Chapter 36
Your Support Team
Until Jerry C. was diagnosed, his life was rather simple. He had dealt with an attorney once when he bought his house. He had an accountant he saw once a year at tax time, an insurance broker he saw once, ten years ago, and of course, he had a general physician. He was startled, six months after his diagnosis, when he realized he was working with nine different experts and had just been advised to speak with one more.
Whatever your economic situation, many experts in different areas are available to assist you. This chapter covers how to decide when the various experts are necessary, how to choose them or to assess the ones you may already have on board, how to maximize your relationship with them, and how either to cover the costs or to access their services without charge.
The sequence in which various team members or matters are addressed by no means suggests their order of importance to you. The relative importance of each will vary over time.
Section 1. General Considerations
1.1 How to Choose Team Members
As you choose team members, keep these two general considerations in mind:
1. You are the captain and the final decision maker. No matter how educated or experienced they may be, these people are your advisers and are there to support you. It’s your life and health so it’s your decision.
2. Trust your instincts. After you do the amount of research with which you feel comfortable, trust your gut instinct when deciding who will fill an expert position.
The two routes to finding a team member.
The “seat of your pants” approach—going with the recommendation of a friend or physician. As discussed in chapter 24 with respect to choosing a physician, the “seat of your pants” method of finding a team member is to blindly accept the recommendation of a friend, family member, doctor, or even the Yellow Pages, when it comes to choosing an expert to assist you.
The ordered approach—research. The more reasoned approach is to do your research before bringing anybody on board.
With a reasoned approach, the initial step is to determine what kind of person you need (e.g., if you need a lawyer, is it a litigator, a tax expert, a contracts person, or an estate-planning expert?). Create a to-do list of the matters that you expect the person to handle to provide an idea of what services and expertise you need from the particular person. Then:
• Ask around for leads. Talk with
• other professionals in the field whom you trust for a recommendation.
• people with a condition similar to yours.
• trusted friends.
• your GuardianOrg.
• associates.
• family members.
• As a last resort, you can respond to ads, but be particularly wary of choosing a team member this way. The person may not really be an expert in the field, and even if she is, she may not be that good.
• If licensing is required, check the appropriate licensing authority to determine if the people you are considering really are licensed, whether they have had complaints against them, and if so, what kind. Licensing does not prove competence, but it is a good sign.
• If there are professional organizations with respect to the person’s specialty, find out whether she is a member of any of them. Again, this does not prove competence, but it is a good sign.
• If peer certification is available that signifies education and experience, does the person have this certification?
Interview. Before you actually hire a prospective team member, have an “informational interview” with several candidates. Seeing several candidates gives you options, as well as bargaining power in negotiating prices for services. These interviews may feel awkward at first, but they can save you money and Life Units.
Be sure to inform the person with whom you make the appointment of the purpose of the visit, and confirm that the interview is at no cost to you.
Since the free visit will be short, be prepared before the meeting:
• Try to anticipate the documents or facts that the person will consider relevant to the subject you want to discuss and take those documents to the meeting. If you’re not sure what documents may be needed, when you set up the appointment ask what the expert would like you to bring with you. Be prepared to lay out the facts. Let the expert define the issues. For example, if you want to speak with an attorney because you are having a problem at work, don’t define it as an Americans with Disabilities Act problem. It would be better to say you are having a problem with your employment because of your physical condition.
• Prepare a written list of questions. Prioritize them in case you don’t get to all of them in the interview.
• Discuss whatever ground rules are important to you. If you are dealing with an office full of people, with whom will you actually be working?
• Find out the base rate charged for services and get an estimate of the overall cost. For example, if a physical therapist charges $50 an hour, how many hours will be required? Ask what you can do to keep the costs lower and what is expected of you.
• If you believe the services should be covered by your insurance, whether it is health or property and casualty insurance, confirm with the expert that the services are covered, and to what extent. If you are expected to pay for any portion, how much will that be?
• Do you and the person share the same outlook and philosophy?
• Obtain a sample retainer agreement or letter that describes the relationship between you.
• Make written notes after the meeting to remind yourself of what you learned and your thoughts about the person. You’ll need them for comparison when you meet more than one professional.
Tip. Before you sign a retainer agreement with any team member, have another team member review it. For example, the lawyer should review the accountant’s retainer letter and vice versa.
While you’re in the candidate’s office, consider:
• Does the office appear to be professionally run, organized, and busy?
• Is your appointment kept on time?
• Does the candidate devote full attention to you or do other activities distract her?
• Do you feel rushed?
• Does the candidate project common sense?
Tip. As you select team members, consider enlisting one or two of the selected members to accompany you to other interviews to solicit their thoughts on the candidate and the proposed arrangement. Their insights can be helpful. For example, if you interview a financial adviser, take your lawyer and/or accountant. If chosen team members insist on charging you to go to the meeting and you don’t want to spend the Life Units, at least get their thoughts on what they would look for and ask about. The more your team members are involved in choosing the other members, the more they will actually feel like a team.
1.2 Other Matters to Consider
Intimidation. Many people feel nervous or intimidated when meeting professionals. If you feel that way, remember that you are the one doing the hiring and your satisfaction is the most important thing.
Attitude. When dealing with team members, take a positive approach and assume that your team members actually want to help you. Be assertive, but not aggressive. There may be a fine line between the two. Assertive will get you what you need while aggressive is likely to put people on the defensive, which leaves them less likely to go the extra distance to assist you.
Second opinions. If you are uncomfortable with the advice you receive, seek a second opinion.
Changing personnel. If the professional doesn’t fill your needs, find one who does. It’s no sin to fire a lawyer, a doctor, or any other professional—no matter how long you have been with her or what emotional ties may exist. I’m not suggesting you change on a whim. You will be trading the known for the unknown. The new professional will need to take the time to become acquainted with you and your history. You will spend Life Units bringing the new member up-to-date. Still, if the balance indicates a change should be made—make it!
Tip. Check with other members of your team when contemplating ending a long-standing professional relationship, particularly if you are considering changing physicians. If you’re acting emotionally, they can help shed some objective light on the situation. If not, they may have suggestions for how to end the relationship without burning bridges and may even have suggestions for replacements they know from experience will likely fill your needs.
Openness. Tell your professional all the facts that may impact the matter under discussion, including the embarrassing ones.
Confidentiality. You can generally expect that between state laws and the ethics of the profession, your professional team members will keep your affairs confidential (except to the extent that may be required by law). Your relationships with your attorney and your physician, in particular, are protected as privileged. If confidentiality is of concern to you, caution is advised when speaking with nonlicensed members of your team. If you have a question about the confidentiality of a specific fact you want or are asked to reveal, ask your attorney whether the matter is protected by confidentiality.
Maximizing use of your team member. Have your facts in order prior to meetings. Since you are probably paying most of these people by the hour, you will spend less money if you organize the facts rather than ask the expert to do it for you. On the other hand, if putting things together overwhelms you, let the professional do it. The effect of stress on your immune system isn’t worth it.
Billing. Every time you get a bill from a team member, ask yourself whether you have gotten fair value for what you and/or the insurance company are being charged. If not, talk it over with your team member.
Changing economic circumstances. If your circumstances change, speak with your team member before deciding to discontinue her services for financial reasons. If you’re open about your financial situation, you’ll be surprised how many people will continue to work with you. If they can’t, they may have an affordable referral for you.
Refusal to treat. In addition to prohibiting discrimination in employment based on disability, the Americans with Disabilities Act also prohibits discrimination by public accommodations. The term public accommodation is broadly defined and includes the “professional office of a health care provider, hospital or other service establishment.” This prohibition means that people with disabilities cannot be excluded or segregated from nondisabled people based on presumptions, fears, or stereotypes. Thus, it has been found that a dentist who refused to treat a patient solely on the basis of the patient’s disease violated the law. Similarly, an emergency room admitting physician violated the law when an HIV-positive person suffering a severe allergic reaction was denied admission because of his HIV status.
If you believe you have been subjected to a violation of the Americans with Disabilities Act, discuss the matter with your GuardianOrg or an attorney for advice on how to proceed.
Section 2. Physician ↑↑↑
See chapter 24 for a discussion on how to select your physician.
Section 3. Lawyer ↑↑↑
3.1 Do You Need a Lawyer?
The first question is whether you need a lawyer at all. At the one extreme, you can hire a lawyer to act as coordinator with your team members. At the other extreme, some people are comfortable handling certain legal work themselves. Sometimes, other less expensive professionals can do the job. For example, accountants can handle routine tax matters. In California, brokers can handle real estate closings. In matters involving small claims, each state has a small-claims court geared for use without an attorney. Most local bar associations can help determine whether an attorney or another person is best for a situation.
Don’t expect any one attorney or law firm to be competent for all of your legal needs. If you hire a generalist when you have specific needs, you may end up paying for that attorney’s education.
Tip. Consider saving money by hiring an attorney as a “legal coach” for advice along the way.
3.2 What Type of Lawyer Is Right for You?
Do you want a large firm with all its contacts and in-house resources or a smaller one with more personalized service and generally lower fees? With a smaller firm, the attorney you hire is usually the one who works on your case. In a medium to large firm the expense, and often the quality, depends on who in the firm works on your case. You may discuss your situation with one person, but another one will do the actual work. A third choice may be a sole practitioner who has expertise in areas of concern to you.
Tip. If you need information about an attorney, the leading directory of lawyers, Martindale-Hubbell, is now on-line at www.martindale.com. For no charge, you can learn a lawyer’s background. It also provides a mechanism to search for an attorney by region and specialty area.
If you don’t have the money to pay legal fees, see section 3.5 below.
3.3 Communication
Discuss the ground rules that are important to you including
• how you want to be updated and how often (keeping in mind, of course, that each of these discussions takes time and will cost you money).
• whether you want to see drafts of documents and any costs for sending them to you.
• that no major strategic decisions regarding the case should be made without your permission.
3.4 Fees
Lawyers bill either at a fixed fee per hour or as a percentage of an amount. When an attorney works for the party who files a lawsuit for payment equal to a percentage of the amount awarded, if any, it is known as a contingency fee. If you are to be charged by the hour, in addition to learning the hourly rates of the various attorneys who may be involved, find out the minimum amount of time that will be billed each time something happens. For example, how much does the attorney charge for each telephone call? The standard charge is a minimum of six minutes per call.
If a contingency fee applies, find out whether your lawyer’s expenses will be deducted before or after the award is divided. Before is preferable because it means more money to you.
In addition to fees, find out what other charges such as photocopying you can expect to incur and how are they billed. How often will you be billed?
Tip. Even a lawyer’s fees and retainer agreement are negotiable. You have nothing to lose by asking. The more you shop around, the more likely you can ask the attorney of your choice to reduce her rate to equal a specific competitor’s. Also, the more business you give the lawyer, the better your bargaining position when asking for a reduction in fees. It is even possible to barter (trade your goods or services for legal fees). If the lawyer agrees to accept barter, consult your tax adviser for the tax consequences, if any. You also have nothing to lose by trying to renegotiate a bill after you receive it. Many firms, when questioned on a bill, will at least cut it a little.
Tip. When you merely want to convey information to your attorney or ask for an update, perhaps an assistant or secretary can convey the information or give you an update at no cost to you.
3.5 Prepaid Services, Clinics, and Legal Aid
Prepaid legal services. Like health insurance, prepaid legal service plans make legal costs manageable by payment of a set sum in return for coverage in the event you need legal services. Today, many of these plans are provided by employers, unions, and associations. While all plans cover the cost of legal consultation and advice, they generally just cover basic, simple legal needs.
Different types of plans available are:
• Referral/discount plans: Not a true prepaid plan, these plans provide a system in which a member of the group is referred to an attorney or law firm that provides free or low-cost advice and consultation.
• Access plans: These plans provide unlimited legal advice and consultation and, generally, cover the review of documents sent by mail to the plan attorney, as well as preparation and review of simple legal documents such as a will. If additional legal services are needed, the member is referred to an attorney who has agreed in advance to furnish such services at a discount.
• Comprehensive plans: Usually only available on a group basis, these plans cover the above services plus coverage for both in-office and courtroom work in most areas of the law. As with health insurance, the member may be responsible for deductibles and/or copayments.
When evaluating a prepaid legal service plan, factors to consider are
• the amount of the premium.
• the services covered, such as writing documents, litigation, and/or court representation, as well as the restrictions placed on those services.
• the lawyers’ qualifications. Also look at how the plan decides which lawyers it includes.
• the reputation of the firm. If you have a claim, how successful has the firm been in pursuing claims of your type?
• whether you have a choice concerning which attorney handles your matter.
• whether, and how, access to attorneys may be limited.
• whether the plan covers preexisting legal problems (most don’t).
• if a matter is not included in the plan, who will handle it, what are their qualifications, and how much more will you have to pay?
• if you’re not happy with an attorney, can you switch? If so, can you choose the new attorney or will she be assigned?
• how are complaints handled?
• is the company financially secure?
• in practice, do the attorneys return calls promptly?
Legal clinics. Legal clinics primarily process routine, uncomplicated legal matters, usually at a low cost and sometimes for free. They can be managed by attorneys (who are generally looking for new business), by law schools (to give students real-life experience), or by nonprofit groups (which advocate a cause, such as assisting women in a divorce). Some GuardianOrgs provide free legal clinics among the services provided to clients.
There are also clinic-type law firms that often advertise heavily on television and generally use standardized forms and paralegal assistants. Paralegals are people who are not attorneys, but who are trained in special legal matters or procedures. States differ as to what services they can perform.
Tip. For simple matters, an experienced paralegal may take care of your needs for about one-third to one-half the cost of an attorney. To find a reputable paralegal, call the National Federation of Paralegal Associations at 871-941-4000 (or log on to www.paralegals.org/ProDirectory/home.html).
Legal aid. If money is a problem, legal aid programs throughout the country may be able to fill your legal needs. Though there is a right to a free attorney in most criminal cases, you do not have such a right in civil matters. Clinics generally have restrictions on your area of residence, size of family, and income. They can be located through your local bar association or county courthouse. The Legal Services Corporation in Washington, D.C., at 202-336-8800 can tell you how to contact your local Legal Services Corporation for housing matters and some civil actions.
Section 4. Financial Planner ↑↑↑
4.1 Do You Need a Financial Planner?
It is preferable to consult a qualified financial planner before instituting a financial plan, even if the only purpose is to review a plan you create yourself.
A good financial planner will review your total financial picture and help you hone your goals. The planner will then work with you to create a detailed plan for making your assets, insurance coverages, and government programs work for you in the best way—given your income, expenses, goals, and physical condition. The planner can also help you keep the details described throughout this book in perspective.
4.2 Choosing a Financial Planner
Be aware. There is little regulation of the financial planning industry, and in most states just about anyone can claim to be a financial planner—with or without appropriate training.
Although an overwhelming number of financial planners are dedicated, responsible, and competent, many people who call themselves financial planners are really just insurance or securities salespeople in disguise, intent on pushing a particular financial product at the expense of your real needs. They may be licensed within subsets of financial planning, such as insurance and securities, but generally they are not regulated for their financial planning activities. If your state regulates financial planners, be sure the planner is registered.
Tip. Recognize that the background of the planner sets the tone. With a planner’s tax background, you can expect a lot of focus on taxes; an insurance background tends to focus on the insurance tools available to meet needs; and a securities background focuses on the use of securities.
Beware of planners who promise quick riches or instant financial gain. Building secure finances is not accomplished overnight or with one single investment.
Tip. Your ideal financial planner should have expertise in working with people with a shortened life expectancy. As you are aware, many of the standard financial planning answers do not work for you. It is better to have a professional already knowledgeable in these issues than one you have to pay to become educated on your behalf. If you’ve read through this book, you may know more about the areas that are critical to your financial well-being than any financial planner who is not an expert in this area.
Certification. The major groups that represent financial planners who have taken courses, have passed exams, have a minimum number of years of experience, and have been awarded certifications are the National Association of Personal Financial Advisers (NAPFA), members of which are fee-only financial advisers (800-36-NAPFA or 847-537-7722), the Registry of Financial Planning Practitioners of the International Association for Financial Planning (IAFP) (800-945-4237 or 404-845-0011), and the Institute of Certified Financial Planners (ICFP) (800-282-7526 or 303-751-7600). Each group will give you the name of planners in your area.
Two of the better financial planning courses are given by the American College in Bryn Mawr, Pennsylvania, and the College for Financial Planning in Denver. When students pass exams and have at least three years of planning experience, they can use these initials after their names: ChFC, chartered financial consultants, for graduates of the American College, and CFP, certified financial planner, for graduates of the College for Financial Planning. Many planners also add initials from their other fields; e.g., CPA for certified public accountants or CLU for chartered life underwriters. While financial planning may be the easiest profession to join these days, at least a CFP or ChFC gives assurance of a degree of knowledge.
4.3 Compensation and Loyalty
Various compensation methods are used by financial planners.
• Most financial planners earn all or part of their living from commissions on the products they sell (either as a sales charge per investment product or as a fixed percentage of total sales), without a charge for the planner’s advice or preparation of a financial plan (commission basis).
• A planner who works on a fee-only basis is compensated entirely from fees on an hourly or project basis, or as a percentage of the assets under management.
• Some planners use a fee-offset arrangement where commissions from the sale of financial products offset fees charged for the planning.
• Some planners work on a combination fee plus commission arrangement: a fee is charged for consultation, advice, and plan preparation plus a commission from recommended products.
A planner who gives you investment advice for a fee is supposed to register with the Securities and Exchange Commission. Such advisers should also disclose any conflicts of interest, tell you how they are compensated, their educational backgrounds, and what their experience has been in financial planning.
Tip. While it is the planner rather than the means of compensation that usually determines whether your needs will be met, you might want to pay for a fee-only planner so you know the advice is more likely to be objective.
4.4 The Interview
Before your first meeting with a financial planner, go through the exercises in chapter 4 so you have your papers organized and an understanding of your income and expenses, as well as your net worth. Think about your long-term financial goals and discuss them with your spouse or partner.
In addition to the questions discussed in section 1.1, consider:
• Is the planner an expert in planning for people with a shortened life expectancy? If you have a specific financial planning concern, does the planner have expertise in that area?
• How long has the person been a financial planner? What education has she had as a financial planner? Does she take continuing education courses, and if so, in what area(s)? What did she do before becoming a financial planner?
• What professional affiliations does the person maintain?
• What is the planner’s business philosophy?
• Will the planner give you a written financial plan as described below?
• Is the person registered with the Securities and Exchange Commission to advise about investments? If so, ask for parts one and two of the form the SEC requires them to complete, which will give you information about their background.
• How is the planner going to determine your unique needs?
• How many companies does the planner represent? If the answer is “just one,” the odds are the planner is really just a salesperson for that company.
• How does the person keep up with the latest financial developments and research recommended products?
• Do you get along personally?
• How does the person plan to work with you in the future? A plan isn’t just made once, but is a living thing that needs to be revisited periodically to be sure you’re on track and to make changes to reflect changing times and your changing circumstances. Clarify the extent of written advice, numbers of meetings, availability for special counseling, and whether you will be expected to purchase investments or other financial products through the planner.
• Ask for references from clients whose situations are similar to your own. Then check those references.
4.5 A Good Financial Plan
A good plan is based on your needs, your views, and your goals. It should be easy to understand and should state the facts as well as make specific recommendations. A good plan should
• be in writing.
• be short so it can easily be digested.
• be molded to your needs.
• list any assumptions made.
• identify trouble spots.
• include a picture of your current finances, including a cash flow analysis and net worth statement.
• review your current insurance and make recommended changes with possible savings in premiums.
• recap your investment portfolio with recommendations.
• touch on retirement planning.
• recommend the estate planning tools mentioned elsewhere in this book.
• include a tax analysis and otherwise list financial areas where you need assistance.
• give you alternatives when it makes recommendations as well as an idea of how to implement and pay for the various ideas suggested. Even better, it should list priorities.
4.6 Maximizing Use of a Financial Planner
It is up to you to keep on top of your finances. No one has as much stake as you do regarding your finances—not even your financial planner.
Once you have a plan, review it with your planner at least once a year, and review it again every time your circumstances change, no matter how often that may be.
The power to buy and sell. Do not give any planner the power to buy or sell assets for you without doing very extensive homework about the person and insisting that you receive a copy of the insurance bond covering the planner in the event of dishonesty or other malfeasance.
Section 5. Accountant ↑↑↑
5.1 Do You Need an Accountant?
If your tax situation is simple and you file a short form, you probably don’t need an accountant. Otherwise, it would be a good idea to at least describe your general situation to one. In addition, a discussion concerning any and all medical expenses you may have and whether you are deferring income or expense to your advantage would be to your benefit. Without an accountant, you may not be minimizing your taxes.
5.2 Choosing an Accountant
Like attorneys, accountants are licensed by the state after taking exams. You can check with your state board to confirm licensing and find out whether your current or potential accountant has had any disciplinary action taken against her. The board will not generally inform you of any pending disciplinary action. An accountant with CPA (certified public accountant) after her name has met additional educational experience requirements.
It helps if an accountant is a member of the American Institute of Certified Public Accountants (AICPA). Members of AICPA’s Division of Firms submit their records for a regular review by other Division of Firms members.
Look for an accountant with whom you share the same philosophy. You may want to be conservative in your taxes, or you may want to push the envelope to maximize tax savings with the attendant greater risk of an audit. Find out if the accountant has expertise in medical questions.
Tip. Get your attorney’s input on prospective accountants. The two of them will probably be working closely together.
Section 6. Insurance Broker ↑↑↑
You can purchase property, casualty, and even life insurance directly from the insurance company, or through various other impersonal mechanisms such as the Internet. However, unless you are sure of the exact coverages you need, including the limits and deductibles that are right for you, you would probably be better off using an insurance professional who is legally bound to work solely in your interest.
State licensing is certainly critical, but it is only a first step. Since insurance brokers typically work for a commission, the more time the person has invested in becoming an accredited expert, the more likely she will work for you and your needs rather than the almighty commission. Thus, if you are considering purchasing life insurance, look for someone who has the initials CLU (chartered life underwriter) after her name. If the question is property and/or casualty insurance, look for someone with a CPCU (chartered property casualty underwriter) after her name.
Tip. To assure coverage, let the broker know immediately when you acquire any assets or make any professional moves, such as starting a new business. Also let the broker know when you dispose of any assets so your coverage, and premium, can be reduced.
Section 7. Stockbroker ↑↑↑
If you want professional assistance in managing your portfolio, it is important to work with a broker who understands your situation. As you have seen in chapter 13, “Investments,” your health conditions should be factored into your investment decisions.
Keep in mind that while a stockbroker may provide expertise and research analysis, her payment is from the sale of financial products. While that is not to say that all brokers will put their commission ahead of your interest, bear that possibility in mind when dealing with a broker. Also, keep in mind that professional portfolio management is no guarantee that your investments will grow or even keep pace with inflation.
Full-service or discount brokers. If you do want to use a broker, there are two distinct types to consider. A full-service broker (the traditional broker) makes investment recommendations, offers advice on asset allocation, and will manage your portfolio. Standard commissions are about two and a half times more than those of a discount broker, although active investors can usually negotiate a rate lower than standard. Discount brokers, on the other hand, just execute buy and sell orders according to your instructions. Some also offer a few basic services. The commission varies based on the number of shares traded and the price per share.
Locating a broker. Check with satisfied people who have the same objectives you do. Also check with family members, friends, colleagues, your attorney, and your accountant. Avoid people who invite you to a seminar or cold-call you.
Do your homework about the broker. Find out
• the broker’s track record. Did the professional advice result in above average returns for her clients over the years since 1986? The year 1986 is picked so you can evaluate how well the broker did through the crash of 1987 as well as during the bullish times. You can ask for a certified history of the firm’s and the broker’s own research recommendations, as well as client references.
• the broker’s education and work background.
• whether the broker’s fees for professional advice are tied to the performance of your investment portfolio and, if so, in what manner.
Verify licensing and whether there have been any complaints about the broker. The best place to start is the Central Registration Depository (CRD), a database run by the National Association of Securities Dealers (NASD). There may be unproved charges in the report, so review it with a grain of skepticism.
You can access this information a number of ways:
• You can obtain a CRD report by calling your state securities agency.
• Call the National Association of Securities Dealers’ Public Disclosure hot line at 800-289-9999.
• The NASD has a Web site (www.nasdr.com) that, in addition to providing investor-protection information, allows consumers to request a free CRD report on both a broker and her brokerage firm.
Be sure the broker is a member of the National Association of Securities Dealers. Look at the financial condition of the firm. Look at the number of floor brokers it has at the various stock exchanges so you can assess if your orders are executed promptly. It also helps if the firm has insurance provided by the Securities Investors Protection Corp., which covers losses up to $500,000 caused by the firm’s bankruptcy, but not losses from bad advice, broker misdeeds, or market downturns. For broker misdeeds, ask for confirmation that the broker and/or firm has errors-and-omissions coverage in the event of mistakes and sufficient dishonesty coverage to protect your investment against theft and similar loss. Check out commission schedules and services.
The interview. Discuss your assets, investment objectives, and risk-tolerance decisions. Be sure you can relate to the broker. Look at whether you will be given the time you need and whether the suggestions you get fit your goals. Let the broker know up front that you are aware the firm often has incentives to move certain securities. Let the broker know if she recommends any such securities to you, you want to be informed about the incentives so you can make a qualified decision.
How to work with a broker. Play an active role in your portfolio management even if you work with a full-service broker. While I’m not suggesting you become paranoid about the subject, prudence suggests you pay close attention to what is happening: we all know how tempting money can be. Periodically revisit the issues you raised in the initial interview and change brokers if you feel the need. Also keep an eye out for “churning” or “switching” (frequent purchases and sales), trading you didn’t authorize, unsuitable investments, misrepresentation, or theft.
If you think you have been mistreated by the broker. Investors who lose money in the market through the negligence, misrepresentation, or manipulation of a broker have a good chance of recouping those funds. Carefully check confirmation slips as soon as you receive them and reconcile them with your monthly statement. If you see that something is wrong, immediately notify your broker’s branch manager of your complaint in writing, with copies to the broker and the firm’s compliance department. If you first notify your broker directly, it puts her on notice to cover mistakes. If the firm doesn’t make good, you can proceed to arbitration covered under your contract with the brokerage house.
Section 8. Claims Assistance ↑↑↑
If you have indemnity-type health insurance or a managed care plan with the right to go outside the system, keeping track of and filing claims or appeals can become a nightmare. This is especially true when you are not feeling well and most likely to be incurring the most claims. (See chapter 14, section 5, for an easy-to-use system for keeping track of claims.)
If you need help and do not have a friend or family available, consider a claims assistance professional. To locate one in your area, you can contact the National Association of Claims Assistance Professionals at 708-963-3500. Membership is open to anyone with an interest in health insurance, so it is not a membership that you can count on. Your GurardianOrg may be able to refer you to claims assistance. As a last resort, look for ads in the phone book under medical claims assistance.
Section 9. Home Care Team ↑↑↑
More and more people want to remain and be treated at home. Home care often requires the services of visiting nurses, attendants, certified home health care agencies, and occasionally a doctor’s visit. Most cities have visiting nurses and home care companies that can perform a large variety of services at the patient’s home, including
• delivery of oral and intravenous drugs.
• postsurgical treatment and wound care.
• infusions of antibiotics and fluids.
• dialysis.
• blood transfusions in some states.
• some X rays with portable X-ray machines.
• occupational or physical therapy.
• nurses to evaluate the need for these therapies as well as the need for a homemaker (cook), a home attendant (to help with bed-to-chair or eating or toileting), or other services. Nurses also have a vital function in teaching self-management to the patient and/or care partner and can alert the partner to when to call the doctor.
See chapter 27, section 3, for a discussion on how to choose the people or company to fill these needs.
Section 10. Pharmacist ↑↑↑
Although we tend to choose a pharmacy on the basis of convenience and price, the pharmacist is important. Generally the pharmacist is the most readily accessible health-care professional most of us have—and no appointment is needed. Also, prescription errors are made more often than we would think. A conscientious pharmacist is needed to add a layer of protection and catch any errors.
Pharmacist and pharmacy. Since the subjects are so interrelated, see chapter 25, section 6, for a discussion about choosing and maximizing the use of a pharmacist and pharmacy as well as minimizing the cost of your drugs.
Section 11. Dentist ↑↑↑
With respect to a dentist, it is important
• that the dentist understand your condition and what drugs and/or treatments you may be taking.
• that the dentist practice proper hygiene, particularly when your immune system may be lower than normal.
Locating a dentist. Pick your dentist according to your needs. Recognize there are general practitioners and specialists. Specialists may be “board certified,” just like surgeons. Certification is not necessarily an indicator of higher skill, merely of additional education.
Dentists either use DDS (doctor of dental surgery) or DMD (doctor of medical dentistry) after their names. According to the American Dental Association, there is no practical difference between the two degrees.
If you have a dental insurance plan, find out whether the dentist accepts it and to what degree before you go to her. Since you will probably have to pay most, if not all, the cost, price is critically important. Find out what the price is before you consent to a procedure. Donald L. gave his new dentist the go-ahead to put in a filling. From past experience, he assumed it would cost about $100. The bill was $450.
Tip. Some dental schools have free or low-cost dental clinics staffed by dental students. Contact any dental schools in your area to see if they have such clinics. The National Foundation of Dentistry for the Handicapped, 1600 Stout Street, Denver, CO 80202 (303-573-0264), may be able to guide you to free care from a participating dentist.
The interview. Since infectious diseases can easily be spread in a dental office, and you may be vulnerable to infection, review the dentist’s infection control methods. The following questions are based on recommendations of the People’s Medical Society.
• What day-to-day infection control procedures are used in the office, and do the dentist and anyone else who may have contact with your mouth wear gloves, masks, and eyeglasses? If not, stop there and go on to the next candidate.
• How are dental equipment and materials disinfected? Are all instruments and items that can withstand exposure to heat sterilized? Are sterilized instruments wrapped in sterilized wrapping for storage? Are disposable items used wherever possible?
• Are all sterilization units checked periodically to verify that they are sterilizing properly?
• Is the hand piece (the device at the end of a tube that holds the attached drill or polisher) flushed regularly before and between each patient?
• Does the dentist wash her hands with antiseptic before each appointment?
How does the dentist use dental X rays (X rays of your teeth for diagnostic purposes)? They are necessary for proper dental care, but can be hazardous and should be limited to as seldom as possible and given only with appropriate protection against scattered radiation. It’s not a good sign if the dentist has a rigid schedule for taking dental X rays or if the equipment is out-of-date with scattered instead of directed X rays.
Dental hygienist. Most dental offices include a number of people who perform specialized tasks. The hygienist is the person of most concern to you because she cleans your teeth. Dental hygienists must complete an educational program and pass regional and state board licensing examinations. If you insist that the dentist clean your teeth, mention this when you interview the dentist or set up your appointment and find out the difference in cost.
Dental clinic. One way to save money is to search out a clinic associated with a dental school. The advantage of these practices is generally their low cost. They are also usually conveniently located with a “no appointment necessary” policy.
The same research you have done about a dentist in general is necessary before you choose a dental clinic. The quality of dentists in clinics may be lower than that of private practitioners, but not necessarily. The pace may be too fast for you to feel comfortable, or you may need follow-up or personalized care that is not available in most dental clinics.
You may have to wait all day at the clinic during your first appointment. In addition, many of these clinics are teaching facilities where you receive care from a student whose work must constantly be evaluated. All of this takes more time than does a regular dentist. Do a Life Units evaluation here to determine which is more valuable to you: the time you will save by going to a regular dentist or the money you will save at a dental school clinic.
Be wary of dental clinics not associated with a dental school.
Denturists. Some states permit denturism—a system under which technicians are trained and licensed to take impressions, construct, and fit dentures. They are usually much less expensive for dentures than dentists, perhaps charging from $200 to $300 versus $500 to $2,000 for the same work by a dentist.
Section 12. Nutritionist ↑↑↑
Good nutrition is important to your health. If you decide to use a nutritionist to help maximize the positive effects of your food and minimize the negative effects, bear in mind that in most states just about anyone can call herself a nutritionist: there is no licensing or other qualification required.
Qualifications to look for. Look for certification. The designation RD (registered dietitian) is issued by the American Dietetic Association. To qualify, a person must have a bachelor’s degree in food and nutrition or dietetics, complete a work study program or internship for practical experience, pass a national qualifying examination, and maintain the RD status through continuing education courses. You can obtain a list of registered dietitians by sending a self-addressed, stamped envelope and $1 to the American Dietetic Association, 430 N. Michigan Avenue, Chicago, IL 60611.
If your doctor, GuardianOrg, or your friends don’t have a nutritionist to recommend, you can get a list of nutrition consultants in your area with advanced degrees in nutrition from reputable schools from the American Nutritionists Association, P.O. Box 34030, Bethesda, MD 20817. For this list, send a self-addressed, stamped envelope with $1 and a letter explaining what you want.
The interview.
• How long has the person been in the business of nutrition counseling?
• Has she ever worked with people with your condition before? How many people? What approach does she use for your condition, and with what results?
• Are her techniques and advice based on research? If so, what research?
• How many people have tried this way of living and to what result? Look for careful, controlled, scientific studies. Ask for the names of people who have tried this approach and speak with them.
• Is the advice based on information the individual will not disclose?
Tip. If the nutritionist recommends a product that is only available from the nutritionist and/or contains secret ingredients, the inherent conflict of interest could reasonably lead you to avoid the products.
Section 13. Social Worker ↑↑↑
Unlike your other team members, a social worker will usually be assigned or be available to you either from a hospital or a GuardianOrg. Social workers are professionals who are familiar with government and nonprofit programs and services that may be available to you. They are paid by the organization for which they work.
Social workers can have a variety of educational and professional backgrounds. Ask about the background of your social worker in order to properly evaluate her advice. Because of her background, a social worker may, for example, steer you toward means-based entitlements and suggest you transfer your assets to qualify. If this occurs, review this advice independently to be sure it’s best for you.
In addition to informing you about the programs that may be available, social workers can help you qualify for them and even complete the paperwork if necessary.
Section 14. Mental Health Provider (Psychiatrist/Psychologist) ↑↑↑
Emotional reactions to a diagnosis are likely to include disbelief, fear or apprehension, anger, and depression. Issues of self-esteem may well rise to the surface. You may feel guilt at “letting down” family and friends, not being able to accomplish all your usual tasks, or at somehow being responsible for developing the condition. Your emotions may reasonably be expected to fluctuate up and down with the ups and downs of your health. Grief over losing the illusion of immortality is not uncommon.
Emotional distress may not always require professional help. But when problems threaten to become overwhelming or interfere with everyday life, or you feel as if you are stuck on the downside of a normal emotional roller coaster, there’s no need to feel defeated. Sadness, dark moods, bad days, and depression are part of life for everyone, but negative emotions that should be dealt with are as different from sadness as an upset stomach is from an ulcer. You can deal with these issues alone or you can add a therapist to your support team.
From a purely financial point of view, a therapist may be critical to your timing as to when you want to leave work on “disability.” If it is questionable whether your physical condition meets the definition of disability for your work, private insurance, and/or Social Security purposes, a recommendation from a qualified mental health professional that you go on disability can make the difference. It is not a simple task to dispute a mental health provider’s finding of “debilitating depression” or other psychological reason why disability status is warranted.
Tip. Your whole family lives with you and your diagnosis. Studies have indicated that a life-challenging condition that leads to depression affects not only the stricken person, but also the spouse/partner and children, as well as the functioning of the family. Since everyone is affected, some kind of counseling should be considered to help the whole family adjust. This is especially true if children live with you. Many GuardianOrgs offer family-oriented programs that you should consider. Contact your local chapter for information or for referral to a counselor.
Choosing a therapist. According to a survey by Consumer Reports in 1995, “people were just as satisfied and reported similar progress whether they saw a social worker, psychologist, or psychiatrist.” However, for purposes of determining whether a person is disabled for insurance and Social Security, there is an order of preference of which you should be aware (see chapter 9, section 2). Also keep in mind that a psychiatrist is a trained medical doctor and can prescribe medications. A psychologist is not a trained M.D. and cannot prescribe medications. If you see a psychologist and drugs such as mood regulators are indicated, there will be a referral to a psychiatrist.
When you look for a therapist, competence and personal chemistry should be your priorities. You must share your most intimate thoughts, feelings, and experiences with your therapist. According to the Consumer Reports survey, the more diligently a person “shopped for a therapist—consulting with several candidates, checking their experience and qualifications, and speaking to previous clients—the more they ultimately improved.”
Maximizing use of a therapist. The same survey also found that once in treatment, those who formed a real partnership with their therapist—by being open, even about painful subjects, and by working on issues between sessions—were more likely to progress.
Referral sources. If you decide to work with a therapist, ask your doctor for a referral. Other good referral sources are national professional associations or their local or state chapters. For information or referrals you can call the American Psychiatric Association at 202-682-6220, the American Psychological Association at 202-336-5800, or the National Association of Social Workers at 800-638-8799, ext. 291. Also, contact your GuardianOrg, local universities, hospitals, and psychotherapy and psychoanalytic training institutes. Family and friends may also know of reputable therapists.
Section 15. Caregivers
Your caregivers, the people who provide your emotional and physical care, as well as the rest of your family and friends, are important to your well-being.
As with any other relationship, whom you want to act as your caregiver(s) is your choice. Generally, caregivers gradually emerge from among your circle of close family and friends. Sometimes the wrong person responds. If that happens, change caregivers. If you are unhappy with a caregiver who emerges, communicate that—but with kindness and consideration. Perhaps there is a way to make that person feel helpful without monopolizing your time and attention. Suggesting such an alternative will help to let the person down easy.
If no caregiver emerges independently, the choice will be up to you. Past success is the greatest predictor of future success. Someone you’ve been close to before when times were rough, or who handled rough times well, would probably be a good caregiver. The person should have a strong empathetic sense and be capable of speaking, listening, and acting from the heart—without his or her own agenda.
Tip. To assist in making your caregiver choices, make a list of family members and friends with whom you are comfortable and in order of caregiver preference.
If you don’t have eligible candidates among friends or family members, speak with your GuardianOrg, social worker, or spiritual adviser. I’m constantly surprised at the number of good-hearted people who volunteer to be caregivers for people they don’t know. The depth of the relationships I’ve seen evolve has been immense for both parties.
Burnout. Watch for caregiver burnout. Before it occurs, be sure there are arrangements for respite: for someone to give your caregiver(s) a break.
Tip. Review your insurance coverage to see if respite care is covered. This is a common feature of long-term-care policies.
Consider pointing your caregivers toward taking care of their emotional needs by joining a support group for caregivers. In addition to taking care of themselves, they may learn information that is helpful to you.
Tip. A good source for caregiver advice is Sometimes My Heart Goes Numb by Charles Garfield, Ph.D. (Jossey-Bass Publishers, 1995). While the book concerns AIDS caregivers, the advice applies to all caregiving. Regardless of the condition, the human need is the same.
The best advice for caregivers: they, and you, should do what comes naturally.
Section 16. Family and Friends
One way to lessen feelings of isolation and anxiety is to live as normally as possible. Let your family and friends know that as much as possible you want to continue with life as it was before.
Independence can mean using help when you need it. Letting family and friends know what you would like them to do and that you need their support will help them—and you. Don’t hesitate to ask friends and relatives to visit if you are feeling up to it. Let them know what they can do for you and what you can do for yourself. They will be grateful for specific suggestions.
You can set the tone for those around you. They will look to you for guidance. You can make them feel comfortable. For your benefit and theirs, don’t let the conversations continually center on your condition.
Tip. You don’t have to be noble and heroic if you don’t feel that way.
Don’t be surprised if closeness with friends ebbs and flows. Ironically, the fear of loss may cause a friend to withdraw. Remember that if friends disappoint you, fear, not lack of caring, is probably the reason.
Those who are close to you need understanding just as you do. They need time to adjust to your illness and to their feelings of confusion, shock, helplessness, and even anger, all stemming from the possibility they may lose you. It may be helpful to try to imagine how they feel and to realistically assess what they can and can’t do.
If you need assistance in relating to your family and friends, speak with your social worker, your clergyperson, or your therapist. It is also a topic for discussion at a support group.
For additional information, whatever your condition, obtain a copy of “Taking Time, Support for People With Cancer and the People Who Care About Them,” published by the National Cancer Institute, free (800-422-6237).
Children. If you have minor children, see the discussion in chapter 2, section 13. Also see the resources section.
Section 17. Clergy People/Spiritual Adviser
Your relationship to the universe and to the spirit is totally personal. A clergyperson and/or spiritual adviser can be helpful in all kinds of situations such as determining who and when to tell of your condition, monitoring and bolstering relationships with family and loved ones, and helping you keep a positive outlook with the strength of a spiritual underpinning. Even with nonbelievers, a clergyperson or other spiritual adviser can be of great help.
Section 18. Malpractice/Errors and Omissions
All your professional team members must conduct themselves in a manner that is reasonable according to the standards in the particular professional community. If they don’t, and you are damaged, you are entitled to compensation.
If you think one of your professionals has not acted properly
• act immediately. Statutes of limitation (laws defining the time by which you must sue or lose your right to sue) vary and can be limited.
• start making detailed notes of the situation.
• if there is physical damage, take photographs.
• speak with two or three attorneys in your community who specialize in malpractice actions. If you have a good case, you will find an attorney who will take the case on a contingency basis. If no attorney agrees to work for you for a contingency fee, it probably means your case is not that strong and is not worth your spending the Life Units or money to pursue. The amount of the contingency fee is negotiable.
• in choosing this type of attorney, look at the quality of the experts whom the attorney uses. Experts are critical to any malpractice case—malpractice actions are typically won or lost based on the quality of the experts testifying on your behalf. Ask whether the attorney will advance the money for the requisite experts. This is negotiable. It is also negotiable whether the fees for the experts are paid out of your share of the ultimate award or the attorney’s share. Generally, these fees are paid from your share.