Dementia: Responding to the Signals of Potential Incapacity

It’s one of the handful of questions that we dread hearing from our clients: My spouse is showing signs of dementia. What do I do?

After taking a deep breath, expressing our sympathy for their concern, and acknowledging the potential seriousness of Alzheimer’s disease and other forms of dementia, we seek to help our clients examine their situation from three perspectives: medical, legal, and financial.

Medical Diagnosis. If your spouse, parent, or other loved one is still at the “showing signs” stage, a medical diagnosis, starting with their primary care physician, is a key first step in determining the nature and severity of their condition. For example, memory loss is often the first apparent symptom, but by itself it does not reveal whether the person is truly experiencing dementia or simply demonstrating, for the first time, some common signs of aging.

Signs of dementia are not limited to memory loss. According to a Mayo Clinic article, “Diagnosing Alzheimer’s,” other indicators include:

• having a hard time concentrating, planning or problem-solving;
• trouble finishing daily tasks at home or at work, such as writing or using eating utensils;
• confusion with location or passage of time;
• having visual or spatial issues, such as not understanding distance in driving, getting lost or misplacing items;
• trouble with language, such as not being able to find the right word or having a reduced vocabulary in speech or writing;
• using poor judgment in decisions;
• withdrawal from work events or social engagements; [and]
• changes in mood, such as depression or other behavior and personality changes.

If testing by a PCP or a neurologist confirms the onset of dementia, early detection can in some cases help slow the condition’s progress and extend the duration of the patient’s mental acuity.

Legal Planning. This is often the easiest step in the process. If we prepared the person’s or couple’s estate plan, the work that went into that plan probably addressed most of the issues that arise in cases of physical or mental impairment. Our wills, trusts, and related documents generally align with the Alzheimer’s Association’s suggested “basics of legal planning”:

• taking inventory of existing legal documents and reviewing and making necessary updates;
• making legal plans for finances and property;
• putting plans in place for enacting your future health care and long-term care preferences; and
• naming another person to make decisions on your behalf when you no longer can.

Our trust-based estate plans typically include, but are not limited to, a:

• Revocable Living Trust, which contains your instructions for your own care and the care of your family if you become disabled, as well as for the distribution of your assets upon your death;
• Last Will and Testament, which addresses the handling of any property that was not transferred to the Revocable Living Trust;
• Durable Power of Attorney for property management, through which you appoint an agent to act for you if you become incapacitated;
• Authorization for Release of Protected Health Information, which identifies persons who may obtain protected health information on your behalf, make informed decisions about your care, and pay your medical bills;
• Healthcare Power of Attorney, which authorizes your agent to make medical decisions for you if you cannot express your wishes or make the decisions yourself; and
• Living Will, which informs your doctors of your wishes regarding the extent of medical measures to be taken on your behalf.

Your legal planning might also include provisions for appointing a guardian or conservator to cover situations in which one or more Power of Attorney documents are inadequate, or if family members are in disagreement about how to handle your legal, financial or health care decisions.

Financial Planning. In-depth planning for elder care and other levels of service associated with dementia is a highly technical and situation-specific area of expertise, and the process of identifying one’s likely financial needs and creating strategies for meeting them is not within the scope of our legal services. 

For an overview of financial planning for dementia patients, we direct you to the guidance contained in the “Financial Planning” page of the Alzheimer’s Association website. Following are some useful excerpts.

Care costs. Since Alzheimer's is a progressive disease, the type and level of care needed will intensify over time. Common care costs include:

• ongoing medical treatment for Alzheimer's symptoms, diagnosis and follow-up visits
• treatment or medical equipment for other medical conditions
• safety-related expenses, such as home safety modifications or safety services
• prescription drugs
• personal care supplies
• adult day services
• in-home care services
• full-time residential care services.

Resources. A number of financial resources may be available to help cover care costs, [including]:

• Medicare, Medicare Part D and Medigap
• insurance, including life and long-term care
• employee or retirement benefits
• personal assets such savings, investments and property
• Veterans benefits
• Medicaid
• Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI), if you are younger than 65
• community support services (see the Alzheimer’s Association’s Community Resource Finder).
  

Conclusion. Addressing your concerns about a loved one’s mental capacity is a responsible and loving first step in helping them determine the extent of their condition and marshal the medical, legal, and financial resources that are necessary to meet their needs.

Within our scope of estate planning and document preparation, we stand ready to guide you through the initial steps of the process and help you identify the appropriate professional resources.