Keeping a list of your accounts and beneficiaries goes at the start of any Estate Planning 101 course. If you don't know what you have and where it is located, how will anyone else? For my clients knowing what they have and where it is located is normally not the problem. However, I am often a surprised when they are unable to tell me the last time they performed a beneficiary audit.
What is a beneficiary audit? This would be the simple act of confirming, with each asset you own, who the listed beneficiary and secondary beneficiary are on your accounts. This homework, while easy, does take some effort, which is why I believe most people put it off. To complete an audit you would contact each bank, investment firm, insurance company, etc you have money with and ask them to mail you a current list of your beneficiaries.
Why do this? In the past I have seen families surprised to find their ex-spouse still listed; friends (who at one time would have been trusted to care for children who are now fully grown), deceased children, estranged children, children with poor judgment (likely to abuse themselves with money), etc… The stories are nearly endless. Certain changes in the law have helped such as the change regarding prior spouses; however, complete reliance on even the new statute would be naïve due to 10 clear loopholes in that law.
In the end your best protection of your goals for those to follow behind you is to know what you have, where it is located, and who stands to receive it when you pass. A beneficiary audit is a simple (free) way to help you become organized and informed.
Do you need help getting organized? We have a free organizer to help you get started. Let us know if you would like a copy.
Shingles is a painful skin rash that affects about a million Americans every year, and one in three people will develop shingles during their lifetime. According to a recent study published in PLOS Medicine, shingles can also lead to strokes and heart attacks.
Previous studies had suggested an increased risk of stroke and heart attacks following shingles. In this study, researchers from the London School of Hygiene and Tropical Medicine looked at more than 67,000 U.S. Medicare patients (age 65 and older) who had shingles and subsequently suffered a stroke or heart attack during a five-year period afterwards.
They determined that elderly patients who suffered from shingles were more than twice as likely to have a stroke and almost twice as likely to have a heart attack. Most of the incidents occurred in the first week after being diagnosed. The risk decreased gradually over the next six months.
Researchers suspect that the shingles virus causes dysfunction within the blood vessels, in which plaques rupture in the artery wall, increasing the risk of blood clots. Also, the pain in acute cases may be so severe that the stress can increase blood pressure to unhealthy levels.
If you had chickenpox, which is caused by the varicella zoster virus, you are at risk of having shingles. Although recovery from chickenpox is usually quick, the virus can live throughout a person’s lifetime inside the nervous system. The dormant virus causes no symptoms, but if it becomes activated, it causes herpes zoster (also known as shingles or zoster).
Anyone who has had chickenpox can develop shingles. It is not clear what causes the virus to reactivate, but it may be due to lowered immunity to infections as we grow older. The condition is most common and most severe in elderly people, with half of the episodes occurring in people over age 60. Multiple episodes are not uncommon.
Early signs of shingles include burning or shooting pain, tingling and itching. Blister-like sores, which last 1-14 days, develop on one side of the face or on one side of the body in a horizontal band. The pain, which can be debilitating, can continue for years after the rash disappears. This condition, called post-hermetic neuralgia (PLN), greatly reduces quality of life.
A person with shingles is contagious while the blister-like sores are present. However, a person who has direct contact with the shingles rash and has not previously had either chickenpox or the vaccine can develop chickenpox but not shingles.
Vaccinations for the virus are available for children (chickenpox) and for adults (shingles). Researchers had hoped to determine the effectiveness of the vaccines, but not enough of the patients in the study had had the vaccine. There is no cure, but vaccination can prevent the condition or lessen its effects, and early treatment with antivirals may prevent lingering pain.
Anxiety occurs in older Americans with surprising frequency. Some reports estimate between 10 and 20% of seniors have generalized anxiety. This number could be even higher, as many often deny having psychological issues when asked by their doctors, focusing more on the physical symptoms anxiety can cause.
In a recent article, Hany Abdelaal, President of VNSNY Choice Health Plans, describes late-life anxiety this way. “It’s a pattern familiar to many of us with aging parents: the overwhelming worry or constant nervousness over day-to-day tasks, from taking medications to parking the car. Left untreated, this anxiety-related agitation in the elderly can disrupt sleep and eating, exacerbate chronic medical conditions, and ultimately contribute to a downward spiral of fear and isolation.”
As his article explains, older adults may have anxiety or worry about physical health (illness, changes in vision or hearing), cognitive difficulties, finances, and changes in life status (widowhood, care-giving responsibilities, retirement). They may feel anxious about keeping medications straight (sometimes to the point of giving up and stopping them altogether), not having enough groceries in the house, driving, and falling.
Anxiety is often accompanied by symptoms that mimic physical illness and may include muscle tension or pain, GI symptoms, shortness of breath, and heart palpitations. Symptoms can also include sleeplessness, an inability to concentrate, irritability, and lack of focus. As a result, complaints are often more about these physical symptoms than the anxiety causing them.
The good news is that anxiety can be treated. Stress can be reduced with social support, communication, education and, if needed, counseling and medication.
Social Support: When there is no one around to provide support or an alternate point of view, anxiety can cause irrational fears to grow. It’s critical to have a support system of family, friends and neighbors who can provide social contact by telephone, email and personal visits. Religious organizations can provide community and a place to visit regularly; most have visitation for those who are homebound. Senior centers can also provide social support.
Communication and Education: Living with chronic medical conditions and managing multiple medications can often trigger anxiety in elderly people, especially if they do not fully understand their situation. Medications should be routinely evaluated and, if possible, reduced. Patients need to understand what they are taking and why, what the desired effect is, and possible side effects. A caregiver or family member should accompany an older person to each doctor’s visit, prepared to ask questions and take notes. A family member can also “join” the appointment via Facetime or speaker phone. Upon request, the doctor’s office can provide a written care plan and prescribed medications at the end of each appointment.
Counseling and Medication: Many anxiety sufferers can benefit from psychological counseling in which they learn to reframe thoughts and behaviors, and challenge their irrational fears. Stress management techniques may be helpful. There are also a number of medications that can help reduce anxiety symptoms. Before adding another medication to what may be an already stressful multi-drug program, a doctor should fully evaluate the patient’s overall situation, reducing or streamlining medications where possible. That said, the addition of one of these medications can make a major difference in the life and outlook of an older person suffering from anxiety.
Jason A. Waddell is a Board Certified Florida Elder Law Attorney who practices on the Panhandle of Florida.