral and cemetery scams have been around for years. The FBI warns about two main types that are targeted toward seniors:

Criminals will read obituaries and either call or attend the funeral service of someone they don’t know just to take advantage of someone there who’s grieving. The scammer will then claim the deceased had an outstanding debt with them in an effort to get money from relatives to ‘settle’ that fake debt.

Unfortunately, there are dishonest funeral homes out there that prey on grieving families by capitalizing on their unfamiliarity with the cost of funeral services in order to get more money from them. How it often works is someone at the funeral home adds unnecessary charges by insisting on extra features, such as the most expensive casket.

SOLUTION: Do some research before agreeing to anything suggested by the funeral home. Also, if your elderly loved one has a friend or other family member pass away, make sure to check on them and monitor their finances to make sure they don’t fall victim to a scam like this.

4. Fake anti-aging products

PROBLEM: If you watch a lot of late night TV, which seniors often do, you’ll notice all the commercials about products that claim to be the perfect solution to signs of aging or other unwanted physical changes.

According to the NCOA, seniors often feel the need to look younger in order to keep up in social circles or to fill some other void in their life. This leads them to seek out new treatments, medications and other remedies — making them vulnerable to scammers who capitalize on this demand. These scams operate in a variety of ways, including offering very expensive treatments that turn out to be harmful or very expensive homeopathic remedies that actually do nothing (except take your money).

SOLUTION: When monitoring your loved one’s finances, look for purchases of these types of remedies or treatments, which you may also find when you visit their home. Talk to them about the dangers of these products, and also just increasing the frequency of your visits may help them avoid these situations.

Read more: Beware of anti-wrinkle cream ‘free’ trial offer

5. Phone scams

PROBLEM: Scammers use several types of phone scams to prey on seniors. Here are a few to watch out for:

IRS phone scam
Caller ID spoofing: Criminals make the name of your bank pop up on the caller ID
Calling back an unknown number
SOLUTION: Here are a few ways to avoid phone scams:

Never call back an unknown number.
Know the IRS will never contact you by phone or email, only by U.S. mail.
Read more: How to protect your elderly loved ones from being scammed

6. Internet fraud

PROBLEM: Microsoft has put out special consumer alerts to warn about bogus computer security engineers making cold calls to convince people their computers are at risk for a security threat.

The phonies offer a free security check over the phone in an effort to get you to give them remote access to your computer for a supposed diagnosis and fix. Once they have remote access, they will download software to your computer that basically allows them to steal money from your accounts.

A Microsoft survey conducted in the English-speaking world (this is not just limited to the United States) found that 15% of people have gotten a call from these scammers at one time or another.

Eight in 10 of those who allowed remote access of their computers had money stolen. One in five became identity theft victims. Finally, more than half of all people who allowed remote access got hit with viruses that fouled up their computers. Very often, the cost of repair was greater than the money stolen.

SOLUTION: Microsoft offers a few recommendations to stay out of harm’s way. First, be suspicious of unsolicited calls from supposed computer security experts. Second, don’t visit any sites or install software recommended by unsolicited callers.

BONUS TIP: Seniors often fall victim to a variety of Internet scams, including fake virus protection pop-ups and fake emails. Warn your loved one about the dangers of clicking on any unknown links or emails. Do not click on any link in any email you were not expecting. If there’s a question and you think there’s a legitimate message or notification intended for you, go directly to the official website of whatever business it is and check for any notifications there. Also, you can protect their computer by downloading virus and malware protection software on it yourself.

7. Investment/timeshare schemes

PROBLEM: Buying a timeshare is bad enough of a ripoff. But imagine getting ripped off twice or three times by crooks promising to help you resell your timeshare!

The crooks typically ask for money upfront for advertising, title searches, and other administrative fees. You may even be told you’ll get your money back if your timeshare isn’t sold in 90 days. That’s a big, fat lie. You won’t get anything back except a lighter wallet.

SOLUTION: Here’s the real truth. Anyone promising you more than a few pennies on the dollar of what you paid is lying. Remember, salespeople should receive commissions at the time of the sale, not a second before.

8. Homeowner/reverse mortgage scams

Homeowner scams

PROBLEM: Seniors who live alone in their own homes are cautioned to be wary of ‘woodchucks’ — fake home contractors who gain their confidence and then charge huge amounts of money for unnecessary work.

These con men usually have some level of handyman skills and will start the relationship by offering to do a benign job such as gutter cleaning. But after they finish that job, they’ll find other imaginary problems — such as a roof or chimney repair — and convince seniors to fork over thousands of dollars.

Woodchucks also love to target people who have failing memories. In some of their most disgusting offenses, they’ll even drive old women to banks and get them to cash bogus checks before disappearing with the funds.

Police expect the woodchuck phenomenon to worsen. After all, we’re an aging population and we no longer live geographically close to our families as we did a few generations ago.

SOLUTION: Pick up the phone and call your aging relatives — or go visit them — to make sure they’re not falling prey to woodchucks. Be nosy if you’re worried that their money may be in danger. With a parent, there’ll be a natural inclination for them to not want to talk to you about money. But you’ve got to be pushy.

Mortgage/reverse mortgage scams

PROBLEM: According to the NCOA, scammers are preying on senior homeowners by offering a property assessment on the value of their home. They find the public information on the home, and then send the homeowner an official looking letter that offers to assess the value of the home for a fee. This is of course just a ruse to get that ‘fee’ money.

As reverse mortgages have increased in popularity, scammers are taking advantage of seniors with fake offers. According to the NCOA, ‘unsecured reverse mortgages can lead property owners to lose their homes when the perpetrators offer money or a free house somewhere else in exchange for the title to the property.’

SOLUTION: Monitor all of your loved one’s important financial and asset information closely. If you are worried they could fall victim to a scam like this, you may need to take control of their power to make decisions involving their finances, investments, assets etc.

Read more: Pros and cons of reverse mortgages for seniors

9. Sweepstakes & lottery scams

PROBLEM: Seniors get a call saying they’ve won a lottery or sweepstakes of some kind, but they need to either pay money or divulge sensitive account information to claim the winnings.

With the lottery scams, a senior’s savings are not eroded all at once. Once they take the bait and send some money in, they’re put on the sucker list. That marks them to receive future calls or solicitations about other alleged lottery winnings. It’s known as a ‘reload scam,’ and it can play out in areas other than just fake lottery winnings.

Another way these scams unfold is a criminal will send the person a fake check to deposit, and during the period it takes for the check to get rejected, the scammer collects money from the senior for ‘fees’ or ‘taxes’ on the supposed prize. Then they’re out of that money, and of course, no money is deposited from that fake check.

SOLUTION: Warn your loved ones about these scams and that they should NEVER hand over money for a ‘prize’ or to anyone that they (or you) do not know.

10. The grandparent scam

PROBLEM: Crooks call senior citizens and impersonate their adult grandchildren in order to hit them up for money. Here’s how a typical conversation might go:

The phone rings and the senior picks up…

Scamster: (in a low tone) Grandma?

Senior: Is that you, Jimmy?

Scamster: Yes, it’s me and I’m in trouble. I’m in jail. I need you to wire money so I can get out.

The typical take on this scam is anywhere between $3,000 and $4,000. There’s even a ‘reload’ on this one. If the scamster gets money, they’ll have another person call up impersonating a police officer and ask for additional funds in order for their grandchild to be released. They claim there are extra charges for property damage. Once the money is taken, you’ll never see it again.

SOLUTION: Never give out personal info over the phone or send money to unknown sources through a wire service.

The Potentially Deadly Condition That May Follow a Hospital Stay

Venous thromboembolism (VTE) might be the most serious condition you’ve never heard of.

The disease starts with a blood clot, or thrombosis, that forms in a deep vein in the leg (or, less frequently, the arm). This clot is known as deep vein thrombosis. If the clot breaks off, travels through the bloodstream and lodges in a lung, it’s called a pulmonary embolism and in about a quarter of such cases causes sudden death.

Together, deep vein thrombosis and pulmonary embolism are known as VTE, a dangerous and deadly combination that can strike anyone, but is particularly problematic for those over 60 who have experienced hospital stays and/or surgeries.

Although some VTE cases are unprovoked (caused by genetic mutations that affect clotting factors in the blood or family history), many others are preventable. That’s according to Jack Ansell, an internationally recognized expert in the field of hematology and thrombosis and a member of the scientific board of the National Blood Clot Alliance.

Since about two-thirds of blood clots occur as a result of hospitalization or after hospitalization, Ansell says that many cases of VTE can be prevented if patients are proactive.

“When you enter the hospital for surgery, ask your doctor, ‘What are you going to do to prevent a blood clot in my leg?’” says Ansell. “More and more doctors are aware of the problem and are using anticoagulant therapies to prevent blood clots.”

VTE: An Underappreciated Disease

While the precise number of people affected by VTE is unknown, as many as 900,000 people could be impacted each year in the U.S., according to a report published by the Centers for Disease Control and Prevention. Up to 100,000 Americans die of VTE annually; 10 to 30 percent of them within a month of diagnosis.

A report by the World Thrombosis Day Steering Committee on common problems that stem from hospital stays found that VTE was the leading cause of death and disability in low- and middle-income countries and was the second leading cause of death in high-income countries. And while VTE per se is not listed as a leading cause of death in the U.S., Ansell cites it as an underlying specific cause of death in many cases of cancer, heart or other types of fatalities.

Despite this, awareness of VTE is woefully low, according to a 2014 global study in the Journal of Thrombosis and Haemostasis. It showed that fewer people were aware of thrombosis, deep vein thrombosis and pulmonary embolism than those aware of heart attack and stroke and health conditions such as hypertension, breast cancer, prostate cancer and AIDS. Less than half of respondents knew that blood clots were preventable or that they were associated with cancer (16 percent), hospitalization (25 percent) and surgery (36 percent).

“In the long term, we will see more cases because it is more common in older folks and the population is certainly aging,” says Gary Raskob, professor of epidemiology and dean of public health at the University of Oklahoma.

Tracking the Disease

“Blood clots work as a defense mechanism to prevent us from bleeding to death if we cut ourselves,” says Raskob, who serves as the head of World Thrombosis Day on Oct. 13, an event designed to heighten awareness of VTE. “What we’re talking about are the formation of clots inside blood vessels or veins when they shouldn’t form.”

Symptoms of deep vein thrombosis include swelling in one leg, pain or tenderness; reddish or bluish skin discoloration and warmth. Pulmonary embolism can cause sudden shortness of breath, chest pain that may get worse with deep breaths, rapid heart rate, an unexplained cough and light-headedness.

Anyone experiencing these symptoms should call his or her doctor right away or call 911 to get to an emergency room, where an ultrasound can determine the presence of a clot.

Risk Factors for Blood Clots

Three prime factors contribute to blood clot formation: “Immobility, which causes blood to pool in the veins; problems with proteins in the blood that balance bleeding and clotting and damage to a vein or blood vessel caused by injury or surgery can all spur unwanted blood clots in veins,” says Raskob, “If any two of these factors are in play, you can be in danger of developing a clot.”

In addition to hospital stays, there are a number of risk factors for developing VTE, including surgical procedures — particularly knee and hip replacements.

“After surgery you need to heal the wound and the body can’t say, ‘Put a clot here where the surgeon cut and not in the vein,’” says Raskob. “In addition, there could be damage to the vein during surgery, such as in hip replacement, where surgeons may manipulate your vein, causing it to get bent or twisted, causing a clot.”

Cancer and cancer treatments can also cause clot formation, says Raskob. They upset the delicate balance between coagulation factors that promote bleeding and those that promote clotting.

Other risk factors include taking estrogen or estrogen-blocking drugs like tamoxifen; long car rides or plane rides, family history and genetic mutations that predispose blood to clotting.

But sometimes, clots can be unprovoked, says Elaine Chiang, a hematologist at Penn Medicine. “If a person develops a clot with no risk factors, that is more concerning,” says Chiang, since they are at a higher risk for additional clots.

Although VTE is not really a “lifestyle” disease, experts suggest moving around every two or three hours if you’ve been sitting in a car, plane or train, maintaining a healthy weight and quitting or avoiding smoking.

Anti-Coagulant Therapies

Treatment for VTE often involves blood thinners. While older anti-coagulants required frequent tests to check if dosages were in a therapeutic range, newer drugs are more predictable and have fewer dietary restrictions, says Chiang.

“Once you have a clot, it’s important to see a hematologist — a doctor specializing in thrombosis and clotting disorders,” says Chiang. Having a blood clot is not a one and done issue, she notes. “We need to evaluate if blood thinners are doing their job and if they need to be adjusted down the road,” says Chiang.

She adds thats there are implications for family members as well. “Make sure family members tell physicians that they are related to someone who has a blood clot,” Chiang says. “If they plan for surgery or pregnancy, they need to know if there are special considerations to be made.”

The Potentially Deadly Condition That May Follow a Hospital Stay

It happens more often to people over 60, and airline travel is another risk factor

Venous thromboembolism (VTE) might be the most serious condition you’ve never heard of.

The disease starts with a blood clot, or thrombosis, that forms in a deep vein in the leg (or, less frequently, the arm). This clot is known as deep vein thrombosis. If the clot breaks off, travels through the bloodstream and lodges in a lung, it’s called a pulmonary embolism and in about a quarter of such cases causes sudden death.

Together, deep vein thrombosis and pulmonary embolism are known as VTE, a dangerous and deadly combination that can strike anyone, but is particularly problematic for those over 60 who have experienced hospital stays and/or surgeries.

Although some VTE cases are unprovoked (caused by genetic mutations that affect clotting factors in the blood or family history), many others are preventable. That’s according to Jack Ansell, an internationally recognized expert in the field of hematology and thrombosis and a member of the scientific board of the National Blood Clot Alliance.

Since about two-thirds of blood clots occur as a result of hospitalization or after hospitalization, Ansell says that many cases of VTE can be prevented if patients are proactive.

“When you enter the hospital for surgery, ask your doctor, ‘What are you going to do to prevent a blood clot in my leg?’” says Ansell. “More and more doctors are aware of the problem and are using anticoagulant therapies to prevent blood clots.”

VTE: An Underappreciated Disease

While the precise number of people affected by VTE is unknown, as many as 900,000 people could be impacted each year in the U.S., according to a report published by the Centers for Disease Control and Prevention. Up to 100,000 Americans die of VTE annually; 10 to 30 percent of them within a month of diagnosis.

report by the World Thrombosis Day Steering Committee on common problems that stem from hospital stays found that VTE was the leading cause of death and disability in low- and middle-income countries and was the second leading cause of death in high-income countries. And while VTE per se is not listed as a leading cause of death in the U.S., Ansell cites it as an underlying specific cause of death in many cases of cancer, heart or other types of fatalities.

Despite this, awareness of VTE is woefully low, according to a 2014 global study in the Journal of Thrombosis and Haemostasis. It showed that fewer people were aware of thrombosis, deep vein thrombosis and pulmonary embolism than those aware of heart attack and stroke and health conditions such as hypertension, breast cancer, prostate cancer and AIDS. Less than half of respondents knew that blood clots were preventable or that they were associated with cancer (16 percent), hospitalization (25 percent) and surgery (36 percent).

“In the long term, we will see more cases because it is more common in older folks and the population is certainly aging,” says Gary Raskob, professor of epidemiology and dean of public health at the University of Oklahoma.

Tracking the Disease

“Blood clots work as a defense mechanism to prevent us from bleeding to death if we cut ourselves,” says Raskob, who serves as the head of World Thrombosis Day on Oct. 13, an event designed to heighten awareness of VTE. “What we’re talking about are the formation of clots inside blood vessels or veins when they shouldn’t form.”

Symptoms of deep vein thrombosis include swelling in one leg, pain or tenderness; reddish or bluish skin discoloration and warmth. Pulmonary embolism can cause sudden shortness of breath, chest pain that may get worse with deep breaths, rapid heart rate, an unexplained cough and light-headedness.

Anyone experiencing these symptoms should call his or her doctor right away or call 911 to get to an emergency room, where an ultrasound can determine the presence of a clot.

Risk Factors for Blood Clots

Three prime factors contribute to blood clot formation: “Immobility, which causes blood to pool in the veins; problems with proteins in the blood that balance bleeding and clotting and damage to a vein or blood vessel caused by injury or surgery can all spur unwanted blood clots in veins,” says Raskob, “If any two of these factors are in play, you can be in danger of developing a clot.”

In addition to hospital stays, there are a number of risk factors for developing VTE, including surgical procedures — particularly knee and hip replacements.

“After surgery you need to heal the wound and the body can’t say, ‘Put a clot here where the surgeon cut and not in the vein,’” says Raskob. “In addition, there could be damage to the vein during surgery, such as in hip replacement, where surgeons may manipulate your vein, causing it to get bent or twisted, causing a clot.”

Cancer and cancer treatments can also cause clot formation, says Raskob. They upset the delicate balance between coagulation factors that promote bleeding and those that promote clotting.

Other risk factors include taking estrogen or estrogen-blocking drugs like tamoxifen; long car rides or plane rides, family history and genetic mutations that predispose blood to clotting.

But sometimes, clots can be unprovoked, says Elaine Chiang, a hematologist at Penn Medicine. “If a person develops a clot with no risk factors, that is more concerning,” says Chiang, since they are at a higher risk for additional clots.

Although VTE is not really a “lifestyle” disease, experts suggest moving around every two or three hours if you’ve been sitting in a car, plane or train, maintaining a healthy weight and quitting or avoiding smoking.

Anti-Coagulant Therapies

Treatment for VTE often involves blood thinners. While older anti-coagulants required frequent tests to check if dosages were in a therapeutic range, newer drugs are more predictable and have fewer dietary restrictions, says Chiang.

“Once you have a clot, it’s important to see a hematologist — a doctor specializing in thrombosis and clotting disorders,” says Chiang. Having a blood clot is not a one and done issue, she notes. “We need to evaluate if blood thinners are doing their job and if they need to be adjusted down the road,” says Chiang.

She adds thatsthere are implications for family members as well. “Make sure family members tell physicians that they are related to someone who has a blood clot,” Chiang says. “If they plan for surgery or pregnancy, they need to know if there are special considerations to be made.”

“The Potentially Deadly Post-Surgery Condition.” Next Avenue, 22 Aug. 2017, www.nextavenue.org/vte-condition-hospital/?hide_newsletter=true&utm_source=Next%2BAvenue%2BEmail%2BNewsletter&utm_campaign=a75faa1231-08_17_2017_Thursday_Newsletter&utm_medium=email&utm_term=0_056a405b5a-a75faa1231-164939389&mc_cid=a75faa1231&mc_eid=8e7e577d68. Accessed 12 Sept. 2017.

Caregiver Burnout: What It Means and How to Cope

Know the signs that you need a break — for your health and your loved one’s

  • By Gina Roberts-Grey

(This article appeared previously on Caring.com.)

Caregiving can bring many positives into your life — but it can also take a toll, both physically and emotionally. Without finding a balance between caring for your loved one and maintaining your own mental, physical and emotional health, you’re at risk of developing what’s known as caregiver burnout.

“Feeling exhausted, unmotivated, constantly frustrated and forgetful, as well as having problems at work or with relationships, are all signs of caregiver burnout,” says Kimberly Hershenson, a New York-based therapist specializing in anxiety and depression.

Caregiver burnout can not only interfere with your ability to care for your loved one, it’s a leading contributor to placement of that person in a nursing home. It’s also risky to your own health, raising the risk of chronic depression, hypertension, diabetes, stroke and premature death.

“It is important to have life balance between caring for loved ones and caring for yourself,” says Hershenson. It helps to know the signs that you need a break, and what to do if you’re close to depleting your emotional, mental and physical reserves.

Spotting the Signs of Caregiver Burnout

Caregiver burnout is mental, emotional and physical exhaustion that may develop through the responsibilities of supporting and caring for another individual. “Caregivers often focus so intently on the needs of the individual receiving care that they may neglect their own health and wellness,” says Darren Sush, a licensed clinical psychologist and board-certified behavior analyst in Los Angeles.

As this lack of self-care persists, along with the ongoing obligations of providing care for a loved one, caregivers’ exhaustion often intensifies, impacting different aspects of their lives as well as their effectiveness and compassion as a caregiver.

Sush says that burnout may be easily misunderstood as simply feeling overly tired or even occasionally exhausted. “Unfortunately, while being tired can often be resolved by taking a break, getting a little more sleep or actively trying to relax, burnout is more often less easily relieved. Individuals who experience caregiver burnout, tend to face an all encompassing fatigue that impacts multiple areas of their lives,” he says.

Caregiver burnout can happen to anyone who is providing care for another person, whether it’s hands-on care, is only occasional, from a distance, or even at the “managerial” level, says Zina Paris, associate director of clinical services at Alzheimer’s Greater Los Angeles, a local nonprofit that helps families affected by Alzheimer’s and other dementias.

“It happens when you feel that the experience of caregiving is overwhelming and that you do not have the support — physically, mentally, emotionally, financially — that you need in order to successfully care for the person and to take care of yourself adequately at the same time,” says Paris.

Very often, caregivers can find themselves accustomed to the routine stress, worry and discomfort that come with providing care for a loved one. And as a result, Sush says you may not acknowledge warning signs of your own needs for gaining support.

Signs of Caregiver Burnout

Those signs include:

  • You no longer find pleasure in things you once found enjoyable, or you have no motivation to participate in previously enjoyed activities
  • Friends and family have expressed concerns about your well-being
  • You’re getting negative feedback at work
  • You’re having problems with your spouse
  • You experience intense and recurrent feelings of anger, sadness, worry or fear
  • You have difficulty concentrating, trouble sleeping, notice drastic weight changes (significant gain or loss), or unexplained health problems
  • You find yourself using a substance to cope with, manage or suppress uncomfortable or painful feelings.

Sush notes that there are also signals caregivers should know that indicate they’re at risk for developing caregiver burnout in the near future. These include:

  • Regular thoughts of anger or resentment toward the person you’re caring for
  • Irritation toward others who aren’t helping with your loved one’s care
  • Isolating yourself from people who aren’t involved in providing care to the person
  • Consistently arriving late to appointments or to visiting the person receiving care, or often leaving early

Combating Burnout

If you notice these signs in your own life, it’s time to take action.

Enlisting the help of a therapist is one option. “That provides a safe, sympathetic and constructive environment where caregivers can express their wants and needs,” says Sush.

Having a supportive community also helps. “Making a connection, such as with friends, family, or support groups, where you can freely share your thoughts and feelings, can be exceptionally important,” he adds. “While there is not necessarily a right or wrong way to get the help you need, it is important to acknowledge when you do need help.”

Here are some other expert strategies to help you cope with caregiver burnout:

Embrace gratitude. Make a daily gratitude list by writing down 10 things you’re grateful for. This could include anything from your family, legs to walk on or even a TV show you find entertaining. Focusing on what is good in your life as opposed to what is going wrong with your loved one’s health helps relieve stress.

Read affirmations every morning. “Starting your day with positivity kickstarts your day on the right foot,” says Hershenson.

Start the day with you. Hershenson says having a morning routine with time to yourself (going to the gym, having your daily coffee while reading the newspaper or stretching for 10 minutes) is crucial to fending off mental stress and fatigue.

Practice acceptance. Make a list of what you can control in the situation (getting enough sleep, eating well) and what you can’t control (your loved one’s health). Focus on what you can control to make changes where needed and try to accept the things that are out of your control.

Paris notes that while the advice to “take a break” may sound cliché, it is repeated for a reason.

“Self-care needs to be a top priority when caring for another person, otherwise neither the caregiver or the one receiving care will thrive,” she says. “This means finding a way to take short respite from caregiving on a consistent basis.”

Caregiver Burnout: What It Means and How to Cope. (2017, June 28). Retrieved August 30, 2017, from http://www.nextavenue.org/caregiver-burnout/?utm_source=Next%2BAvenue%2BEmail%2BNewsletter&utm_campaign=d8aba6fdc2-08_10_2017_Thursday_Newsletter&utm_medium=email&utm_term=0_056a405b5a-d8aba6fdc2-164939389&mc_cid=d8aba6fdc2&mc_eid=8e7e577d68

5 Myths About Obsessive-Compulsive Disorder

When people learn that I am a psychiatrist who has spent the last 20 years studying obsessive-compulsive disorder (OCD) at Columbia University Medical Center, I get various reactions.

They include jokes (“Hey, we could really use you in my family”) and minimization (“We all have some OCD, right?”) that unwittingly trivialize the suffering of my patients.

These patients include: the mother tortured by intrusive thoughts about hurting her children; the grown son who calls his elderly mother weekly but has not visited her in years because he has intrusive sexual and violent images about her; the lawyer whose “just right” obsessions made her unable to meet deadlines and the teacher with such severe contamination fears that he washes with bleach each night.

People with OCD often avoid situations that trigger their obsessions or compulsions.

In the last few decades, we’ve learned a lot about OCD. It’s time to dispense with some common myths. (Some of the details of examples below have been changed to protect patients’ privacy.) Here are five big ones:

Myth No. 1: OCD is rare.

Two of every 100 Americans will suffer from OCD in their lifetime. This means that OCD is twice as common as schizophrenia. Unfortunately, OCD usually starts early (half of all cases start by age 18; a quarter begin before 14), and its course is often chronic. Thus, OCD is not rare.

Moreover, once OCD develops, one can wrestle with it for a lifetime, as many of my patients have.

Myth No. 2: We all have OCD.

Yes, we all have occasional intrusive thoughts (e.g., did I just say the wrong thing?). Many endorse some type of ritual or repetitive behavior (such as double-checking to make sure the door is locked). Most of us also have habits (like taking the same route to work). Some of us are very rigid in our views and perfectionistic. This is not OCD.

OCD is a specific illness characterized by obsessions (repetitive thoughts, images or urges) that generates significant distress and by compulsions (repetitive thoughts or acts) that the person feels driven to perform. To be OCD, these symptoms must cause impairment and be highly distressing and time-consuming (taking up more than an hour a day). Many OCD patients obsess and ritualize on and off all day.

Although most people with OCD have both obsessions and compulsions, the specific content can vary between individuals. The result is that different patients can have very different symptoms.

Some common themes include: intrusive thoughts about harm with checking rituals (like the mother); taboo (usually sexual, religious or violent) thoughts (like the son); concerns about symmetry and exactness with ordering and arranging behaviors (like the lawyer) and obsessions about contamination with washing rituals (like the teacher). Note: Hoarding behaviors can also occur as part of the compulsions of OCD, but if the primary problem is difficulty discarding, this is now diagnosed as Hoarding Disorder.

Yet the OCD devil is in the details.

For example, I once worked with a man whose contamination concerns were focused not on an illness but on the state of California; as a result, he forbade anything with the word California in his house and he once forced his entire family to move after receiving mail from a California address.

Importantly, not all repetitive thoughts or behaviors are OCD. For example, people with depression can ruminate, those with generalized anxiety disorder can incessantly worry and people with trichotillomania can repeatedly pull their hair. The point is that we do not all have OCD. Some people do, and they suffer.

Myth No. 3: OCD is helpful.

The data show that OCD impairs functioning across many different domains, including worklife, social relationships and family. OCD is impairing because of its relatively early onset, its typically chronic course and the likelihood that most people with OCD will have moderate to severe symptoms.

When beset by hours of obsessions and compulsions each day, it is hard to perform at your best at work, socializing is difficult and family life is turned upside-down.

People with OCD also often avoid situations that trigger their obsessions or compulsions. For example, the mother I mentioned forbade her children to join her in the kitchen (fearful she would harm them with the cutting knives), the teacher never invited anyone to his home and the lawyer eventually lost her job.

Imagine having to move your entire family if you got mail from California.

The bottom line is that OCD interferes with life and can cause people to miss important milestones, such as graduating from high school or college, leaving home, marrying and having children and advancing in your worklife. The disability can accrue over time and be devastating.

Myth No. 4: OCD is “made up.”

The brain underlies our behavior, including abnormal behaviors like obsessions and compulsions. Dysfunction in specific brain circuits has been linked to obsessions and compulsions. The data come from: imaging studies comparing the brains of people with OCD to those without OCD; case studies of new-onset OCD in people following acute brain lesions and studies that disrupted specific brain circuits in animals and produced repetitive behaviors that could be “treated” using the same medications that work in people with OCD.

Of course, how the brain develops this dysfunction is a different question. Like most medical illnesses, OCD is likely to have multiple causes that play out across development and range from genes that increase risk for the illness to environmental triggers.

Myth No. 5: OCD is untreatable.

There are two effective treatments for OCD: medications called serotonin reuptake inhibitors (like Prozac, Zoloft and their siblings) and a specific form of cognitive-behavioral therapy (CBT) that includes exposure and ritual prevention. Either alone or in combination, these treatments help up to half of patients keep their symptoms to a minimum within eight to 12 weeks, even in adults who have been ill for decades.

Very intensive CBT protocols — daily sessions or residential programs — can achieve results even more quickly. This offers incredible hope.

“It’s Time to Stop These 5 Myths About Obsessive-Compulsive Disorder.” Next Avenue. N.p., 19 July 2016. Web. 11 Aug. 2017.

Old and Young Want to Get to Know Each Other Better

Old and Young Want to Get to Know Each Other Better
A new report cites huge benefits from intergenerational programs

In a national report released recently, two out of three adults surveyed said they want to spend time with people who aren’t their age, while three in four wish there were more opportunities to get to know different age groups. Why, then, aren’t there more intergenerational programs and initiatives?

I Need You, You Need MeThe Young, The Old, And What We Can Achieve Together, published by the nonprofits Generations United and The Eisner Foundation, lays out the case for more mixing of the generations, and suggests ways to achieve it.

The online Harris Poll survey of 2,171 U.S. adults ages 18+ conducted in February 2017 for this report, points to few opportunities for interaction. According to the report, in the U.S., “intergenerational friendships are the exception rather than the rule: for the most part, age segregation prevails.”

Separation Between the Generations Begins Early

Consider this: Students go to school with peers, older adults often live in retirement communities or assisted living, college students hang out together in dorms and classes, youngsters attend day care. Neighborhoods are often segregated, with six in 10 leaning either young or old.

When generations work together, this can break down stereotypes, change attitudes, foster mutual empathy and improve communities.

In the survey, 53 percent of people said they rarely spent time with other age groups except family members. The demographic with the least contact with other generations: 18- to 34-year-olds.

Not having exposure to different ages often leads to ageism, an us-vs.-them mentality, and missed opportunities, maintains the report. In fact, 76 percent of adults surveyed believe ageism is a serious societal problem.

But, the report says, there are some encouraging signs.

“A scattering of pioneers in both the public and private sectors have already begun the work of reuniting the generations, and they’re reaping extraordinary results,” the report says. “Through carefully designed ‘intergenerational programs’ in towns and cities around the country, kids are getting the attention they need, elders are finding purpose and connection, and the two groups are working together to make their communities better places to live.”

Intergenerational Partnerships Benefit All

When generations work together, this can break down stereotypes, change attitudes and lives, foster mutual empathy and improve communities. Intergenerational partnerships allow each group to see the other as individuals, just people — rather than “old” or “young.”

Adults can share their knowledge (through mentoring and tutoring) as well as provide love, attention and emotional support. Many older adults have time and want to spend it doing something that really matters.

The report notes that intergenerational programs can also improve kids’ and teens’ social skills;,self-esteem, school performance and decision-making, while expanding their world. By contrast, children offer affection, purpose and fun, reducing the loneliness that consumes many older adults. That loneliness can lead to depression, isolation and poor physical health.

And, there are advantages to communities that mix the generations, the report says. Shared spaces and various programs under one roof make intergenerational contact informal and ongoing. These might include pairings of a day care center and a long-term care facility, a Headstart program with a congregate meal site or an alternative high school with a clothing and food pantry. Equally important, sharing facilities and resources is cost-effective, saving taxpayers money.

The Power of Sharing Stories

One example highlighted in the report is a project started by residents at the Asbury Methodist Village in Gaithersburg, Md., a continuing care retirement community.

Recently, the group has been working with a nonprofit that helps Muslim kids cope with discrimination. A panel of older adults from Asbury shared their experiences of discrimination as part of a Courageous Conversation series: one Asbury resident fled the Holocaust as a little girl; another was imprisoned in a Japanese internment camp during World War II.

Zahra Riaz, 18, immigrated to the United States from Kuwait eight years ago. Because she wears a hijab, she was called “towel head” and “terrorist” by kids at her junior high in Texas. Since moving to Maryland, things have been better, but she still feels gets unwelcome stares. Sometimes, she feels unsafe, the report said.

It helped to be part of a Courageous Conversation, Riaz said.

“When I heard those people’s stories, I thought to myself, ‘It’s not just Muslims; it’s other cultures, too, that have been discriminated against. And it’s not just me, one Muslim; it’s many Muslims who have been impacted,’” the report quoted her as saying.

Riaz is especially grateful for some advice the now-90-year-old Japanese internment survivor gave her.

“She said, ‘Don’t be bitter in life. You’ll go through a lot of things; people will try to break you. But you have to try to be positive, and you have to move on with a smile on your face,’” the report said.

An Interest in Connecting

There is deep interest in intergenerational interaction. According to the report:

  • 77 percent of adults wish there were more opportunities for intergenerational interaction in their community
  • 92 percent of adults believe that older adults benefit from having relationships with children and 93 percent think kids gain greatly from interacting, and getting to know, adults
  • 93 percent say children and young people are vulnerable and should be protected; 92 percent feel similarly about older adults
  • 88 percent of adults want the federal government to invest in the well being of both old and young

Successful Intergenerational Initiatives

Take a look at four of the programs highlighted in the report:

  1. DOROT — A New York City program that has 7,000 children, teens and young adults visit 3,000 isolated older adults and has an intergenerational book club, baking program, arts and crafts, singing and mentoring
  2. San Diego County — Its local government has a team of five intergenerational coordinators tasked with finding volunteer older adults for needy kids
  3. Asbury Retirement Community — As mentioned above, this retirement community in Gaithersburg, Md., partnered with a nonprofit for immigrant and Muslim youth to discuss the older adults’ past discrimination and the children’s current discrimination through a program called Courageous Conversations.
  4. St. Ann Center for Intergenerational Care — Preschoolers and older adults both attend the day care program, with formal intergenerational activities twice daily and ongoing informal interaction.

Abrahms, S. (2017, May 30). Old and Young Want to Get to Know Each Other Better. Retrieved July 31, 2017, from http://www.nextavenue.org/old-young-better/

Sorry, Nobody Wants Your Parents’ Stuff

Advice for boomers desperate to unload family heirlooms

By Richard Eisenberg Money & Work Editor February 9, 2017

After my father died at 94 in September, leaving my sister and me to empty his one-bedroom, independent living New Jersey apartment, we learned the hard truth that others in their 50s and 60s need to know: Nobody wants the prized possessions of your parents — not even you or your kids.

Admittedly, that’s an exaggeration. But it’s not far off, due to changing tastes and homes. I’ll explain why, and what you can do as a result, shortly.

The Stuff of Nightmares

So please forgive the morbidity, but if you’re lucky enough to still have one or more parents or stepparents alive, it would be wise to start figuring out what you’ll do with their furniture, china, crystal, flatware, jewelry, artwork and tchotchkes when the mournful time comes. (I wish I had. My sister and I, forced to act quickly to avoid owing an extra months’ rent on dad’s apartment, hired a hauler to cart away nearly everything we didn’t want or wouldn’t be donating, some of which he said he’d give to charity.)

Many boomers and Gen X’ers charged with disposing the family heirlooms, it seems, are unprepared for the reality and unwilling to face it.

They’re not picking out formal china patterns anymore. I have three sons. They don’t want anything of mine. I totally get it.

— Susan Devaney, The Mavins Group

“It’s the biggest challenge our members have and it’s getting worse,” says Mary Kay Buysse, executive director of the National Association of Senior Move Managers (NASMM).

“At least a half dozen times a year, families come to me and say: ‘What do we do with all this stuff?’” says financial adviser Holly Kylen of Kylen Financials in Lititz, Pa. The answer: lots of luck.

Heirloom Today, Foregone Tomorrow

Dining room tables and chairs, end tables and armoires (“brown” pieces) have become furniture non grata. Antiques are antiquated. “Old mahogany stuff from my great aunt’s house is basically worthless,” says Chris Fultz, co-owner of Nova Liquidation, in Luray, Va.

On PBS’s Antiques Roadshow, prices for certain types of period furniture have dropped so much that some episode reruns note current, lower estimated appraisals.

And if you’re thinking your grown children will gladly accept your parents’ items, if only for sentimental reasons, you’re likely in for an unpleasant surprise.

“Young couples starting out don’t want the same things people used to have,” says Susan Devaney, president of NASMM and owner of The Mavins Group, a senior move manager in Westfield, N.J. “They’re not picking out formal china patterns anymore. I have three sons. They don’t want anything of mine. I totally get it.”

The Ikea Generation

Buysse agrees. “This is an Ikea and Target generation. They live minimally, much more so than the boomers. They don’t have the emotional connection to things that earlier generations did,” she notes. “And they’re more mobile. So they don’t want a lot of heavy stuff dragging down a move across country for a new opportunity.”

And you can pretty much forget about interesting your grown kids in the books that lined their grandparents’ shelves for decades. If you’re lucky, you might find buyers for some books by throwing a garage sale or you could offer to donate them to your public library — if the books are in good condition.

Most antiques dealers (if you can even find one!) and auction houses have little appetite for your parents’ stuff, either. That’s because their customers generally aren’t interested. Carol Eppel, an antique dealer and director of the Minnesota Antiques Dealers Association in Stillwater, Minn., says her customers are far more intrigued by Fisher Price toy people and Arby’s glasses with cartoon figures than sideboards and credenzas.

Even charities like Salvation Army and Goodwill frequently reject donations of home furnishings, I can sadly say from personal experience.

Midcentury, Yes; Depression-Era, No

A few kinds of home furnishings and possessions can still attract interest from buyers and collectors, though. For instance, Midcentury Modern furniture — think Eames chairs and Knoll tables — is pretty trendy. And “very high-end pieces of furniture, good jewelry, good artwork and good Oriental rugs — I can generally help find a buyer for those,” says Eppel.

“The problem most of us have,” Eppel adds, “is our parents bought things that were mass-produced. They don’t hold value and are so out of style. I don’t think you’ll ever find a good place to liquidate them.”

Getting Liquid With a Liquidator

Unless, that is, you find a business like Nova Liquidation, which calls itself “the fastest way to cash in and clean out your estate” in the metropolitan areas of Washington, D.C. and Charlottesville and Richmond, Va. Rather than holding an estate sale, Nova performs a “buyout” — someone from the firm shows up, makes an assessment, writes a check and takes everything away (including the trash), generally within two days.

If a client has a spectacular piece of art, Fultz says, his company brokers it through an auction house. Otherwise, Nova takes to its retail shop anything the company thinks it can sell and discounts the price continuously (perhaps down to 75 percent off), as needed. Nova also donates some items.

Another possibility: Hiring a senior move manager (even if the job isn’t exactly a “move”). In a Next Avenue article about these pros, Leah Ingram said most NASMM members charge an hourly rate ($40 to $100 an hour isn’t unusual) and a typical move costs between $2,500 and $3,000. Other senior move managers specializing in selling items at estate sales get paid through sales commissions of 35 percent or so.

“Most of the people in our business do a free consultation so we can see what services are needed,” says Devaney.

8 Tips for Home Unfurnishing

What else can you do to avoid finding yourself forlorn in your late parents’ home, broken up about the breakfront that’s going begging? Some suggestions:

1. Start mobilizing while your parents are around. “Every single person, if their parents are still alive, needs to go back and collect the stories of their stuff,” says Kylen. “That will help sell the stuff.” Or it might help you decide to hold onto it. One of Kylen’s clients inherited a set of beautiful gold-trimmed teacups, saucers and plates. Her mother had told her she’d received them as a gift from the DuPonts because she had nursed for the legendary wealthy family. Turns out, the plates were made for the DuPonts. The client decided to keep them due to the fantastic story.

2. Give yourself plenty of time to find takers, if you can. “We tell people: The longer you have to sell something, the more money you’re going to make,” says Fultz. Of course, this could mean cluttering up your basement, attic or living room with tables, lamps and the like until you finally locate interested parties.

3. Do an online search to see whether there’s a market for your parents’ art, furniture, china or crystal. If there is, see if an auction house might be interested in trying to sell things for you on consignment. “It’s a little bit of a wing and a prayer,” says Buysse.

That’s true. But you might get lucky. I did. My sister and I were pleasantly surprised — no, flabbergasted — when the auctioneer we hired sold our parents’ enormous, turn-of-the-20th-century portrait of an unknown woman by an obscure painter to a Florida art dealer for a tidy sum. (We expected to get a dim sum, if anything.) Apparently, the Newcomb-Macklin frame was part of the attraction. Go figure. Our parents’ tabletop marble bust went bust at the auction, however, and now sits in my den, owing to the kindness of my wife.

4. Get the jewelry appraised. It’s possible that a necklace, ring or brooch has value and could be sold.

5. Look for a nearby consignment shop that might take some items. Or, perhaps, a liquidation firm.

6. See if someone locally could use what you inherited. “My dad had some tools that looked interesting. I live in Amish country and a farmer gave me $25 for them,” says Kylen. She also picked out five shelters and gave them a list of all the kitchen items she wound up with. “By the fifth one, everything was gone. That kind of thing makes your heart feel good,” Kylen says.

7. Download the free Rightsizing and Relocation Guide from the National Association of Senior Move Managers. This helpful booklet is on the group’s site.

8. But perhaps the best advice is: Prepare for disappointment. “For the first time in history of the world, two generations are downsizing simultaneously,” says Buysse, talking about the boomers’ parents (sometimes, the final downsizing) and the boomers themselves. “I have a 90-year-old parent who wants to give me stuff or, if she passes away, my siblings and I will have to clean up the house. And my siblings and I are 60 to 70 and we’re downsizing.”

This, it seems, is 21st-century life — and death. “I don’t think there is a future” for the possessions of our parents’ generation, says Eppel. “It’s a different world.”

Why Not to Leave Too Much to Your Grown Kids

(This provocative article is adapted from the new book, Entitlemania, by Richard Watts.)

Somewhere in our DNA as parents, we believe it is an act of love, generosity, or for some, contrition, to leave our children an inheritance after we die. And the more money we leave, we think, the better! But despite the wisdom and warnings of historical philosophy, religious texts and psychology, we refuse to heed the whispers and acquiesce to our irrefutable belief that our children will both benefit from, and appreciate our gift.

Beware . . . For everything you give your child, you take something away.

Perhaps we need to change the question we ask ourselves from ‘How much is too much?’ to ‘How little is too little?’

Yet parents often adjust their retirement budget for food, shelter, travel and recreation so they can “leave a little something” to their children. And many, modestly surviving on Social Security, even feel a twinge of guilt if they exit the planet saddling their children with funeral and burial expenses.

How Inheritances Can Cause Permanent Damage to Families

How would you react if I told you that your children would never speak to each other again because you left your three kids your house? What if the son you designated as your executor or trustee seized control of your assets and was sued by his brothers and sisters? What if the family business you built during your life dismantles the family after you depart?

But you say, “No! Not my family!” To the contrary. In my 35years of managing wealthy families every day, the incident of permanent damage occurring to a family is most of the time.

And just in case you believe your kids are going to be appreciative of the money you leave, it takes about three days of grieving for your children to consider your inheritance all theirs. Remembering that dear old Dad and Mom provided them a unique opportunity of financial security lasts about as much time as it takes the bank to clear the inheritance check.

Carnegie, Buffett, Gates and You

One of America’s richest men, Andrew Carnegie, wrote an essay in 1889 entitled The Gospel of Wealth and lamented: “I would as soon leave my son a curse as the almighty dollar.” Modern-day financial icons, Bill and Melinda Gates and Warren Buffett, similarly plan to leave relatively small portions of their massive estates to their children, choosing to promote their kids’ long-term emotional well-being instead of feeding their materialistic cravings.

Money is supposed to provide a security blanket, not a blank check. Your lifelong achievement in building a nest egg is like a dam being built across a stream. For you, a lake of financial security forms behind the dam. Downstream, your kids often nest, staying close enough to the stream to take advantage of the flow you permit from the lake. Too often, inheritance of any size is like a break in the dam. The kids downstream have no sense of controlling the flood, and all can be swept away.

So how do we fix this? And how should we think about what we leave our kids?

Changing the Question We Ask Ourselves

Perhaps we need to change the question we ask ourselves from “How much is too much?” to “How little is too little?”

Do your kids expect you to hand over the loot? If they do, try this: Sit down with your children in a family meeting. Tell them Mom and Dad have decided to leave all of their money, excepting the personal belongings, to charity. Or an alternative would be to leave all of your money to a family foundation where the kids are the directors who would designate the money only to charities.

How would they react? If they say, “Great, Mom and Dad, it’s your money to do what you want!” you have probably raised kids that can control the cash. If, however, after the meeting, they secretly convene to discuss what they’ve concluded must be your newly-discovered early-onset dementia, perhaps you ought to rethink your intentions.

Cold Money and Warm Money

One afternoon at my office in Southern California, a family of three adult children in their 40s called for a meeting with their financially-successful parents and me. The oldest spoke on behalf of his siblings and began: “Mom and Dad, there is something called warm money and cold money. Warm money is money you give us with love, while you are alive, and you’re able to witness our appreciation of the gift. Cold money is the money we get, whether you like it or not, after you’re both dead.” There was a brief pause. He continued: “Your children would prefer to have more of the warm money.” The following week, Mom and Dad came to me and asked to revise their estate plan, giving their kids substantially less.

There are two parts to this debate: the process of your disbursing an inheritance and the amount you give for inheritance.

The first is simple. Do not let your kids be the executors and trustees of your will and trust. You will find this is contrary to most estate planning experts’ direction, but they only draft wills and trusts, they rarely deal with the aftermath.

And sell it all! Even the family business! Hard to say that out loud, isn’t it? But you must separate your kids from being involved with your estate upon your death. The best solution is to have an independent party liquidate everything except the personal property, then divide the proceeds by the number of kids you have and give them each a check. Your family will soon realize your actions kept them together.

How Much to Leave

The second question of how much to give your adult children is a little trickier. How affected would your kids be if you left them nothing? Put another way, how dependent are your kids on your financial support? The irony is that the ones who do not need your money will probably be okay and the ones who do will most likely be negatively affected.

A suggestion might be to leave half your estate to your kids and the other half to charities, allowing your kids to designate which ones they would like to choose to give the money. Doing this will leave a valuable life lesson to your kids that will be remembered.

The Colored Stickers Story

As to the question of how to divide your personal property and memorabilia, my friend Mel (a host on 1430 KASI Radio in Ames, Iowa) had the best answer. His father had passed away and when his mother was dying, she asked Mel and his siblings to each choose a different color of sticky paper dots. They were then asked in succession to put their colored sticker on something in the house they’d like to have after their mother passed — furniture, antiques, jewelry, silver and family heirlooms.

Each time it was Mel’s turn, he waived his brothers and sisters on, skipped his turn and continued the conversation with his mother. When all the items in the house were tagged with dots, the kids circled around their mother. Mel’s mom asked: “Mel, don’t you want anything?” He carefully peeled off one yellow sticker from his unused sheet of dots and gently placed it on his mother’s forehead.

Perhaps this is your last act of “tough love.” Don’t turn a blind eye to the reality that even modest amounts of money carelessly given to your children can have unexpected and corrupting results.

Money is like a narcotic; a little more is always welcome and the last amount never quite fills your present need. Give your children enough that they do something, but not so much that they do nothing.

 

“Why Not to Leave Too Much to Your Grown Kids.” Next Avenue. N.p., 07 June 2017. Web. 05 July 2017.