Can a family meeting be scheduled with a primary care physician or geriatrician to discuss a patient's worsening dementia and potential financial exploitation by their live-in partner?

Family Meetings for Patients with Worsening Dementia and Financial Exploitation Concerns

Yes, a family meeting can and should be scheduled with a healthcare provider to document worsening dementia and address concerns about financial exploitation by a live-in partner. This is an appropriate and necessary intervention when financial abuse is suspected in a vulnerable patient with cognitive impairment.

Medical Documentation of Cognitive Status

Primary care physicians and geriatricians play a crucial role in documenting cognitive decline and addressing potential financial exploitation:

• Healthcare providers should conduct formal cognitive assessments using validated tools to document the patient's current cognitive status 1
• Documentation should include:
  • Results of formal memory testing
  • Assessment of functional abilities (basic and instrumental activities of daily living)
  • Evaluation of decision-making capacity, particularly financial capacity
  • Presence of neuropsychiatric symptoms

Addressing Financial Exploitation Concerns

Financial exploitation is a recognized form of elder abuse that requires intervention:

• Warning signs of financial exploitation include 2:

  • Unpaid bills despite adequate resources
  • Limited money for provisions
  • Sudden changes in financial arrangements
  • Unexplained transfers of assets
  • New signatories added to accounts

• Healthcare providers should document these concerns in the medical record and can help by:

  • Assessing the patient's capacity to manage finances
  • Documenting the patient's vulnerability to financial exploitation
  • Recording family concerns about potential exploitation

Structure of the Family Meeting

The family meeting should be structured to address both clinical and protective concerns:

1. Assessment component:

   • Review cognitive testing results
   • Document progression of dementia symptoms
   • Assess functional limitations
   • Evaluate decision-making capacity

2. Intervention planning:

   • Discuss preventive measures against financial exploitation 2:
     • Setting up direct debits for bills
     • Appointing a trusted person as financial proxy
     • Considering legal protections like Power of Attorney
   • Address caregiver concerns and family dynamics

3. Documentation requirements:

   • Document all participants present at the meeting
   • Record specific concerns raised about financial exploitation
   • Note any disagreements among family members
   • Document recommendations made during the meeting

Legal and Ethical Considerations

The family meeting provides an opportunity to address important legal protections:

• Discuss advance care planning options while the patient still has capacity 1

• Consider recommending:

  • Durable Power of Attorney for finances
  • Healthcare Power of Attorney
  • Advanced directives
  • Guardianship/conservatorship if capacity is already significantly impaired

• If financial abuse is strongly suspected, providers should be aware of:

  • Mandatory reporting requirements in their jurisdiction
  • Resources for adult protective services referrals
  • Options for emergency protective orders if needed

Pitfalls and Caveats

Several challenges may arise during this process:

• The alleged financial exploiter (live-in partner) may attempt to block the meeting or control the narrative
• The patient may have anosognosia (lack of awareness of their cognitive deficits) 1
• Family conflicts may complicate the intervention process
• Cultural factors may influence how financial management is viewed

To address these challenges:

• Consider meeting with some family members separately if needed
• Ensure the patient has an opportunity to speak privately with the provider
• Document any attempts to interfere with the assessment process
• Focus documentation on objective findings rather than accusations

Follow-up Plan

The family meeting should establish a clear follow-up plan:

• Schedule regular reassessments of cognitive status
• Establish a monitoring system for financial management
• Consider referrals to:
  • Elder law attorney
  • Adult protective services if appropriate
  • Care management services to provide ongoing monitoring 3
  • Support groups for family caregivers

By facilitating a structured family meeting and providing thorough documentation, healthcare providers can help protect vulnerable patients with dementia from financial exploitation while supporting their families through this difficult situation.