Families rarely discuss what to do if one of them loses their mental capacity, yet starting that conversation is essential. People with dementia lose their ability to make good decisions and function as adults. They need care for daily living, and that care usually falls to a family member. Sometimes the decline progresses slowly at first, and everyone attributes the first signs as a natural part of aging. Other times people decline rapidly in the span of a few months. The progressive nature of dementia is heartbreaking and stressful for the people experiencing it and their loved ones.
Start Small and Start Now
The eventual goal is to have legal documents and a financial plan for the possibility of dementia. However, this process will take some time, and you certainly do not have to get to that point in one sitting. The first conversation should establish that you care about their well-being by listening.
Timing the conversation is crucial because you want everyone to be in their best mental and emotional state when discussing and planning for the possibility of dementia. While the topic is unpleasant, remember that you are allowing your loved ones to express the type of care that they would choose for themselves. Some seniors may have already been thinking about what they would want and feel relieved at the chance to share their thoughts. Others may need more time to process different possibilities.
Without the threat of imminent decline, you can gather information and explore options calmly. The best time to start talking and planning for dementia is before anyone notices the signs. The second best time is when you start wondering if the person’s “senior moments” indicate bigger problems. If someone you love is already diagnosed with progressive cognitive decline, try to talk about what they want when the person is experiencing a window of clarity.
You might start by saying, “I want you to know how much I care and want the best for you. Can we talk about what each of us would want if something happened and we couldn’t care for ourselves?” This approach takes the focus off of them and their declining health. It is also a good idea to share what you would want even if you are young and healthy. After all, life can change in an instant.
Or you could provide an example of someone you know struggling to make hard decisions for a family member and ask what they would do in that situation. Ideas about your loved one’s values and desires may come out as you listen.
After initial conversations, consider specific ideas about care options and financial implications. It is a good idea to write down what they said to reference later. It will ease the burden of remembering many details and make an excellent reference tool when you talk with an elder law or estate lawyer.
There are many different solutions for care for aging and dementia. What you eventually choose will depend on many factors, such as the level of care, family members willing to be caretakers, and financial resources. Options may include:
- In-home care
- Adult daycare
- Assisted living facilities
- Nursing homes
Most people with dementia eventually need assistance with activities of daily living and near constant supervision. Family caregivers frequently provide the bulk of in-home care, and the emotional toll can be considerable. Some families elect specific circumstances that would warrant hiring an in-home caretaker or using a residential nursing home. Your discussions need to consider family circumstances and personalities. Remember that people with Alzheimer’s frequently experience extreme emotional and behavioral changes. They often become agitated and interact in ways they never do when healthy.
Caring for a person with dementia is expensive. Family members who act as caregivers often have to quit their jobs. Health insurance usually does not cover any costs related to activities associated with daily living. Medicare covers some in-home health care and a limited number of days of skilled nursing home care, but not long-term care.
Medicaid covers long-term care, but to qualify, the person’s assets must be spent down or can be legally transferred to a trust. Veteran benefits like Aid & Attendance may be available for veterans and their spouses. Home equity and retirement savings can also be a source of funds.
Long-term health insurance is also an option, but it is best to purchase it when premiums are lower before age 65. An elder law attorney will help you find the right combination of options for long-term care goals.
Make Decisions Official
Find out what legal documents your loved ones already have and who has access to them. Every adult, especially seniors, should invest in basic legal documents. The most important may include an advance health directive and a trust or will. A power of attorney will also help avoid the need to go to court for guardianship if someone loses their cognitive capacity.
Learning about these issues and starting critical conversations is an act of love. However, you should not feel like you have to go through this process alone. Few people understand all the legal, financial, and emotional burdens that dementia puts on a family.
This article offers a summary of aspects of estate planning law. It is not legal advice and does not create an attorney-client relationship. For legal advice, contact us today at 505-830-0202.