Health Care Decisions: How to Plan for Dementia and Alzheimer's

When a family member begins showing signs of dementia or Alzheimer’s, the future can feel uncertain. Decisions that once seemed simple (like managing medications, choosing doctors, or handling day-to-day care) suddenly become a pressing issue. And the truth is, planning early makes all the difference. 

The most important steps to plan for dementia and Alzheimer's involve choosing who will act and decide on your behalf, putting your specific wishes in writing, and establishing a support system that protects your health, dignity, and finances well before your memory begins to fade.

Many people wait too long. They assume they’ll “get to it later,” or believe their family will “figure it out.” But dementia doesn’t wait for convenience, and families often end up scrambling at the worst possible time. The goal of planning in advance is simple: make decisions while you’re still able so your family doesn’t have to guess. With the right documents and clear communication, you stay in control of your future—even if the disease eventually takes your ability to communicate.

Let’s break down what planning really looks like, why it matters, and how you can begin long before a crisis.

Why Planning Early Matters More Than You Think

Dementia and Alzheimer’s progress slowly at first, then quickly. One month, a loved one may just be forgetful of simple things; the next, they can’t remember familiar routines or manage daily tasks. The window where a person is still legally able to sign documents is often shorter than families expect.

If you wait until symptoms advance, the law steps in. Doctors may determine that the person lacks mental capacity. The court may need to appoint a guardian to take charge of this person's life. And loved ones who thought they were “on the same page” may disagree about what care should look like.

Early planning prevents all of that. With properly prepared documents, you choose your decision-makers, outline your preferences, and protect your well-being. Instead of reacting on the spot, your family follows a plan you created.

Start With the Most Important Decision: Who Will Speak for You

One of the first steps in planning for dementia-related care is choosing someone who can legally make health decisions if you can’t. This is done through a Health Care Power of Attorney, which lets you appoint a trusted agent—usually a spouse, adult child, or close friend.

The key is choosing someone who understands your values and is able to advocate for you under stress. Not everyone can do that. Some people freeze during medical emergencies. Others struggle to stand up to doctors or family. Some simply don’t share your beliefs about medical treatment.

This is your chance to choose someone who will protect your dignity, honor your beliefs, and keep the family together—not someone who will be overwhelmed by responsibility. And the sooner you choose, the more time you have to talk through how this process will go.

Document Your Wishes Before Memory Declines

A Health Care Directive (sometimes called a Living Will) spells out what you want in medical situations where you are unable to speak for yourself. This helps guide your family and doctors if you reach a late stage of dementia where decisions become extremely complex—like whether you want artificial nutrition, what level of life-prolonging treatment you want, and under what circumstances you prefer comfort-focused care.

These conversations can feel uneasy and difficult to confront at first, but they are really a gift to your loved ones. When families don’t have direction, they’re forced to guess. And guessing leads to guilt, disagreements, and familial disputes. 

Plan for Finances at the Same Time

Health care planning and financial planning go hand in hand. Dementia can bring long-term care needs, medical bills, home modifications, adult day programs, and eventually full-time skilled nursing.

A Financial Power of Attorney ensures someone you personally trust can manage bills, access accounts, apply for the right benefits, and protect assets if you can no longer handle your finances. This prevents unpaid bills, financial mistakes, or unauthorized decisions from draining your bank accounts.

Families are often surprised by how early financial confusion begins in cognitive decline. Even mild impairment can lead to missed payments, bad investments, or susceptibility to scams. Putting someone responsible in charge early avoids financial damage that is often irreversible.

Think About Long-Term Care Before It’s Urgent

Without a plan, families end up making these decisions in a crisis. That usually leads to choices based on urgency rather than preference. When you go over these possibilities early, you get to prioritize comfort, routine, affordability, and location.

You may also want to explore long-term care insurance, Medicaid planning, or trust-based strategies to protect assets while ensuring you can afford the level of care you deserve.

Have Clear Conversations With Your Family

The legal documents matter, but conversations matter just as much. It’s important to talk openly with your family about:

• the kind of care environment you’d prefer

• what quality of life is your ideal

• how aggressively you want medical treatment handled

• your feelings about end-of-life care, hospitalization, and dementia-specific facilities

  
  

Families that avoid these conversations often end up in conflict, not because they don’t care, but because they care so much they’re afraid of doing the wrong thing. 

Use a Team Approach: Doctors, Lawyers, and Family Together

Planning for dementia isn’t all legal paperwork—it’s a team process. Your doctor can help you document the early stages of impairment, outline what future progression might look like, and discuss care needs. An estate planning attorney (like us) makes sure your documents are legally enforceable, leaving no room for open interpretation. Your family provides emotional and practical support.

When everyone is aligned and working together from the beginning, transitions become smoother. The person with dementia stays safer, the family experiences less stress, and the care provided stays consistent with your values.

What This Looks Like in Real Life

Imagine Maria. In her late 60s, she begins forgetting appointments, repeating stories, and misplacing everyday items. Her family brushes it off as “normal aging,” but she decides to plan anyway.

She chooses her oldest daughter as her Health Care Agent because she’s calm and level-headed under pressure. She writes down her medical preferences while she’s still completely clear-minded. She updates her financial power of attorney and reviews how long-term care could be paid for if needed.

Two years later, her diagnosis becomes official: early-stage Alzheimer’s. Although the disease is progressing, her family isn’t panicking. They know exactly who is in charge, what Maria wants, and how to manage her finances responsibly. Her daughter handles medical decisions confidently, and the rest of the family supports the plan without arguments.

Because she acted early, Maria’s world stays safe and stable—something every family dealing with dementia needs. 

The Bottom Line

Dementia and Alzheimer’s can take away memory, independence, and eventually the ability to communicate. It’s a horrible thought, but they don’t have to take away your ability to control your life. With early planning, you keep your authority. You choose your care. You decide your future. And you give your family clear direction, certainty, and peace during this time.

We hope this article was of use to you, and if you have further questions, feel free to contact us for more information.