If you want to give yourself the best chance of navigating the changing times that lie ahead, learn as much as you can about Alzheimer’s. 

Learn about your parent’s specific condition (every case is individual). If possible, consult with the professionals involved in their care. Ask about available treatment options, as well as how the disease is likely to progress for your parent.

There are many wonderful resources on-line for Alzheimer’s support. The Alzheimer’s Association has a great deal of information on their website (www.alz.org).  

The Alzheimer’s Association website can direct you to your local chapter of the Alzheimer’s Association. The local chapter can provide many levels of support both for yourself and your parent (including care consultation).

The degree to which families are able to acknowledge and accept this progressive disease directly correlates to their ability to align around the emotional realities and the impact on each member of the family.

Emotions after an Alzheimer’s diagnosis can run the gamut from crushed to fear to anger. Create an atmosphere within the family unit of support. Acknowledge that you are entering a new season as a family that will be filled with uncertainty and may strain relationships…commit to stay open and connected. Relationship health in the family is key to coping with care requirements.

Early on, determine and clarify family member roles (who will handle finances, who will take parent to appointments, who will be primary caregiver, etc.). Determine areas in which outside partnerships can be utilized to defray some of the load. 

If your parent is receptive, locating these items before they’re needed will alleviate stress later

a. Safe Deposit Box keys

b. Power of Attorney

c. Will

d. Health Care Directives

e. Home Deed or Mortgage Papers

f. Tax Returns

g. Certificates of Birth, Marriage, Divorce

h. Veteran’s Papers

i.  Social Security Number

j.  Car Title and Keys

k. Insurance policies (Personal and Property)

l.  Passwords (computer, cell phone, online accounts and social media accounts)

A list of their doctors, medications, accountant, attorney, banks, financial planner and brokerage firm could also prove beneficial.

While your parent is cognizant, spend some time learning more about their history (if you don’t already know these things). If they have allergies, are allergic to specific medications, etc. Also, knowing past surgeries / medical procedures may be helpful. 

Having the conversation about taking control of finances is rarely easy with a parent. Parents are typically reluctant to share financial information with their children, much less relinquish control.  

Ideally, though, the conversation needs to begin well before your parent needs help.

If your parent is hesitant to share this information, perhaps the suggestion might be better received if it comes from a trusted third party such as their doctor, accountant or attorney.

One of the earliest signs of diminished mental capacity is in the area of handling routine financial matters. Signs may include:

- Unpaid bills. Late notices when this is not typical.

- Unopened bills

- Hiding bills

- Lots of new purchases on credit card statement

- Strange new merchandise

- Unusual donations to charities

- Payments to telemarketing schemes (unproven memory aids)

- Money missing, and unaccounted for, in checking account

Your Financial Checklist should include the following:

a. Sources of Income

1. Social Security

2. Pension

3. IRA Withdrawals

b. Power of Attorney

Be sure your parent has a Power of Attorney in place, if not naming yourself as Power of Attorney, some other trusted individual.

Without it, you won’t be able to access the accounts, sign checks or manage their money when they are no longer able. If you wait until they are unable to do this, it may be too late to get a Power of Attorney, as the person must be competent when he or she signs it. If they are not competent to authorize the Power of Attorney, you would need to go to court and a judge would need to deem your parent incompetent.

With Power of Attorney in hand, begin to contact financial institutions and gain access to the accounts so you can closely monitor. 

c. Health Care Directive 

Make sure your parent also has a healthcare decision-making document in place (such as a healthcare proxy or living will). It will give you (or another trusted individual) authority to make medical decisions for them when they can’t.

A note about Health Care Directives: some states will only honor those from their state, so be sure you know the rules of the state where your parent resides. 

d. Will

If your parent does not have a will, encourage them to put one in place.  

If they already have a will in place, confirm their wishes and beneficiaries are current.

e. Long-term Care 

Long-term care Insurance can be purchased to insure beyond what healthcare insurance covers. If your parent has a financial advisor, they can provide guidance on long-term care options, if a plan is not already in place.

An attorney specializing in elder care can offer counsel on how to properly re-position assets to access government assistance, such as Medicaid or Medicare, if this is necessary.

Have a back-up plan in the event the plan you’ve designed is unable to be carried out. 

The Alzheimer’s Association (www.alz.org) has a Legal and Financial Worksheet, providing a nice starting point for capturing this information.

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 Alzheimer’s patient as well as caregiver) 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 loved one can likely continue driving as usual. Subtle changes, however, will put them (and, others) at increased risk if they continue. Your loved one 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:

1. Suggest your loved one only drive at off-peak times, only on lower speed roadways (no highways), short routes and only in clear weather.
2. Ride with your loved one at least once a month. If you feel unsafe, it is time for them to stop driving.
3. Enlist your loved one’s physician to provide safe driving guides. The opinions of doctor’s versus family members is often valued more by older drivers. 
4. If your loved one has a smart phone or navigation device, program address of common destinations and recommend they utilize the navigation every time they drive.  
5. Provide viable alternatives. Senior shuttle services, buses, taxis, family members or friends.
6. If taking the keys presents great conflict, disable the vehicle.