Wednesday, April 20, 2016

Take These Four Steps If Your Client Wants to Do Things That Seem out of Character

what to do if you suspect a client has cognitive impairment

Changes in how a client makes decisions may simply be signs of normal aging, but they might also signal something is wrong.

Changes in hearing, vision and the speed at which we mentally process information are normal as we get older. But if you have concerns that your client’s mental competency is changing beyond what is normal, take these four steps:

  • Validate your concerns.

  • Check for understanding.

  • Document client actions and directions.

  • Plan, if possible, for competency issues.

Validate Your Concerns

  • See your client at different times of the day, on different days of the week and, if possible, in different settings. Ask general health questions such as “How have you been feeling lately?” or “Are you having any trouble hearing me?” Clients might share their concerns about memory, sight, or hearing issues, all of which can affect decision making.

  • Clearly and fully explain the consequences of the client’s choice versus your recommendation and check for the client’s understanding (see tips below).

  • If you believe there could be a medical problem, make sure your client sees a doctor.

  • Having other people at client meetings:
    • Ask your older client if you have his or her permission to speak of your concerns with your client in the presence of his or her family members, doctor, attorney, tax accountant, or another professional.

    • The client may suggest another family member be present (the client may feel uncomfortable making decisions but is not ready to admit it.) This can be ideal for the professional, who then has the opportunity to meet the family before a capacity situation becomes critical.

  • You may need to postpone the transaction until the client’s competency can be checked.

Check for Understanding

  • Summarize by using cue words, for example: “We talked about doing something with your CD that matures next month. Can you tell me what your understanding is?”

  • Slow down. Say, “Let’s talk about this first point. What do you think is good or not good about this option?”

  • When you document your discussions or your client’s decisions, go over your memos and letters together to ensure the client has received, read, and understood the information.

Here are some ways you can make it easier for your older clients to mentally process information:

  • Prioritize as much as possible. Avoid compound sentences, multiple concepts, and lists of choices. Divide information into separate small pieces. Use bullet points or numbers and go over each, one at a time.

  • Limit distractions. Speak clearly and face the client.

  • Use type sizes that are large enough to read easily, and provide generous lighting.

Document Client Actions and Directions

Lack of written authorization could expose a professional to liability should clients change their minds or forget the agreement. If you have any doubts about a client’s capacity, put all client orders in writing. If the client questions this action, you can truthfully say you are uncomfortable executing the client’s orders without written authorization.

Plan Ahead

Discuss competency issues with clients before they happen. It’s easier to talk about a hypothetical future event than a reality. Find out what clients would want you to do if they begin to show signs of suspected incompetency. Would clients want you to go to another family member or professional if you become concerned? Have your clients put their decisions and instructions in writing so you have this authorization on file should you need it? And, have the clients shared their written instructions with key trusted others such as their family members, health care agent (named in their medical power of attorney), tax accountant and estate attorney?


Source

Society of Certified Senior Advisors, Working with Older Adults: A Professional’s Guide to Contemporary Issues of Aging (2015). Adapted from Maximizing Integrity in Decisions with Seniors. Copyright © 2005 by WebCE LP LLLP. Used with permission of WebCE LP LLLP.