If the aging are without dementia-specific advance directives, they could potentially lose all their money after they are diagnosed.

If the paperwork isn’t prepared before an individual is experiencing dementia, it may be too late, according to Dr. Verna Reynolds Sellers, who was among the lecturers on Thursday at the American Geriatrics Society 2019 Annual Scientific Meeting in Portland, Oregon.

“People get stuck because they don't realize they are demented,” said Dr. Sellers who practices out of Lynchburg, Virginia. “They think they can handle things but short of getting a court appointed guardian, it's hard to secure a representative payee because the forms require you to agree to it.”

Dr. Sellers was on the Dementia-Specific Advance Directives panel, which took place at the Oregon Convention Center, along with Florida Attorney Debra G. Simms, Texas geriatric physician Ramona Rhodes and Dr Daniel Sulmasy, acting director of the Kennedy Institute of Ethics at Georgetown University in Washington, D.C.

“When someone is diagnosed with dementia, it does not mean they have lost their decision-making capacity,” Dr. Sellers told Financial Advisor. “There will, however, be questions about medical treatment, issues with bill paying and finances. Preparing for that could be something specific in your advanced directives related to dementia.”

Every 65 seconds, someone in the U.S. develops Alzheimer’s disease, according to the Alzheimer’s Association, and as cases of cognitive decline among the aging continue to rise, so too does the number of opportunities for senior citizens to outline their future care preferences and expectations concerning Alzheimer’s.

The state of Virginia, for example, provides a form online that includes space for illness-specific instructions while Dr. Barak Gaster offers on his website a downloadable health directive for dementia that was developed with the help of geriatric, neurology and palliative care experts. AARP posts free printable advance directives by state.

“I'm seeing fewer documents drawn up by attorneys and more people using the standard state specific forms,” Dr. Sellers said.

But Dr. Sulmasy isn’t certain that being dementia-specific is the answer.

“Dementia specific advance directive can’t cover every possible scenario within a disease state,” Dr. Sulmasy told Financial Advisor. “Many patients have multiple co-morbidities. Don’t be fooled into thinking that a new piece of paper will solve all the messy problems of decision making for patients living with dementia.” 

Instead, he advises naming a healthcare decision maker.

“It’s incredibly hard to imagine what it’s going to be like in that state and to write an advance directive so specifically doesn't necessarily get anyone much further because it has be interpreted by people,” said Dr. Sulmasy.

Financial advisors can help by reviewing their client’s advance directives once a year whether they are dementia specific or not in order to avoid situations in which the named healthcare decision maker may also be demented.

“In those circumstances, it’s a good time to get an ethics consult at the hospital because that’s one situation that can invalidate the person named as the healthcare decision maker when they don't have decision making capacity themselves,” said Dr. Sulmasy.

Because managing money, calculating numbers and paying bills requires the highest level of cognitive function, Dr. Sellers suggests advisors have a conversation with their aging client sooner rather than later about assigning a representative payee to help with their finances.

“They can also refer the client to their primary care physician for an assessment if they notice slippage in this area,” Dr. Sellers said.