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What Steps to Take when Dementia Begins

Estate Planning for Unmarried Senior Couples
Holiday season is often a time when out-of-town children visit their parents for the first time in a while and notice that one of their parents has declined since they last saw them.

Covid-19 has made traveling more difficult, reducing or eliminating traditional holiday visits these past couple of months.  Clients of Beck, Lenox & Stolzer Estate Planning and Elder Law, LLC have reported virtual celebrations as the way many of them have stayed in touch with loved ones.  While not ideal, an online holiday visit can help family members observe declining cognitive conditions in a elderly relative, reports a recent article “Elder Care: When the children don’t notice” from The Sentinel.  It is important to know what steps to take when dementia begins.

An elderly spouse caring for another elderly spouse may not notice that their loved one’s needs have increased. Caregiving may have started with the spouse needing a reminder to take a shower on a regular basis. As dementia progresses, the spouse may need “stand by” or “hands on” assistance in order to complete the shower.

This quickly becomes exhausting and unsafe, especially when the caregiver may have his or her own health conditions to manage.  An uncooperative spouse can cause an enormous amount of stress on the other spouse.  If one spouse suddenly does not recognize the other and perceives their spouse as an intruder, a dangerous situation may occur. It’s time to discuss this with the children if they are not available to notice this decline for themselves.

People are often reluctant to tell out-of-town children about this problem because they don’t want the added stress of having the children come to the rescue and taking over the decision making for their parents. The children may also think they can come out for a visit and fix everything in the space of a few days. It’s not an easy situation for anyone.

A starting point, especially when early-stage dementia has been diagnosed, is to get an estate plan in place immediately, while the person still has the capacity to sign legal documents. Anyone who is old enough for Medicare (and anyone else, for that matter) needs to have an updated last will and testament, durable financial power of attorney for financial matters and a durable power of attorney for medical matters (POAs).

The financial POA document will be the most practical because the family will be able to access financial accounts and make decisions without having to petition the court to appoint a guardian. A family member who can act under the power of attorney may be a much better solution for all concerned.

Speak with your estate planning attorney to be sure the financial POA permits wealth preservation. If it contains the phrase “limited gifting,” you want to discuss this and likely change it. You should also be sure that there is a secondary and even a third backup agent, in case there are any issues with the people named as POA.

Spouses typically have wills that leave everything to their spouse, and then equally among their children, if the spouse dies first. However, what if your spouse is in a nursing home when you die? The cost of nursing home care can quickly exhaust all funds. If any family member is receiving government benefits and then inherits directly, they could lose important government benefits. These are all matters to discuss with your estate planning attorney.

Have a conversation with your children about your medical POA, also known as a healthcare directive. It’s not an easy conversation, but when the children know what their parents want concerning end-of-life care decisions, it relieves an enormous burden for all. Get specific—do you want a feeding tube to keep you alive? What about if the only thing keeping them alive is a heart-lung machine? Better to have these conversations now, than in the hospital when emotions are running high.  See for more information on the importance of POAs.

Another important document today is the HIPAA release. This permits healthcare providers to discuss and share information about your loved one’s medical care. Without it, even close family members are not legally permitted to be part of the conversation about health care, lab test results, etc.

As stated earlier, it is important to know what steps to take when dementia begins or progresses with a loved one.  You can count on Beck, Lenox & Stolzer to insure that all of the above legal documents, as well as others necessary for your family’s situation, are discussed and put into place to protect those you love.

Reference: The Sentinel (Dec. 11, 2020) “Elder Care: When the children don’t notice”


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