We often wait too long to take care of the legal and financial issues once an older relative has been diagnosed with Alzheimer’s disease (AD). However, many of these decisions should be made before one’s judgment or decision-making skills become impaired. Sometimes the patient or the caregiver is not emotionally ready to confront legal or financial issues but it is important to do so.
Most people have specific wishes and desires concerning their healthcare, end-of-life decisions and even how they want their belongings distributed. To ensure that one’s wishes are carried out, communication is essential because cognitive impairment affects one’s ability to think clearly, and legal documents must be prepared and executed when the individual still has legal capacity. The earlier one makes these decisions, the better. Ideally, one will have experts who can advise them. Attorneys, geriatric care managers or social workers, financial or estate planners and of course, a trusted loved one can all be helpful. It is a good idea to work with an attorney when preparing documents such as wills, giving power of attorney, or to establish or manage a trust.
What is a will? It is the most familiar financial planning document. It dictates how a person’s assets and estate will be distributed among the beneficiaries or heirs. An individual must have “testamentary capacity” (the legal ability to make a will) in order to make a valid will. Obviously, it is best if one has a valid will long before a diagnosis of AD is made, but if not, a newly diagnosed AD patient must move quickly to make or update a will and secure his/her estate before decision-making skills become too impaired.
Other areas that an attorney may also discuss are estate planning, end-of-life issues such as preparing a Living Will, having a “Do Not Resuscitate” order in one’s medical records, executing Durable Power of Attorney for healthcare and finances. Depending on the size of one’s estate, Living Trusts can be established and funerals can be planned (the cost of pre-paying one’s funeral will not be calculated in the spend down needed to qualify for Medicaid, for example). Remember that even if one has executed all of these documents, they should be revisited from time to time in case adjustments are needed because situations change over time. Copies of important documents should be kept in a safe but accessible place.
Geriatric care managers can help deal with sensitive or difficult medical or social issues. They can evaluate one’s needs, provide a care plan, evaluate in-home care options, long-term care options, make referrals and coordinate medical services. Geriatric care managers are especially helpful if the patient does not live near family members who can help.
While legal help can be expensive, there are many services available to low income families in most states. Check with the local Area Agency on Aging, the state Legal Aid Bureau, the state Bar Association, and other local nonprofit agencies or social services agencies that provide an umbrella of services or referrals to agencies that offer low or no-cost services. Templates for wills, living wills, and power of attorney can often be downloaded from state government websites.
Facing AD is hard enough without all the planning that must also be done. Confronting tough questions about one’s future healthcare, care options, end-of-life wishes and legal affairs early on can help increase both the patient’s and family’s sense of empowerment and control. The information below contains some helpful information and resources for legal and financial concerns. ?
This information was adapted from the ADEAR newsletter, Connections, Vol. 15, Number 1-2.