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    Dementia Symptoms & Caregiver Strategies: Cognitive Impairment and Legal Planning

    It's important for everyone to plan for the future, but legal plans are especially important for a person who has cognitive impairment. The sooner planning starts, the more the person with cognitive challenges may be able to participate.

    Why plan ahead?

    Early legal planning allows the person experiencing mild cognition issues to be involved and express his or her wishes for future care and decisions before their impairment gets worse. This eliminates guesswork for families, and allows for the person experiencing cognitive challenges to designate decision makers on his or her behalf. Early planning also allows time to work through the complex legal and financial issues that are involved in long-term care.

    Legal planning should include:

    • Making plans for health care and long-term care
    • Making plans for finances and property
    • Naming another person to make decisions on behalf of your loved one
    Legal capacity

    Legal capacity is the ability to understand and appreciate the consequences of one's actions and to make rational decisions. In most cases, if a person with cognitive impairment is able to understand the meaning and importance of a given legal document, he or she likely has the legal capacity to execute (carry out by signing) it.

    The requirements of legal capacity can vary from one document to another. A lawyer can help determine what level of legal capacity is required for a person to sign a particular document.

    Before a person with cognitive challenges signs a legal document:
    • Talk with the person.
      Find out if your loved one understands the legal document and the consequences of signing it. Make sure the person knows what is being explained and what they are being asked to do.
    • Ask for medical advice.
      If you have concerns about the person's ability to understand, ask for medical advice. A doctor can assist in determining the level of a person's mental ability.
    • Take inventory of existing legal documents.
      Verify whether living wills, trusts and powers of attorney were signed before the person started experiencing cognitive difficulties. The person may no longer remember having completed them. Even if legal documents were completed in the past, it is important to review them for necessary corrections and/or updates.
    Meeting with a lawyer

    You can complete certain legal documents without a lawyer, but getting legal advice and services from an attorney who specializes in elder law can be especially helpful.
    If you meet with a lawyer, be sure to discuss these three key issues and any other concerns you may have:
    • Options for health care decision making for the person with cognitive impairment
    • Options for managing your loved one's personal care and property
    • Possible coverage of long-term care services, including what is provided by Medicare, Medicaid, veteran benefits and other long-term care insurance
    Gather all documents relating to ahead of time so you can bring them to your appointment.

    Checklist: What to Bring to the Lawyer
    • Itemized list of assets (e.g., bank accounts, contents of safe deposit boxes, vehicles, real estate, etc.), including current value and the names listed as owners, account holders and beneficiaries
    • Copies of all estate planning documents, including wills, trusts and powers of attorney
    • Copies of all deeds to real estate
    • Copies of recent income tax returns
    • Life insurance policies and cash values of policies
    • Health insurance policies or benefits booklets
    • Admission agreements to any health care facilities
    • List of names, addresses and telephone numbers of those involved, including family members, domestic partners and caregivers, as well as financial planners and/or accountants
    Help Is Available

    If you already have a lawyer, he or she may be able to refer you to an attorney that specializes in elder law. Otherwise, there are several resources available to help you locate elder law services in your community.
    • National Academy of Elder Law Attorneys (http://www.naela.org - Click the red "Find an Attorney" link on the upper right hand side of the page)
    • Visit the Eldercare Locator online (http://www.eldercare.gov) or call 800.677.1116
    • Visit LawHelp.org online to learn about free or reduced cost legal aid programs


    Cognitive Impairment can have many causes. The patient’s doctor should be consulted to determine a specific diagnosis and treatment options. But whatever the cause, the symptoms are often alike, and the Caregiver Strategies are often similar.

    The information in the resources listed above was compiled by the Ray Dolby Brain Health Center through clinical experience and commonly available published materials. For information on additional Caregiver Strategies, go to: cpmc.org/brainhealth.