When we read about the onset of dementia, we assume its symptoms will develop gradually over a period of months and even years. We think that, if it happened to us, we’d have time to adjust. But with the unpredictable nature of dementia, that’s not always true.
A few years back, we came across a column called The Moneyist, a regular feature on the MarketWatch website. In a February 2024 edition of The Moneyist, financial writer Quentin Fottrell responds to a man whose dementia came on him suddenly and caught him and his wife off-guard. Fottrell gives the shocked couple some helpful advice – but is it enough? Let’s take a look, after which we’ll get Rajiv’s response to this devastating situation.
Couple’s Life Upended by Sudden Onset of Dementia
Fottrell opens his article with the letter in full, in which the man writes chillingly about his sudden brain damage and dementia.
“Word to the younger folks,” the man begins, “I woke up last year and suddenly could not spell or write legibly. No warning. No symptoms.”
He goes on to add that his intention in writing the letter is to get advice about how to protect his wife and their family finances.
“She will get half my pension and she has an even better pension than I do,” he explains. “We have two long-term care policies — one is paid off and the other is 5 percent inflation-adjusted with lots of positive riders, et cetera.”
He then poses the question: if he ends up living a long time, and uses up his long-term care policies (which, he adds, are currently valued at $600,000) and has to go on Medicaid, will they have to sell their house to pay for it? And would consulting an elder-law attorney help?
The man’s conclusion is both heartbreaking and sincere:
“I don’t want my wife to lose everything,” he writes. “Thanks for reading and a note to your readers from someone who knows: Do your bucket list traveling as soon as you can because you may not have the time left you think you do.”
The Moneyist Responds: Get Plenty of Support, Reassess Goals
Fottrell begins his response with the general advice:
“Keep all your options open, and don’t embark on this journey alone.”
He adds, “You will need financial, legal, medical, social and emotional support. That will involve enlisting the help of loved ones and, yes, relying on a network of professional support. You will need to reassess your financial goals, debts, savings, insurance, income and expenses. Take it one day, one step at a time. There are government programs that could provide help, and you may be able to withdraw money from your IRA even if you are not 59½ without incurring a penalty.”
Dementia Isn’t a Disease – It’s a Symptom
For context, Fottrell provides some deeper information about dementia itself. A common misconception is that dementia is a disease, when it is in fact a symptom of a larger issue.
He explains, “There are over 100 diseases that could cause symptoms consistent with dementia,” of which Alzheimer’s disease is the most common type, according to the Centers for Disease Control and Prevention.
The latest numbers from the CDC tell us that approximately 6.7 million people in the U.S. have Alzheimer’s disease, a figure which is projected to double by 2060.
Frontotemporal degeneration, or FTD, is another type of lesser-known dementia brought into the spotlight in recent years because of the public diagnoses of former talk-show host Wendy Williams and actor Bruce Willis.
“That is a common cause of dementia, and characterized as a group of disorders that occur with the loss of nerve cells in the frontal and temporal lobes,” Fottrell writes. “Aphasia, the inability to process words and communicate properly, can be one symptom.”
Smooth the Dementia Path by Updating Essential Documents
Fottrell then gets down to brass tacks, explaining that the best way to “smooth the path ahead” is to update several documents, including the will and financial power of attorney.
And make sure they are airtight by consulting with an expert.
“Don’t do a DIY version,” he warns, and recommends using “The Power of Attorney’s Notebook” to help keep track.
He also encourages the man to reassess his investment portfolio based on their new financial plan and risk tolerance.
Other documents needing attention could be an advanced healthcare directive, which informs your healthcare providers about what actions you would like them to take if and when you are unable to make those decisions on your own.
He advises, “You may wish to list your wife as your healthcare proxy to carry out those decisions. You are a team, but serious medical issues can put pressure on a marriage, so she will need emotional support, too.”
Share Your Dementia Journey and Create a Team
Fottrell consistently emphasizes the need for all kinds of support multiple times throughout his response, especially in these updated documents.
He encourages the man to list a successor to his wife on both the POA and the healthcare directive to lift some of the considerable burden from her shoulders in what will already be a complicated time for her.
“Share your story with trusted family and friends and create a team — a community of people who can provide support, the latter of which should include updating your beneficiaries,” Fottrell writes. “You could also write instructions for easy access to your devices, documents and even your daily habits.”
Long-Term Care Insurance Helps with Dementia-Related Costs
But it’s not all to-do lists.
Fottrell highlights and praises one thing in the man’s letter that he calls the “power of example for others reading”: the man’s early investment in long-term care insurance, especially policies worth $600,000.
“[H]aving a LTC policy, more than anything, will help alleviate the financial burden that lies ahead,” he writes.
This is because, as he explains, nursing-home care costs can vary dramatically depending on the type of care, state, and institution (up to $125,000 a year).
As to the man’s question about working with an elder-law attorney, Fottrell is in favor, and says that the cost is well worth it.
He estimates that an elder-law attorney can cost anywhere in the neighborhood of $100 to $600 an hour depending on the services required. But experts in your corner are worth the money.
“An attorney and financial adviser will help you take an accounting of your assets, income, expenses and projected long-term care costs, and help you plan accordingly,” he explains. “Financial planners often have a professional network that includes attorneys and accountants, who can collaborate on your case, and share valuable information.”
A Safe Harbor Trust Can Help Protect Your Assets
Attorney Elizabeth Forspan also agrees with enlisting the help of experts, especially in regards to Medicaid, saying:
“Perhaps you can create a trust and divest yourselves of some of your assets now in order to make it through the five-year Medicaid look-back and during that time use your long-term care policy. You will not be able to determine this on your own, most likely.”
Fottrell adds, “An attorney and financial planner can help you weigh up the pros and cons. It may be that you decide to keep your home. Selling any valuable asset, particularly a home, should be a last resort.”
He goes on to explain that there are exceptions to the five-year look-back rule for Medicaid eligibility, writing:
“They include paying off debts, buying medical devices or home improvements to improve accessibility, according to the American Council on Aging, a Medicaid resource funded by planning firm Eldercare Resource Planning.”
He adds, “But your income and other assets may also disqualify you from Medicaid eligibility. You can read more on Medicaid rules here.”
In his conclusion, Fottrell goes on to elaborate about the rules in various states that exempt homes from assets calculated by Medicaid. We invite curious readers to explore the original article for more about that, if interested.
Rajiv’s Take: Why You Cannot Assume You Have Unlimited Retirement Planning Time
We asked retirement planning expert Rajiv Nagaich to weigh in on this couple’s sudden dementia situation, and he has some powerful, urgent insights.
Most importantly, he questions the common habit of waiting until an unexpected healthcare crisis hits before taking critical action.
Rajiv notes that while the fear of a sudden health crisis is completely valid, waiting for an emergency to structure your legal and financial protection is a dangerous strategy.
He often observes that procrastination remains the number one threat to a secure retirement.
According to Rajiv, when couples wait until a crisis to organize estate plans, set up family support networks, or establish power of attorney, they force themselves to make life-altering decisions under extreme pressure.
Adjusting a retirement plan while actively managing a progressive illness like dementia adds immense, unnecessary stress to an already devastating situation.
Critical Choices: How a Proactive Long-Term Care Plan Preserves Your Autonomy
Fortunately, a sudden medical diagnosis does not mean you are entirely powerless.
Rajiv points out that there are actionable steps available to support health and slow cognitive decline, ranging from nutrition and physical exercise to maintaining a strong sense of daily purpose.
When it comes to the fear of losing a family home or being forced into institutional care, Rajiv offers an encouraging perspective.
A dementia diagnosis does not mean you are automatically destined for a nursing home, nor does it mean you must become a financial or emotional burden to your family.
Instead, the solution lies in proactive planning that ensures professional care comes to you as your medical needs increase.
By designing a comprehensive long-term care plan early, you can protect your assets, spare your adult children from becoming unpaid caregivers, and ensure your retirement savings are not entirely wiped out.
To avoid a retirement crisis and learn how to build an effective family support team long before you need it, read our comprehensive guide on the Blog.
Meet Rajiv Nagaich: Your Trusted Retirement Planning Coach and Guide
To help families navigate these complex issues, Rajiv Nagaich’s latest program on PBS, called Designing Your Ideal Future, is now broadcasting to audiences nationwide.
This thought-provoking television special encourages viewers to move past generic estate planning and build a truly resilient system for the future.
Throughout this educational one-hour special, Rajiv demonstrates how to align your personal values, family dynamics, and financial goals with your legal documents.
Rather than relying on standard, disconnected paperwork, viewers learn how to create a cohesive retirement strategy that protects their choices and quality of life.
The program features practical, real-world planning case studies alongside an interactive audience Q&A session.
It provides essential guidance for anyone approaching retirement, current retirees, and adult children who are currently managing care for an aging parent.
Take the Next Step to Secure Your Future and Protect Your Family
As Rajiv frequently warns, a staggering 70 percent of traditional retirement plans ultimately fail.
If you want to avoid the common pitfalls of running out of money, losing independence in an institutional nursing home, or overwhelming your loved ones during a medical emergency, these resources are essential.
Check your local PBS station listings to find upcoming broadcast airtimes in your area.
By visiting the station website, you can also gain immediate access to valuable companion tools, including our free Legal Readiness Quiz and step-by-step guides for building your personal LifePlanning system.
Do not let procrastination leave your future vulnerable to sudden health changes.
You can actively shape a secure, fulfilling retirement by watching, implementing, and sharing this crucial planning message today.
Remember to stay proactive, take control, and Age On, everyone!
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