Visits to the doctor, whether routine or for a problem, are stressful for any age person, but with age comes significantly more information, more instructions, and more room for error and omission.

Often a doctor – frequently hurried – launches into a rapid explanation of a medical issue, writes out a quick prescription, and vanishes before the information sinks in and the questions start forming. Or it doesn’t all sink in, and a patient is left asking: “Now what did the doctor say about this?”

I have found that an important role I can play is attending office visits, taking notes and getting clear instructions for next steps. My approach is not that I am taking control of the doctor-patient relationship, but rather I am acting as an assistant to both. I help make sure information is written down and that instructions are clear and understood.

If you have an aging relative or friend who needs someone involved in the medical process, begin by showing them that you are there to assist, not jump into the middle of the doctor-patient relationship. Until everyone becomes more comfortable with the arrangement, I follow the old adage of “being seen, but not heard.”

Here are some steps I follow:

1. Before a doctor’s visit, ask your senior what are the chief concerns they want addressed: Fatigue? Memory? Gastro-intestinal problems? etc. Perhaps come up with a list of questions specific to each issue.  Write them down.

2. Have a complete and detailed list of current medications: names, dosages, when they are taken. This is a must-have for anyone with multiple medications to keep on hand. If an ambulance is ever needed, this information can be invaluable to emergency responders and ER doctors. You will also find that many doctors ask at every appointment what medications a patient is taking and often rely on that information to make decisions.

3. At the appointment, take careful notes, ask for clarification when needed, but let the interaction be between the doctor and patient. Sometimes the patient will need a reminder about the issues he or she wanted addressed.

4. Make sure the conversation with the doctor includes next steps. In fact I always write (in bold) a clear list of next steps at the bottom of my typed notes.. “Mary: Will pick up prescription, add to weekly pill box and create updated medication list. Doctor: Will set up stress test and call patient and Mary with time and location. Patient: Will alert Mary and doctor’s office for any noticeable reaction to new medication.”

A list of “next steps” reviewed in the appointment makes clear to everyone involved what their responsibilities are.

5. When you as the caregiver have completed your “next steps” or have new information, update your senior and keep them involved.

While I write about caring for aging parents and friends, these steps clearly make the medical process better and less stressful for anyone going through a serious illness. Let’s face it, a patient can be overwhelmed with the news of a health problem and all the details that accompany these stressful events can be hard for the patient to manage well.

I have found time and time again that it only takes one visit acting as an assistant to have a senior say, “Thank goodness you were with me. I never would have remembered all of that.”

As I wrote in my previous post (“A soft approach to getting involved in an elder’s business”), assisting with bill paying and checkbook balancing is a helpful way to start taking a bigger role in a parent or other senior’s affairs. In this online, rapid transaction world, navigating businesses and banking institutions can be an area of increasing frustration for a senior.

How often do you get a live person when you call a credit card company to ask about a bill?  How many buttons do you have to push to finally reach someone at your health insurance company?  For many seniors, navigating phone systems is an almost impossible feat and, without assistance, it might be easier to simply pay a questionable bill than to try to figure out how to reach someone on the phone.

For one of my clients, I started out simply helping him to sort mail and clean out boxes of historical papers. As his trust in me grew, I began organizing his bills, calling businesses with any questions, preparing his checks to sign and balancing his checkbook. He is a sharp man, and has his own methodical way of doing things – slowly. I couldn’t help but think: “I could put this all online so easily and pay these bills in a flash, tie it to Quicken and have a beautiful printout of income and expenses.”

He was, however, already giving up a lot of control, and sharing a lot of personal financial information with me. If I put everything online, he would be forced to entirely abandon control to me – he did not own a modern computer – which was asking a lot of a proudly independent former businessman.

I learned that when dealing with seniors who are facing a loss of independence, you need to meet them where they are, not where you want to be yourself.

This is often why professional bookkeepers may not be the best choice as a personal financial assistant. They are quick and efficient, and very proficient on the latest online and software advances.

However, we are talking about something more important than efficiency: the slow and often painful eroding of independence that goes along with aging. My goal as a daily money manager is to help my clients feel like they have an extra set of helping hands (and eyes), but they are in control. In this new era of declining independence, I want them to feel as capable and independent as possible.  I mold my work to their existing systems and provide the support that they need to maintain that system (to the best of our ability.

My stepmother, always independent, and even more so after my father’s death over a decade ago, was very resistant to my entry into her affairs. As I wrote in a previous blog entry, I simply offered to balance her checkbook one day. That grew into balancing it each month. At the same time, the impact of what is probably Alzheimer’s became more prevalent, and I offered to write out her checks for the bills that came in, always reviewing them with her before she signed them.

Behaving as an assistant – and not showing how things should or could be done – lets a senior with a long history of independence continue to feel in charge of his or her affairs, while the person helping can keep an eye on things and bring questionable payment to the attention of the person.

As trust builds and abilities decline – it could be merely eyesight loss – the transition can be drama free. Today, my stepmother simply puts the mail aside for me to go through, grateful for the help. She signs what I prepare for her, knowing that I have only her best interest at heart. Had I a pushed harder at the start, I doubt we would be where we are without significant conflict.

The American Association of Daily Money Managers is committed to promoting high standards of client services provided by its members.

	As Daily Money managers (DMMs), we provide personal business assistance to clients who have difficulty managing their personal monetary and business affairs. As DMMs, we are not acting as accountants, financial advisors, or attorneys, unless separately educated and properly licensed to do so.
	DMMs shall have concern for the well being of their clients.
	DMMs shall treat clients, family members, colleagues, and other professionals with fairness, discretion, and integrity.
	DMMs shall not exploit their clients financially, socially, emotionally, sexually, physically, or in any other manner.
	DMMs shall avoid those relationships or activities that interfere with professional judgment and objectivity.
	DMMs shall disclose in writing any affiliations, associations, or interests that may pose a potential conflict of interest or the appearance of impropriety.
	DMMs shall not exploit a relationship with a client for personal or financial gain.
	DMMs shall strive to ensure fees are fair, reasonable, and commensurate with the services performed.
	DMMs shall take reasonable precautions to avoid harm to the client or his/her property.
	DMMs shall respect the rights of their clients.
	DMMs shall protect the client’s right to privacy and confidentiality in accordance with the laws of the state where the services are performed.
	DMMs shall maintain detailed, accurate, financial records for the client, based on information made available from the client.
	DMMs shall achieve and maintain high standards of competence.
	DMMs shall accurately represent their professional experience and training and shall not act in any capacity for which they are not separately educated and properly licensed.
	DMMs shall keep current with issues affecting their clients (health insurance, consumer fraud, etc.)
	DMMs shall acquire and maintain all licenses, registrations, certifications, and insurance required by law to perform their services.
	DMMs shall keep current with public and private services available to their clients for use in resource referrals.
	DMMs shall refer clients to other service providers or consult with other service providers when additional knowledge and expertise are required.
	DMMs shall define their roles clearly to other professionals.
	DMMs shall comply with all federal, state, and local statutes and regulations.

The following is an article I wrote for a special section of the Addison Independent newspaper focused on issues for senior citizens

Think no one uses regular mail or old-fashioned landline telephones anymore? Think again. Especially when it comes to soliciting charitable contributions from senior citizens, a population known among fund-raisers for three things: opening their mail, answering their phones and being generous and trusting with their money.

Sorting out the many organizations that call and send small gifts like labels, notepads, and calendars with their requests for contributions can be challenging and very confusing. Many national organizations hire professional fundraisers who take a percentage of the contributions to cover their costs and profits. Many groups have similar names, then buy and sell lists of contributors, and others still may be nonprofit (even if their hired fundraisers are not) but do not qualify as charitable contributions for tax purposes.

Other solicitors are not non-profit organizations at all, but businesses interested in getting at your bank account in order to sell you marked-up questionable products.

Combine this with recent research showing that as people age, they become less able to discern suspicious behavior, including from telephone solicitors. Aging Americans simply become more trusting at a time in their lives when they also become more generous.

Just how confusing and difficult can giving be, especially in an age of aggressive mail and telephone campaigns? Veterans groups provide one example of running the gamut from worthy use of donations to heavy use of donations for fundraising to outright scams. The confusion is understandable when one looks at the names of three out of many organizations: Disabled American Veterans (DAV), Paralyzed Veterans of America (PVA), and Disabled Veterans of America (DVA).

Using Charity Navigator, an online tool that lists nonprofit organizations and how they spend their money on programs and fundraising, we learn that the DAV spends more than 90 percent of its money on its programs, and less than 5 percent on fundraising – an admirable ratio. The PVA, according to Charity Navigator, spends nearly 60 percent of its money on fundraising and less than 35 percent on programs. And the Disabled Veterans of America does appear to exist, but in November, a Michigan man was sent to prison for using the name and soliciting donations by phone.

Another area of confusion is the professional associations that hire out-of-state telemarketers to do their fundraising by phone. These include, for example, the unions representing professional firefighters and police officers. While one can debate the merits of these Vermont organizations using paid fund-raisers, many people who receive the telemarketing calls do not readily realize that these organizations are unions, and contributions to them are not tax-deductible, even though that is stated in the pitch for donations or follow-up mailings.

What can a person do to keep charitable giving from turning from a joy to a chore, and to protect themselves from scams? Here are a few suggestions:

• Focus on your areas of interest to streamline your giving. Those areas could be a few local organizations you know well, and just a couple national organizations in your interest area. Discard and decline solicitations from others.
• Research before donating. There are several guides available in print and online that rate charities for their use of donations. Online help can be found at charitynavigator.org or charitywatch.org. Each has a simple search engine and ratings. For those without online access, a printed “Charity Rating Guide” is included with membership in the American Institute of Philanthopy, P.O. Box 578460, Chicago, IL 60657y.
• Examine your mail carefully. Many organizations try to look “official” and they are sophisticated in their marketing, sometimes even making an envelope look like a bill, a renewal or membership dues that you owe.
• Get help. Ask a trusted friend or relative to review charitable requests with you (they can even do the background checks online) or get together with friends to open the envelopes together. Often a second set of eyes can catch the fine print.
• Keep a list of the gifts you make.  Some national organizations will increase their requests the more you respond.  It can be confusing and you may forget that you just made a gift last month.  Never give a gift without checking your list first.
• Make an annual charitable budget.  Think about your interest areas, including geographic interest. Many national organizations inundate you with mail and phone calls, and without intending to, you may end up giving more to them than to organizations in your local area.
• Make it a rule never to give financial information out over the phone to someone soliciting money – not credit card numbers and especially not bank account information, most notably the numbers from the bottom of a check. Any reputable organization will respect your wishes to only receive information by mail.
• If you do not wish to receive phone calls, tell each caller to remove your name from their list. The government Do Not Call list made an exemption for charitable organizations, so the organizations must be told individually.