With financial planning, the most effective is often done far in advance and considers both anticipated and unexpected events. The same holds true in planning after an Alzheimer’s diagnosis. (These items don’t have to correlate with a diagnosis, it would be prudent practice to have these in place now.) No one ever plans to be sick or disabled, yet this type of planning can be empowering and ensure the wishes of your spouse are met.

a.  Have your spouse share what is important to them. Write it down or record it.  

b.  Durable Power of Attorney

c.   “Living Will” or “Advanced Healthcare Directive”

d.  Will

e.  Pertinent Information

f.  Living Trust

g.  HIPAA Form

Upon completion of the Living Will (also known as Advanced Healthcare Directive), Power of Attorney and HIPAA, distribute copies to the care team (including attorney, physicians). This will enable these individuals to know your spouse’s wishes and can ensure they are carried out.

Keep in mind that creating a legal document (such as Power of Attorney) does not imply that your spouse’s rights are immediately revoked. The legal forms completed at this stage will not be implemented until your spouse legally no longer has the capacity to make decisions.

The Alzheimer’s Association has a free online workshop available: www.alz.org/education (Legal and Financial Planning for Alzheimer’s Disease)

Costs of continuing care for someone diagnosed with Alzheimer’s disease can easily double the amount of money needed in retirement. Since Medicare only covers screening, diagnosis and limited short-term care associated with Alzheimer’s disease, the brunt of the remaining costs are borne by families and state Medicaid programs. 

 

a.  Social Security Disability Insurance (SSDI)

1. Income through Social Security Disability Insurance (SSDI) may be available, even to an individual with significant assets. While there are limits on the amount of earned income a patient can make in order to be part of the program, there are exclusions for some types of unearned income.  
2. In 2010, the Social Security Administration added early onset / younger onset Alzheimer’s to the list of conditions under their Compassionate Allowances initiative. This helps to streamline the process for qualifying individuals and reimbursing expenses through SSDI programs.

b.  Healthcare Insurance

1. Can help to defray some of the costs of Alzheimer’s care. 

c.  Long-term Care Insurance

1. Long-term Care Insurance can be purchased to insure beyond what healthcare insurance covers, but these plans generally need to be in place prior to a dementia diagnosis.
2. Typically, when the insured is unable to perform at least two of the six activities of daily living (eating, bathing, dressing, toileting, transferring and continence), the benefits can be triggered.
3. Mental impairment alone may not trigger the benefit. So, it’s important to understand what is covered on the policy, and make sure the policy covers dementia care and not just nursing care.
4. Policies may include an Elimination Period, which will be the number of days for which you are responsible for paying for Long-Term care services before your policy begins to pay benefits.

Some life insurance policies may include a rider that accelerates death benefits if the client is terminally ill or meets the standard of requiring nursing home care.

  

Note: It is important to set up third party notifications to alert a family member or other responsible individual in the event a premium is missed, so this coverage (and other insurance coverages) remains in place.

a.  Preparing the Residence

In preparing the residence, it is important to consider existing risks, identifying areas in home needing improvement, and putting measures in place to prevent wandering outside of residence.  

Some items to consider:

1. Bathroom

1. Install grab bars in bathrooms
2. Put non-slip mats in bathtubs. If bathroom is not carpeted, consider putting nonskid strips on floor beside bathtub, shower, toilet, etc.
3. Use a handheld showerhead and shower bench.
4. Use a faucet cover in the bathtub. This can help prevent serious injury if one falls in the bathtub.
5. Install childproof latches on cabinets and drawers to limit access to potentially dangerous items.
6. Reduce water temperature.
7. Consider removing door locks to prevent accidentally locking himself or herself in.

2. Kitchen

1. Install an automatic shut-off switch on the stove. 
2. Place a fire extinguisher in the kitchen. 
3. Remove artificial fruit and food shaped magnets, as these may appear edible.
4. Install childproof latches to prevent access to potentially dangerous items (scissors, knives, matches, cleaning products, alcohol, plastic bags)

3. Bedroom

1. Install a baby monitor in their bedroom. This will enable caregivers to hear if they need help.
2. Be cautious with using heating devices (portable space heaters, heating pads, electric blankets)
3. Place nightlights in the bedroom (also in bathroom and hallways).

4. Living Room

1. Clear any clutter.
2. Remove any plants that might be toxic if eaten.
3. Mark glass doors, windows, furniture at eye level to help them see glass panes.
4. Use caution if using fireplace. Never leave your loved one alone with an open fire in the fireplace.

5. Garage

1. Lock all vehicles. Consider covering or removing vehicles altogether if they should not be driving (more on this below in Driving Dilemma).
2. Install childproof latches or locks on cabinets where tools, tackle, machines, paint, gas or other toxic materials are kept.
3. Remove all guns or weapons from the home.

6. Perimeter

1. Install locks on all windows and doors. If they tend to wander out, keep them locked. Deadbolt locks can be installed on doors requiring a key to open. 
2. Mark edges of steps with bright tape to prevent falls.
3. Restrict access to the pool. Install a gate with a lock and keep covered when not in use.
4. Keep walkways clear of hoses, foliage and other debris.
5. Install outdoor flood lighting to illuminate walkways.
6. Remove fuel sources for grill or other outdoor equipment when not in use.

7. General

1. Adjust home phone (if they retain a landline) ringer volume to prevent distraction and confusion.
2. Set voicemail or answering machine to turn on after lowest number of rings.
3. Prepare for emergencies by displaying emergency numbers and home address near all telephones.
4. Install smoke alarms and carbon monoxide detectors.
5. Keep a spare set of house keys outside of the house.

8. Keep a “to go” bag (for yourself and your spouse) packed in the event of a need to

    go to hospital. Include toiletries, change of clothes, undergarments, current list of medications,

    medical treatment team contact info).  

b.  Driving Dilemma

Driving a car is a symbol of competence and independence for most. So, the discussion surrounding the cessation of driving should be handled delicately. Unfortunately, a person readily recognizing the need to cease driving rarely comes prior to a significant event (accident, getting lost). 

In the early stages of Alzheimer’s, your spouse can likely continue driving as usual. Subtle changes, however, will put them (and, others) at increased risk if they continue. Your spouse will not recognize these changes as easily as someone close to them, so having this conversation early is imperative.

Studies show that even in early stages of Alzheimer’s, the driver’s ability to keep proper distance between cars, adjust for road changes, adjust for speed changes, and anticipate other driver’s actions is diminished.

Following are a few tips for making the decision more palatable: