Episode 40: Why dementia care belongs in your financial plan

Oscarlyn Elder: 

What would happen to your family if you or a loved one were to be diagnosed with dementia or Alzheimer's disease today? And what would happen to your financial plan? I'm Oscarlyn Elder, Head of Investment Management at Truist Wealth, and this is I've Been Meaning To Do That, a podcast from Truist Wealth, a purpose-driven financial services organization. We appreciate you listening. Today we're talking about why planning for the possibility of dementia matters to all of us. What does it mean to plan for dementia care in a thoughtful and proactive way? Our guest is Annalee Kruger, an expert on the subject of caregiving, the founder of the education and advisory firm Care Right Inc., and the author of The Invisible Patient: The Emotional, Financial and Physical Toll on Family Caregivers. Welcome to I've Been Meaning To Do That, Annalee.

Annalee Kruger:         

Thank you so much for having me, Oscarlyn.

Oscarlyn Elder: 

Annalee, let's first make sure we're on the same page regarding terminology. What is dementia, and how does it relate to Alzheimer's disease?

Annalee Kruger:               

A lot of people get those terms confused, or they'll use them interchangeably. So dementia is a cluster of symptoms that impact day-to-day living, forgetfulness, short-term memory loss. Those are clusters of symptoms that negatively impact someone's day-to-day functioning. Alzheimer's is a form of dementia, and there are tons of different types of dementia, like Parkinson's disease can be a dementing illness. Mild cognitive impairment is a dementing illness. Alzheimer's is a form of dementia, but all of them are a progressive disease process, so they're not going to get better, and that's where families get a little stuck.

Oscarlyn Elder: 

So the key is they're all progressive. It's an umbrella of perhaps different expressions of a progressive disease.

Annalee Kruger:               

Correct. And so the takeaway is that it's not going to get better. So I'm glad that we're talking about this today because this impacts millions of families across the world.

Oscarlyn Elder: 

It does. And so why don't you tell us about your experience with caregiving, because you've obviously focused a lot around caregiving within your career, and how has that experience shaped your career specifically in the way that you address dementia and aging with individuals and families who work with you?

Annalee Kruger:               

Yeah. My grandparents actually lived with us on the farm in Iowa when we were growing up because back in the '70s there wasn't all this home care. There wasn't independent living; there wasn't assisted living. So seniors at that time, they either failed and died at home or they moved in with their kids or they went to a nursing home because that was essentially their three options. So I was fortunate and grateful to be able to have my childhood with my grandparents, both sets of grandparents. And I saw from a very young age how aging can just be so different for two different people. So like my grandfather, he didn't need care. He just needed the socialization aspect of living with us. We didn't have to do any hands-on care for him at all. He just needed to be around people so that he could thrive.

My grandmother on the other hand, she was very, very ill, and she had chronic pain. And so, with that, she also had a lot of depression. And so I saw very different formats of aging. And my grandmother, she needed all help with all activities of daily living. So that's what shaped me into thinking, I really love working with seniors and families. And, unfortunately, about two years after my grandparents moved in, my oldest sister who had gone off to college became a missing person. And I saw how Mom and Dad had to struggle with, OK, we've got to go try to find our daughter, but we've also taken in these two vulnerable adults as well.

So I saw how life has its own agenda and family caregivers are pulled in all sorts of different directions and really trying hard to maintain the commitments that they made to grandparents or parents, but also have to be responsible for the rest of their family as well. And that's what shaped me into realizing in third grade that I wanted to become basically a social worker. I just didn't know what it was called back then, because I was little, and that's all I've ever done is worked with families and long-term care.

Oscarlyn Elder:

So you really experienced firsthand, a sandwich generation?

Annalee Kruger:               

I did, yes. I just saw firsthand from a very young age how this whole caregiving thing impacts families, the good, the bad, and the ugly.

Oscarlyn Elder: 

Well, people often recognize dementia and Alzheimer's as serious health risks of aging, but you say families often overlook key points about the financial risks of these diseases. Can you talk about that, the financial element?

Annalee Kruger:               

Sure. Dementing illnesses are one of the most expensive diseases because they're long-term. Someone with dementia, that can be a 20-, 30-year disease progression, and we know that those folks with dementia are going to need 24/7 care. The challenge is that it's a family that provides the bulk of that care until they get so utterly burned out where it's just affecting their careers, their lives, their health. That's often when they turn to hiring professional caregivers. And it's quite pricey, but that's the quandary that families are in when they have a long-term disease progression like that. And not understanding how care gets paid for is another challenge that I see with families.

A lot of families unfortunately assume that Medicare is going to pay for everything, and they think Medicare and Medicaid are the same program, so financially they're not equipped or prepared because they're assuming someone else is going to pay for all of that care. It's when they start engaging and paying for home care and cutting those checks for 20, 30, 40,000 per month that they're like, "Oh my gosh, how are we going to do this long term?" And so then they start looking at senior care facilities, and those aren't cheap either. So that's the financial risk is, we have to plan ahead and think things through proactively, preferably, versus waiting until crisis mode.

Oscarlyn Elder: 

And Annalee, there may also be another element of the burden, which would be kind of the lost income related to the individual who may be caregiving or the group of individuals because often the caregiver is forgoing or leaving their job or cutting back hours or doing something, bringing something in so that they can spend time with the individual who's experiencing dementia.

Annalee Kruger:               

For sure. The financial toll for the family and caregiver is enormous. A lot of my sons or daughters or spouses who are caregiving, first of all, they usually get thrust into caregiving, and they're ill-prepared. The financial toll is significant. Like you've mentioned, a lot of families are taking FMLA, they're quitting their jobs, they're not taking the job promotion that they wanted because they're like, "I can't travel and have more responsibility when I'm trying to take care of two or three or four elderly loved ones." My typical client has six people that they're in charge of. They've got in-laws, they've got Aunt Bessie who never got married or had kids, and they're like, "Oh, you're so good with all these other elderly loved ones that we have, let's just throw Bessie on your roster too." And the sons and daughters are like, "Look, this isn't Thanksgiving. There's not always room for one more."

 And so the financial toll is significant, and we haven't even talked about what I call the rescue missions. Our typical families are spending out of pocket at least $15,000 a year coming for rescue missions because if you live in New York and you have to get to Phoenix, Arizona tomorrow because Dad fell or Mom's a caregiver to Dad with Alzheimer's and she just had a stroke, that airfare isn't $69. No, that's expensive. And that's the toll on your career. A lot of our women caregivers, they stayed home to take care of their kids, and now they're finally getting their career on track. And now Mom had a stroke or Dad's dementia progressed, and they're like, "I just am finally getting my foot in the door at the company that I wanted to work at." And now they're having to jeopardize and sacrifice some of their career as well.

Oscarlyn Elder:  That's a lot to juggle.

Annalee Kruger:               

And every week I talk to either spouses or adult kids who took early retirement, not because they wanted to, but because they didn't know that there was a solution, like an aging plan. So they took early retirement to now become a full-time caregiver, and they're very resentful. They end up being very resentful because soon after they quit their job, they realize they're really in over their head as a caregiver. They're like, "Wow, I did not realize my husband's needs were going to be so significant." Or you've got sons trying to bathe their mothers. And this is the predicament families find themselves in, they get thrust into caregiving. They don't have an aging plan, and now they've quit their job or retired. And now that resentment starts to fit in because they often think siblings are going to help with caregiving to find out they're kind of on their own sometimes, depending on the family dynamics.

Oscarlyn Elder:  So you've mentioned “aging plan” a couple of times. Share with us what you mean by that.

Annalee Kruger:               

To me, it just makes perfect sense. Why wouldn't you put a plan in place for the most vulnerable years of your life, when you're going to be dependent on other people to help take care of you? So when I talk about an aging plan, it's facilitating family meetings as a neutral third-party meeting facilitator. What's working well? What's not working well? You can imagine Oscarlyn, when families call me, it's not because they're like, "Oh, you sounded so cool on this podcast. We just wanted to get ahead of this aging stuff." No, it's crisis, like, "Mom just had a stroke. What do we do?" And so what's working well? What's not working well in the current situation? Usually things aren't going well, so there's dementia involved or a stroke or the primary caregiver died, or just the kids are just plain burned out, and they're just done.

 And so we have to talk about the good, the bad, and the ugly of, OK, what are the goals as you age? And for us, our client is the whole family because everybody's input matters. And so we talk about, "OK, Mom and Dad, Ethel and Marvin, what are your goals as you age?" And they'll all say the same thing. "I want to age in place at home, and I don't want to be a burden on my kids." But it's always the kids reaching out to us. And so the kids, when I ask them, "What are your goals for your parents?" It is always a variation of the same thing, but it's always safety first.

Oscarlyn Elder:  Safety, yeah.

Annalee Kruger:               

And that's why they're afraid because they're like, "I'm not a caregiver. I'm not a nurse. I'm an engineer, and here I'm doing wound care for Mom." It's not the right fit for their personality or their time that they have. And so, when the kids say they want their loved ones to be safe, happy, have the best quality of life and the best quality of care possible, the only way to achieve those goals is to put a plan in place. So we educate families about the landscape of senior care. Let's talk about aging in place at home. What are the pros and cons of that? What if it's not safe? What if there's no care available? What if Mom and Dad can't afford 30, 40, $50,000 a month in care?

 So we need to also outline care communities that at least on the surface would be a viable fit as far as what levels of care they offer. Meaning, what if Mom needs assisted living, but Dad needs memory care? These are things that have to be talked about preferably proactively. So we have to be realistic and have plan A, plan B, and plan C. We also need to look at what do you have in order? Do you have living will, power of attorney, long-term care insurance? Do you have your grab-and-go binder? Do you have your accounts, your passwords? Do you have your funeral arrangements taken care of? What's your pet plan emergency in case you have a hospital stay? What are you going to do with your cat or your dog? If you're a business owner, what's your business succession plan?

 If you have a special needs child, what's the special needs information that someone would need to know if you become incapacitated? We also talk about what is your aging in place at home care budget? So knowing that these senior care facilities, you have to financially qualify to get into those. And if you need 3 million or 10 million of net worth, then we need to reverse engineer and say, "OK, how much money can we spend staying at home so we don't jeopardize our future care facility options?"

Oscarlyn Elder: 

We talked about an aging plan, and ideally it's proactive, but most people really start to experience more when they're in a crisis. Why is it so hard, especially around dementia, for folks to behave or think about it in a proactive way?

Annalee Kruger:               

Denial. Denial. Denial. I've worked with over 20,000 families in my 30-plus career, and most of my families are in that dementia journey in some way. And so I've yet to work with a family who understands dementia. They tend to learn the hard way. Just as an example, they're like, "Well, I guess you don't argue with them. I guess you don't try to tell them it's 2026 when they think it's 1971." And so they learn the hard way instead of being educated about the disease that they're dealing with. Or, "I never got along with my parents, and now Dad has dementia and Mom had a stroke, and now I'm taking care of people that we have strained relationships going into it."

 So there's a lot of denial about, "Well, maybe Mom and Dad will get better" Or, " Maybe Dad's just having a bad day." Or, "Dad's always been a little bit quirky." And it's not, unfortunately, until there's a drastic crisis that it kind of wakes them up. And it seems like it takes, in my experience, it seems like six is the number. It seems like it takes six falls or six somethings for families to really wake up and get out of denial and say, "Hey, you know what? Something's really going on here now. We better try to get ahead of it." But they're already behind it.

Oscarlyn Elder:  What's the risk of waiting too long to call the family together to develop the aging plan?

Annalee Kruger:               

Yeah. So here's what I can share with you, Oscarlyn. Ninety-two percent of our families come to us in crisis mode. Eighty-five percent of those families, I'm doing family mediation with them because even in the most close-knit families, aging, caregiving and dementia can absolutely cause wedges in those, even the most—best family relationships. And that's if you actually got along at one point. If families didn't get along to start with, because brother Joe said something stupid at Thanksgiving 25 years ago, and now no one talks, but now there's a crisis, now the kids have to get reintroduced to each other and their parents and say, "OK, what are we going to do now?" And so the tone of those family meetings that's more proactive, where we're like, "Hey, we're starting to see the writing on the wall with Mom and Dad. They're not doing well. They've had a couple falls." That's when you need to start thinking, "OK, we're just at the tip of the iceberg of what's going to happen as we age." The tone of those family meetings is so much more positive because they're not at each other's throats yet.

 So the outcome is when you plan ahead, your family gets along better because now we're communicating, they're understanding the disease, they're understanding the lay of the land for senior care, they're understanding the cost of care, and our parents have better care outcomes because we're planning ahead. The tone for those who wait until they're in crisis mode, there's fighting, there's tears. It's not good. The family meetings are challenging and because there's a lot of emotion. And then, unfortunately, that's when families wait until they're in crisis mode, of course their loved one's not going to get the best care possible because you get whatever care is available or whatever facility has an open bed.

 And one more quick note on that, because a lot of times parents don't have their power of attorney, they don't have their grab-and-go binder stuff. They don't have anything in order. And so when that crisis happens, the kids can't just put their fingertips on the power of attorney documents or the living will. They don't even know if it exists. So they have to fly to wherever their parent lives, rummage through a desk, try to find what they think they're looking for to get it to the doctor. So all of that can be prevented when we start putting an active, robust plan together now instead of in crisis mode.

Oscarlyn Elder:  I'm just kind of struck by how if you wait and you're in intense crisis, the amygdala gets hijacked and you're trying to have this complicated communication and your brain is just, you're just trying to survive. And it's very difficult to have meaningful, peaceful, thoughtful conversation, communication when you're in that fight-or-flight stage. And what you're kind of advocating for is, do it beforehand when your full brain can engage and you have some time to think and process and not be in complete reaction mode.

Annalee Kruger:               

I've never, ever, ever, ever had a family ever come back to me and say, "Gosh, Annalee, I feel really confident about decisions that we had to make in crisis mode." When you're in crisis, you don't think clearly, and you don't know what you don't know. And families make a lot of just tremendously awful mistakes because they don't know what they don't know, and it's sad.

Oscarlyn Elder:  Where do you see even the well-prepared, the well-resourced families getting caught off guard when dementia enters the aging picture?

Annalee Kruger:               

Dementia doesn't care how much money you have. So it's going to progress whether you have $100,000 or 30 million or 500 million, dementia does not care. Yes, you might have the money to be able to afford care, but the challenge is on our end, in senior care, we have a massive shortage of quality healthcare workers. The pandemic did a number, did a true number on our senior care industry. We had a lot of, and we still continue to have really good quality, compassionate healthcare workers leaving the industry in droves because they're just simply burned out. They're not treated very well, usually by the companies that they work for. And so that's where we, it's on our end as the senior care industry, where families get in a snag. Because even if you do have money, it can still be challenging to try to find quality, properly trained, properly supervised healthcare workers.

 From a home care side, a lot of home care companies are not taking on new patients because they don't have the staff to staff them. And then the senior care homes, a lot of them, they have staffing and leadership issues. They have a massive turnover in leadership. And if there's no leadership, it's the wild, wild west in these care communities. And many of them have been cited for abuse and neglect year after year after year. And that's why we do aging planning to show them these are the care facilities in your area that have been cited for abuse and neglect.

 These are the ones that have the levels of care that you need or that you will need. We need to plan around that. And we also need to learn how to be a bold advocate. And that's great when families have the funds to be able to afford an advocate, because oftentimes as a family member, you just want to be the family member. You don't have to be the care advocate, the care patrol, the care coordinator, the care manager, the care provider, you just want to be the son or the daughter or the husband or the wife.

Oscarlyn Elder:  I think it's an important context because folks may think that it's relatively easy or simple to arrange the care to work through the progression of care. And what I hear very clearly from you is that it is incredibly challenging. So don't underestimate that task and the level of lift that a family might need to do to, frankly, care for their loved one in the way that they want to.

Annalee Kruger:               

Families aren't large like they used to be. They don't have eight, 10, 12 kids anymore. And so when families are smaller, and we have the most solo agers that we've ever had so far in history, where people didn't get married or they outlived their spouse or they didn't have children. They don't have a son or a daughter that they can call and say, "Hey, honey, I know it's three o'clock in the morning, but I fell and I need help getting up." There's no one for them to call. So we just need to understand the lay of the land. If the families are smaller, then there's less family caregivers, which then equates to less professional caregivers. And there's not a lot of huge incentive for people to go into senior care. The pay isn't great and they're not treated well, and society doesn't really embrace aging.

Oscarlyn Elder:  Annalee, you've given us a lot to think about. We've invited you here at Truist to give trainings to our advisors on this topic because dementia and Alzheimer's can have such a big impact on wealth planning. What role can a financial advisor play in helping individuals and families manage these risks?

Annalee Kruger:               

That is one of my favorite questions, actually, Oscarlyn, because as you know, I've spent almost two decades focusing on training advisors, and I'm so grateful for Truist, for the advisors who have gone through my training so far. They're engaged, they're interactive, and they're like, "Wow, this is fantastic education." Because advisors are realizing that their aging book of business has entirely different needs than when you onboarded Ethel and Marvin in their 30s or 40s. Now that they're in their 70s or 80s and they're really approaching potentially needing care, the conversations and the education need to be enhanced. So conversations for advisors that I train advisors, start asking questions.

 Do not leave it up to your client to bring these things up. The advisor needs to be proactive in starting these conversations. Are you a family caregiver? Is there anything in your personal life that's impacting your health, your career, your finances, your relationship, your life at home? What conversations have you had with your family about aging and the what, whens of aging? What documents do you have in order? Where are the documents? Have you talked to your kids about the documents? Or if you're talking to Ethel and Marvin, what challenges might you be having at home? Can you get to the doctor? Is your car working OK? Do you need care? Have you had any falls?

Oscarlyn Elder:  We've heard it said before on our podcast that people plan with best case in mind versus base or even worse. And the other thing that comes to mind for me, and you've talked about how often families are in denial, folks may be in denial, is that a key role for an advisor often can be to provide a window or a mirror in an effective way to a client. And so asking a thought-provoking question, allowing clients to explore the answers to those questions, helping guiding the conversation. Sometimes a voice that isn't a family voice is able to make an observation or ask a question in a way that begins to bring that wall of denial down.

Annalee Kruger:               

Well, and often the advisor is the one getting the crisis call from the family. So the advisor is in a unique position to really add even more value than what they already do and say, "You know what? This is a really overwhelming situation that you're in. I've got your financial plan in place. But, again, just as important is here's a resource that can help you navigate this crisis that you're in." And so not trying to train them to be a family mediator or a social worker, but just start the conversation and then use that collaborative approach. And don't feel like you have to have all the answers because you don't, not everybody has all the answers.

Oscarlyn Elder:  Well, understanding the risk that dementia and Alzheimer's disease pose to our wealth plan is important, but we also want to take control of managing that risk. We'll talk about practical planning steps when we come right back.

All right, Annalee, who really needs to have dementia care planning high on their priority list, and when should individuals and families start to think about it?

Annalee Kruger:               

Well, given that there are millions of families in the dementia journey, seriously, everyone needs to be thinking about this. So priority people who should be thinking about it this very second are people who already have a diagnosis, and they already know that they have a dementing illness. Anyone who suspects that they or a loved one has some memory issues going on, and if you have a family history of dementing illnesses, those are three categories of people right out of the gate. If you're a solo ager and this is something that you worry about is, what if I lose my memory? Who's going to take care of me? Where am I going to live? Do I have enough money? Because it's not like you can draw on a husband's Social Security. You’ve got to have all this money yourself to be able to be self-supporting, to pay for care. So literally everybody needs to be thinking about dementia care.

Oscarlyn Elder:  And if you fall into the categories that you've talked about, even more so. You really cannot afford to wait any longer. You need to engage and start planning. How is planning for dementia care different from other less disease-specific long-term care planning that you've seen?

Annalee Kruger:               

Demanding illnesses or most dementias, like Alzheimer's, that's a long disease process most of the time. We're talking decades, and we know that those folks are going to need 24/7 care. Eventually, the caregivers, they're not going to be able to sleep through the night. They're going to have to have one ear and one eye open to make sure that Mom's not wandering around. That's where we talk about the toll on the family caregiver. It's different taking care of someone who has a broken hip and will be hopefully back to baseline in six to eight weeks. Now, if you're talking about people who have, like, ALS, those are intense, but they don't live very long when they have ALS. And so that's a very intense and more brief period of caregiving, but it's still intense; it's just not going to be years and years and years.

 If your spouse has MS, multiple sclerosis, that's going to be a decades-long disease as well. But it's typically not a dementing illness, but they'll need physical care. And so that's why I say in the beginning, it's really important to know what disease you're actually trying to take care of so that you can be emotionally prepared, physically prepared, and financially prepared and not be blindsided.

Oscarlyn Elder:  Recap for us what you believe families really need to understand about the realities of in-home dementia care.

Annalee Kruger:               

Most people want to age in place at home, and that's great if they can, but it's not always safe. And so when you think about home care, it's one thing if you are what we back in the day would call a walking, talking cutie—you're pleasant, you're cooperative, you follow through with what the caregivers want to help you with, like the bath and medications and meals. But it's a whole other ballgame if you're in the throes of really extreme dementia and you've got paranoia, you're aggressive, you're violent, you're sexual, you're wandering out all of the time, you've got your days and nights mixed up.

 It can be challenging trying to find a caregiver who wants to do a 12-hour shift with someone that's going to keep them on their toes or potentially be abusive to them. And so that's where there's challenges in trying to stay at home is the caregivers can choose which patients that they want to work with. And if your loved one, maybe they have just a very difficult personality and they're not nice to the caregiver, the caregiver isn't going to keep coming back for that. It can be challenging trying to find caregivers that are properly trained and patient and calm and know how to redirect dementia behaviors. It's very difficult to find that.

Oscarlyn Elder:  Let's take it to probably the next level. What would care in a memory care facility offer in terms of specialized support?

Annalee Kruger:               

So the value proposition of a properly run memory care, I always have to say that, because so many facilities are not properly run, and so a properly run with proper leadership is an ideal option for someone in a dementia journey. They have their activities, their meals, their socialization, they have medication management, they have a doctor that comes, these memory care units or care facilities have a physician that comes to see the patient in-house. So there's a lot of value that memory care units, they're specifically designed for people with memory issues. So they're not going to be a 100-bed memory care unit.

 They're going to be much smaller, more intimate, where they're just shorter wings, smaller wings, six, eight, 10, 12 residents eating in a small dining room. Why I talk about the dining room is because we know that as dementia progresses, it can be very hard for us to get them to eat because they don't know that they're hungry or they'll eat things that aren't food. So the memory care units are specifically designed for what a dementia patient's needs are, and they're staffed accordingly because dementia patients need more. I don't want anyone thinking that it's one-on-one care because it is not, but it is a safe, structured unit.

Oscarlyn Elder:  Let's turn and talk a little bit more about solo agers.

Annalee Kruger:   Sure.

Oscarlyn Elder:  If I'm a solo ager, what do I need to be thinking about? And, more importantly, I think, what do I need to do in order to prepare for a potential situation?

Annalee Kruger:               

I can speak to this personally because I will very likely still be one, because I'm one now. No spouse, no kids, and I don't think my two senior dogs are really going to help a lot when I need help, because they don't help with anything right now. So things that I have already put into place, and I'm 53 years old, and you have to realize, I work with people who didn't do any planning or very little planning, and so I have to help them put a better plan in place. So I probably have overplanned, but that's because I don't want to be vulnerable when I am the most sick and frail and dependent on someone because I can't advocate for myself. So make sure that you build your support system now in a diverse way. Don't have just friends that are your own age group because they're going to start dying too. So have a diverse age group of friends that live close by to where you think you're going to stay.

 And it's OK to even think about, "OK, who else are solo agers that we can be each other's power of attorney?" For example. So that's step two. Step one is build out your social environment, build up your friendship network, whether it's usually the next question people ask is like, "OK, but where do I find friends?" Because it's hard to these days. So church, go on an activity website, like social activity platforms. There's activities for people to do, if you like to hike. Social activity platforms can be really helpful to find activities in your area. Bible study at the salon. If you like to travel, find people that you like to travel with. So build out your friendship and then start the conversations about, "If something happens to me, would you be my decision-maker?" But then the next step after that is this process, the next step after that is you need to actually talk to whoever you appointed as the power of attorney.

 And this goes for everybody, solo agers or anyone else. You actually have to let them know that you appointed them as the power of attorney and what your wishes are for end of life. You need to give them the documents for power of attorney, for finances. "Here's the people that you need. Here's my long-term care insurance representative." So prepare them so that they have the information at their fingertips. And then the other thing to think about is, OK, when you need care, we're starting to see, or I've been noticing the last decade probably of solo agers, they're leaving their homes proactively when they don't need care to move into independent living because that's another avenue to develop relationships and friendships.

Oscarlyn Elder:  Well, thank you for sharing your observations about what folks are doing. And, importantly, I think the call to action for potential solo agers is think about it, but actually start to do and to follow through. Because again, once you're in a position of crisis, it becomes too late to plan ahead. And at that point, you're reacting and the folks around you are reacting. So be proactive as much as possible.

Annalee Kruger:               

And I know we've talked, and I'm not an attorney, so I just want to say that, but I'm just saying from what I see, families are not getting their advanced directives done until after the crisis. You need to make the job of the power of attorney easy instead of like, "Ugh, I can't believe Annalee left me all this junk that I have to do and I don't know how to do it, and it takes a bazillion hours of time to figure things out." So be responsible, and this is for everyone, get everything in order now to make the life easier for those that are going to have to pick up where you left off.

Oscarlyn Elder:  Well, let's turn and talk about your book, the Invisible Patient. You say that protecting the caregiver is essential to a successful plan. What does that look like in practical terms?

Annalee Kruger:               

Yeah, so we always, always, always have to safeguard that family caregiver, whether it's 82-year-old Ethel, who also has her own health issues and she's trying to take care of Marvin, or you're the son or the daughter and you get thrust into caregiving, we always have to safeguard that family caregiver. The invisible patient is that caregiver, and that's why I wrote the book because even when I was caregiving for my own family, they're always like, "Well, how's your mom or how's your dad?" And I'm like, "They're doing great, but I'm not." And I think this is an important thing to talk about, self-care preservation for the caregiver. Self-care means different things to different people. For example, I'm an introvert. I am kind of a loner. I'm a homebody. So for me to go to a concert that would stress me out, but if you give me a book and a glass of wine and cello music, that's my jam.

 Most caregivers, we're in survival mode. We're just trying to make sure Dad is safe or that Mom doesn't wander out. You're just living hour to hour, and you can't even think about next week because you're just trying to get through today. So we don't want that for the caregiver. That's not good quality of life. We also need to keep tabs on our caregivers and be proactive and say, "We haven't seen you at Bible study." Or, "We haven't seen you at book club. Tell me what's going on in your life and how can we help you?" And if you're a caregiver listening to this, one of the things that we are terrible about is reaching out for help. We all think that we should just be doing this and not complain about it. So give yourself grace and be patient with yourself. Step away when you can, use respite services. Lean on other people so that you don't end up depressed, anxious, isolated, and have your own health issues.

Oscarlyn Elder:  Well, Annalee, what's really striking about all of this is how much difference timing and preparation can make. We'll come back in just a moment for some final thoughts.

Annalee, you know better than most how daunting the idea of proactive planning for dementia care can be for some people. What's one step a listener can take now to get started?

Annalee Kruger:                Realize that we don't get healthier as we age. So start the conversations or start thinking, actually start thinking now. Take some time, put some space into your day to think about, "If I had a stroke today, how prepared am I? Do I have my documents in order? What conversations have I had with my kids?" If you have kids. If you are a solo ager, this is the time to be thinking about, "If I need care, where am I going to go? What if we can't stay at home?" If you live in a house that's like a tri-level, maybe now is the time to be thinking about, "Is this house going to serve my needs if I need a walker or if I need a wheelchair?" Maybe you don't live in an area where there's a lot of care.

Maybe now is a time to be thinking about a relocation so that you have time to adjust and meet new people before care is needed. And for sure, I can't stop harping on this, make sure you get your grab-and-go. Get all of documents, your accounts, get all of that prepared now because that is daunting. But if you start doing it and say, "OK, this month, I'm going to work on getting all of my accounts and passwords. Next month, I'm going to get my funeral arrangements taken care of." Piece it down so it doesn't feel so overwhelming.

Oscarlyn Elder:  Well, you've given us a lot to think about and a lot to do, and we just really appreciate your expertise and your passion and purpose comes through very clearly …

Annalee Kruger:                Thank you.

Oscarlyn Elder:  … in all that you're doing. So thank you for sharing that with me and with our listeners. I know that you've impacted and will impact many people by the advice that you're giving today. Before we wrap up, we have a tradition here at I've Been Meaning To Do That. We ask all of our guests, what's the one thing that you've been meaning to do that you haven't done yet and that you're willing to commit to do now with our audience listening?

Annalee Kruger:                So I love that question because I just bought my house, and so I got my trust documents. So now, I need to review the trust documents and make sure that there's no edits, and then I need to go to the bank and fund the trust. So that's actually on my to-do list tomorrow.

Oscarlyn Elder:  Fantastic. Interestingly, that comes up a lot with our guests that they have estate planning, trust documents that they either want to put in place or that they're reviewing, waiting to finalize. So I think you're in great company. A lot of folks need to do this. What's really encouraging is that you have it ready to go. All you have to do is proof it and then get it across the finish line. So best of luck on that.

Annalee Kruger:                Thank you.

Oscarlyn Elder:  Annalee, thank you again for joining me today.

Annalee Kruger:                Well, thank you so much for taking the time to ask all these different questions and have this dialogue. It's so needed because families are continually getting caught off guard and they don't know that there is a resource that can help them, and advisors—your team is amazing. So I'm so thankful and grateful for our relationship.

Oscarlyn Elder:  Listeners, I want to thank you as well. If you'd liked this episode, please be sure to subscribe, rate, and review the podcast and tell friends and family about it. If you have a question for me or a suggestion for this podcast, email me at DoThat@Truist.com. I'll be back soon for another episode of I've Been Meaning To Do That, the podcast that gets you moving toward fulfilling your purpose and achieving your financial goals. Talk to you soon.

Speaker:              Oscarlyn Elder is an investment advisor representative, Truist Advisory Services Incorporated. Any comments or references to taxes herein are informational only. Truist and its representatives do not provide tax or legal advice. You should consult your individual tax or legal professional before taking any action that may have tax or legal consequences.