I am going to ask you to imagine that you are 86 years old, your hearing and eyesight have never been worse but you still have a sense of what is going on around you. You need care: someone to cook and clean, bring your medications, help you dress and with personal care items. For a variety reasons you cannot afford to stay in your own home and pay $12,000 to $18,000 per month for live in care givers. You live in a facility with a bunch of other folks in the same predicament, some even worse. Believe me you are NOT alone. There are thousands of elders and disabled people in the same situation.

Sounds gloomy, but you’re one of the fortunate ones. Before life became so confusing and your needs became so great and necessary you visited with your attorney and drafted an estate plan that said when the times comes and you can’t handle the care for yourself and or your finances you nominate a Professional Fiduciary to do those things for you. You knew that you didn’t have any family or friends that you can rely on to step up to the plate for you.

The reason for this post is that I recently had the adult son of one of my clients complain that I wasn’t hired to be his mother’s friend. And he is right. And wrong. I was hired to make sure that no one takes advantage of his mother; to make the best possible effort to see that her finances last as long as she does; to pay her bills; oversee her medical care AND maintain or improve the quality of her life. He ranted and raved at me that there was no reason to drop off a small box of fresh strawberries, a small hazelnut latte or bring a bouquet of fresh flowers occasionally. He felt that there was no reason why I or my case manager should visit with his mother, ask about her feelings, her life, her family, her opinions. Talk to her about her. Get in and get out was his view and spend as little as possible. Now mind you it is not his money that is being spent for the care of his mother.

We, my staff and other Professional Fiduciaries see old or disabled adults sitting day after day in their small rooms staring at the TV or the wall. No one comes to visit, not family, not friends. NO one. If a conversation could be held, understandably other residents usually want to talk about their families, their past, their hopes, NOT yours. Staff at assisted living facilities, convalescent homes, board and cares and the like have way too many patients to look after and their available time is short.

Unfortunately many sons, daughters, grandchildren or other family members are concerned about how much is being spent on mom or dad, grandma or grandpa because that will leave less for them in the end. They don’t provide the funds to support and care for mom or dad. They don’t come to visit. But they are the first to call when the loved one passes. “You know I was her favorite. I thought of her often. How much do I get?”

Even more unfortunate, some judges believe that corners should trimmed, fees reduced, number of visits shortened, quality of life reduced so that there is more for the ultimate beneficiaries. They don’t care how poorly the children or grandchildren or other beneficiaries treated their supposed loved one.

Our clients have worked to support their families, raised their children, sacrificed for the well being of their family. And now they are forgotten, left to live and die alone. Professional Fiduciaries and their case managers take their responsibilities seriously. The elder doesn’t want stuff, more money, better food, fancy clothes. They want time. The one thing that is the most valuable in their lives.

Should the Professional Fiduciary charge for the time they or their case manager spends with the client? Should they be reimbursed for that box of strawberries, the latte, the flowers? I believe that they should. The benefit is for the client not the fiduciary. The fiduciary’s time is valuable, that’s how they make a living. I don’t know a Professional Fiduciary that doesn’t reduce the number of hours that they charge for seeing a client in that situation. Depending on the client’s financial abilities the fiduciary often just buys the small treats out of their own pocket.

Now back to the imagined elder you. If your situation were as described: no one came to visit; you were alone even in a facility with several other people; you either don’t want or can’t involve yourself in the activities of the facility; you don’t get the personal attention or the little occasional gifts. Would you be willing to spend a little more to have someone bring you treats, talk with you instead of at you, walk with you, visit with you, sometimes just sit with you for a bit, show concern for your well being?

A brief story: I had a client that was 94 years old. He was never married, never had any children, never had any close friends, outlived his parents and brother and sister. Mentally he was alert but physically he had some significant challenges. On his last visit to the hospital he was scared not only because of the pain and the cold and sterile atmosphere of the hospital but of dying alone. He had been alone most of his life. Does that mean he has to die alone? The doctor was very clear that it was only a matter of hours. I sat with him for over 24 hours until he passed. Should I have said I’m sorry but I’m not allowed to be “your friend” to be human, to be compassionate? Should I have left him and gone to attend to other clients that I could bill? I have expenses and financial responsibilities like anyone else. Is there a reason that I should not have been compensated? Money was not an issue, this man was extremely well off. What would you have wanted me to do?

I’m not talking about the fiduciary gouging or overcharging or looking for a way to pad the bill. I talking about normal charges and the quality of a person’s life.

These are tough questions and not meant to be rhetorical. I would really appreciate your views. There is substantially more to this profession than paying bills, arranging for services, making health care decisions. In other words the business of the client’s life. The peace of his soul, the quality of her life play a huge role.

I look forward to your comments.