Planning for a person with Alzheirmer’s dementia

Planning for a person with Alzheirmer’s dementia

My husband is in the middle stage of Alzheimer's disease I believe. He seems to be gradually losing ground. How do we protect our assets in case he needs assisted living or nursing home care?


There are two aspects to your question, each of which needs to be addressed. We'll also give you a list of things to prepare for meeting a lawyer to address these.


First and most importantly, if your husband has Alzheimer's it is essential that he have the following documents in place to protect him as a person. The key issue is whether his Alzheimer's has progressed to the point where he does not have the legal competency to sign documents. If you are not certain, or its "gray" consult an estate planner in your state immediately. The estate planner may need to consult with the physician or neurologist that is treating your husband for input. The following are documents to consider:

  • Durable power of attorney. A power of attorney is a document that authorizes someone to address legal, tax, financial and other matters when he cannot do so. Since Alzheimer's is a long term debilitating chronic illness be sure to name several successor agents who can serve if you cannot. Address compensation of the agents. You may not need or want compensation, but a successor to you perhaps should be compensated. They could potentially spend a decade or longer managing your husband's affairs if you cannot.
  • Living will which is a statement of health care wishes. Review this with your husband and his attending physician, not just a lawyer, so the document can be best tailored to your husband's conditions and future disease trajectory. Address religious issues if they are or may become important to you, your husband or family. Most forms don't. Be sure it includes a guardianship designation so he can indicate who he would want as a guardian if that becomes necessary (but see below).
  • Health care proxy - appoints an agent and successor agents to make medical decisions. Be sure to include rights to hire and fire companion care, address hospice if that is desired, and so forth. Look at some of the sample forms on this website and the book Shenkman, Living Wills and Health Care Proxies: Assuring Your End of Life Decisions. You can get it through Most living wills and health care proxies are simply to vague and short to really help with many situations your husband may face.
  • Will - to distribute property.
  • Revocable Living Trust - to manage assets through your husband's future disability and distribute property when he passes away. If he is competent to sign all of the above documents, including a living trust you will have done all you can to avoid a court appointed guardianship for him in the future.


While all the above is advisable to protect your assets and husband, the second part of your question pertains to the elder law issue of protecting assets from nursing home costs. With Alzheimer's this is an especially critical issue in that your husband, if otherwise in good health, could have a long term nursing home stay which could deplete or wipe out your assets. You have to consult an elder law specialist in your state. This is a subspecialty of estate planning (an estate planner would address the documents discussed above, or you could use the elder law specialist to do both the documents and planning). Planning needs to be coordinated with any long term care coverage, the magnitude and nature of your assets, and other facts. Many planning options have been eliminated by recent legislation which can require a five year look back period for any transfers, limits on how much of an interest can be protected in a personal residence ($500,000, unless your state increased the amount up to $750,000), etc. It may be feasible to transfer or restructure assets now, create certain contractual arrangements, etc. to provide some protection.


When you make the appointment to meet with the elder law specialist, it would be helpful for you to have the following items:

  • Letter from the physician or neurologist treating your husband indicating level of current competency and likely disease course (how long before nursing home, etc.) and general health.
  • Family tree - information on immediate family.
  • Balance sheet of all assets owned by you and your husband with sufficient detail as to title (how it is owned, e.g., joint, tenants in common, etc.).
  • Copy of the deed for your house.
  • Recent mortgage statement indicating balance due on your mortgage.
  • Copy of any health and long term care insurance you and your husband have.
  • Lists of names of agents for all the above legal documents and several (two or three at minimum) successors.

Preparation will save time and get you better advice at less cost.

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