What is chronic illness and why must you care? An acute illness is one that has an immediate impact, lasting for a short or limited duration. This contrasts markedly, from a planning perspective, with chronic illness, which may last for many years, often for a lifetime. Planners must care because the aging population brings with it great incidences of chronic illnesses and every aspect of planning is affected. Most important, relying on the generalizations made about chronic illnesses, or worse, relying on the myriad misconceptions, could cause tremendous disservice to the client affected.

NUMBING NUMBERS

Chronic illness is far more common than most practitioners realize. An estimated 120 million Americans are living with some type of chronic illness, and many have two or more chronic diseases concurrently. More than five million Americans have Alzheimer's disease (AD), which accounts for approximately 70% of all dementia in Americans age 71 and older. In addition, 50% of those over age 85 suffer from cognitive issues. Parkinson's disease (PD) is also not rare; about 1% of all those over age 65 are diagnosed with PD.

This is not an elder law issue. Chronic illnesses do not discriminate in favor of older clients. About 25% of PD cases are diagnosed before age 60. Young-onset PD has been diagnosed at ages as early as 30 years. A small percentage of individuals are diagnosed with AD in their fifties or earlier. Multiple sclerosis (MS) is typically diagnosed between ages 20 and 50, but has also been diagnosed in young children.

WHAT PLANNERS CAN DO

Most clients living with significant chronic illnesses are loath to talk about it. They may be self-conscious, fearful or assume you don't care-or that if you do, there is nothing you can do to help. If you have the tools to help, you'll be much more likely to inquire and offer guidance.

When talking to clients with chronic illnesses, however, bear in mind a couple of points:

* Every client's experience of a particular disease is different. You need to find out what that specific client's experience and anticipated disease course is likely to be.

* If you open the door (and your heart) to a conversation about health, you'll be amazed at the number of clients who'll open up to you.

* Planning for clients with chronic illnesses is most often based on modest modifications of the traditional planning steps and techniques already in the realm of your expertise. But seemingly modest modifications can make a huge and positive difference in your ability to help the client.

COMPASSIONATE TOOLS

You need to add some new tools in your planning toolkit. Here are a few:

* Create a communication plan. As a client's cognitive functions are affected by chronic illness, the client may become less capable of communicating or making decisions. With whom should you communicate? Is it permissible to reach out to family members or are you limited to discussing the client's affairs with an agent named by the client under a durable power of attorney?

When working with a client whose disease is likely or assuredly going to lead to cognitive decline, consider obtaining authorization well in advance to communicate with key family members, caregivers, the client's accountant, etc. Be certain that the client's estate plan reflects appropriate similar provisions in any power of attorney or revocable living trust.

* Preserve autonomy. Chronic illness robs a client of independence. Help preserve it when feasible. If a client sets up a funded revocable living trust, consider recommending a provision authorizing and even directing the trustee to establish a small checking account, with an attached credit or debit card, in the client's own name and outside the title of the revocable trust. This can empower a client, even one struggling with cognitive or other issues, to continue such everyday activities as buying a gift or taking family or friends out to dinner-the simple social actions most of us take for granted.

A small account preserves the client's independence by providing unencumbered funds and credit, within reasonable limits, while protecting the majority of the client's assets in a trust structure, perhaps with an institutional or other co-trustee. As the small checking account is depleted or the low-limit credit card used, funds can be replenished if appropriate.

* A person's home is a castle. For many struggling with the fears and limitations of a progressive chronic illness, home assumes a significant emotional and physical role. Home is a safe haven and a retreat from what is often a rather uncaring outside world.