Planning for Alzheimer's Disease and Other Forms of Dementia

According to the Alzheimer’s Association, an estimated 5.8 million Americans are living with Alzheimer’s disease. This includes approximately 5.6 million people age 65 and older and another 200,000 individuals under age 65 who have early-onset Alzheimer’s. These numbers are expected to rise dramatically—every 65 seconds, a person in the U.S. is diagnosed with Alzheimer’s disease.

Alzheimer's disease is a form of dementia that leads to memory loss, physical and behavioral problems, and ultimately, death. It is the most common form of dementia, accounting for between 60 and 80 percent of all cases. While there is no cure for Alzheimer's disease, numerous research studies and clinical trials are exploring ways to diagnose, treat, and manage it.

Some medications have shown promise in lessening or delaying the cognitive symptoms of Alzheimer's disease. Meanwhile, various strategies and tools have been developed to improve the comfort and quality of life of people with Alzheimer's and other types of dementia. Hopefully, medical science will soon discover more effective treatments, and one day, a cure.

The look-back period begins on the date a person applies for Medicaid. In 49 states and Washington, D.C., the look-back period is five years. In California, it is 30 months. So, for example, if you reside in any state other than California and apply for Medicaid on January 1, 2020, your look-back period goes back 60 months to December 31, 2014. Financial transactions made during this period of time will be subject to review. (Transactions made before the look-back period will not be reviewed, nor are they subject to penalty.)

Planning for the Cost of Long-term Care

Given that the symptoms of Alzheimer's disease worsen over time, many families find that they can no longer care for their loved one themselves and are forced to seek nursing home care. In the U.S., the median annual cost of a private room in a nursing home exceeded $100,000 in 2019. On average, a person with Alzheimer's lives four to eight years after diagnosis, but some people can live as long as 20 years. Obviously, very few families can afford this.

Fortunately, we can use a variety of tools to plan in advance for the possibility of needing long-term care in the future. We can also help a person with Alzheimer's become eligible for assistance from Medicaid to pay for nursing home care.

Planning for Loss of Memory and the Inability to Make Sound Decisions

A person with Alzheimer's disease may lack or gradually lose the ability to think clearly. This development impacts his or her ability to make decisions and participate in legal and financial planning. If you have been diagnosed with Alzheimer's disease, you should begin the planning as soon as possible.

Certain legal documents can help ensure your wishes are followed as the disease progresses and make it possible for others to make decisions on your behalf when you are no longer able to do so. These documents include:

Power of Attorney for Health Care

A power of attorney for health care allows you to name a person you trust to make health care decisions on your behalf when you are no longer able to make them on your own.

Medical decisions covered by your power of attorney for health care can include choice of doctors and other health care providers; types of treatments; long-term care facilities; end-of-life care decisions, such as the use of feeding tubes; and do not resuscitate orders.

Power of Attorney for Finances

Similar in concept to the power of attorney for healthcare, a power of attorney for finances allows you to designate another person to make decisions about your finances, such as income, assets, and investments, when you can longer make them yourself.

By choosing your decision-makers in advance through powers of attorney, you and your loved ones can avoid the expense, stress, delays, and potential for family infighting associated with a court-ordered guardianship proceeding.

Living Will

A living will allows you to express your wishes regarding what medical treatments you want, or do not want, in an end of life situation. A living will differs from a durable power of attorney for health care in that it outlines your wishes specifically, whereas a power of attorney for health care allows someone else to make health care decisions for you. Another benefit of a living will is that it spares your loved ones from having to make difficult decisions about your care without knowing what you would have wanted.

We are dedicated to helping families in our community who struggle with the challenges of Alzheimer's disease and want to prepare for the possibility of incapacity and the need for long-term care. We invite you to contact us at your earliest convenience to discuss your particular situation.

How to Discourage Challenges
to Wills and Trusts

Try to treat siblings equally

If you have two or more children, leaving each of them the same amount can eliminate one of the main reasons wills and trusts are contested in the first place. Another potential problem is when inheritances are left to grandchildren, and one sibling has more children than the other. If you follow the equality principle, this and many other potential conflicts can be avoided.

If you gave a significant amount of money to one of your children in the past, your estate plan should reflect that

Since your goal is to treat all of your children equally, you might want to "balance" a significant gift to one child in the past by deducting it from the inheritance you ultimately leave to that child.

Consider a "no contest" clause

If you think one of your children (or that child’s spouse) might dispute your will, a no contest clause can make the risk of challenging your will outweigh the potential benefit of doing so. Generally, a no contest clause stipulates that if a beneficiary contests the will’s validity or its provisions, his or interest in the will is forfeited.

Prove that you are of sound mind

Challenges to wills often involve allegations that the maker of the will was not of sound mind when the will was signed. You can help prevent this by obtaining an evaluation from a treating physician and a psychiatrist stating that you are indeed of sound mind when you sign the will.

If you must disinherit someone, note it clearly in your will

Our children sometimes disappoint us. When the level of disappointment is so severe that the only solution seems to be disinheriting a child, make sure your decision is noted in your will. You don’t have to give a reason for your decision, but you should make it clear that your decision was intentional.