When a “Family” Relationship Isn’t Enough - Dementia & Legal Authority
With dementia diagnoses increasing every year, it’s important to consider how this possibly could affect your family. Dementia is a disease that over time progresses to a point where a person loses what is considered to be legal “capacity.” With regard to dementia specifically, this generally means:
They are easily confused and can’t understand the purpose and potential consequences when making decisions impacting their financial, healthcare, or legal matters.
They can be easily coerced or pressured by others.
They may not be able to communicate a decision.
Assessment of whether a person has capacity or not can be determined by a doctor or legal professional at the time of a specific interaction. Once capacity is lost, a person can no longer legally authorize someone else to act on their behalf.
Taking care of someone with dementia once they have lost capacity requires the ability to manage their finances and oversee their medical care. Making important decisions is an integral part of that.
However, our laws don’t grant authority to someone just because they are family. So, if the proper legal authorizations haven’t been put in place before a lack of capacity is made, family members face difficult roadblocks Those roadblocks vary depending on whether someone is a spouse, an adult child, or a sibling to the person diagnosed. Let’s start by taking a look at what those roadblocks are.
When the Caregiver Is a Spouse
Surprising as it may sound, marriage alone does not guarantee access to finances or the right to make medical decisions for their spouse.
Financial Challenges for Spouses
Even after decades together, a spouse may face barriers such as:
Inability to access individually titled bank or investment accounts
Restrictions on selling property titled in only one name
Inability to manage retirement accounts or pensions
Delays in accessing funds needed for memory care or in-home support
As a result, many spouses end up:
Draining their own savings
Using credit cards to pay medical and care expenses
Delaying necessary care because funds are locked
This often leaves spouses feeling helpless, frustrated, and blindsided during an already overwhelming time.
Medical Decision Limits for Spouses
In medical settings, spouses may encounter the following:
Delays in approving procedures
Limited access to medical records due to privacy rules
Disputes with providers if adult children disagree
Pressure to seek court approval when capacity is questioned, especially if there is family conflict
When the Caregiver Is an Adult Child
Adult children often face even greater obstacles than a spouse. And unlike spouses, children often have no legal standing at all without formal documents.
Financial Limitations for Children
Adult children generally:
Cannot access bank or investment accounts
Cannot pay bills from the parent’s funds
Cannot sell or manage property
Cannot apply for benefits on the parent’s behalf
This frequently forces adult children to:
Personally fund care and hope for reimbursement
Quit jobs or reduce work hours
Navigate financial strain while caregiving
Medical Decision Challenges for Children
Healthcare decisions can be equally complicated:
Providers may default to a spouse, or treat multiple children as having equal authority
Siblings may disagree on care decisions
Hospitals may require consensus—or court involvement
Children may be excluded from conversations altogether
When the Caregiver Is a Sibling
Siblings face some of the most restrictive limitations of anyone. Without authorizing documents in place, they generally:
Have no automatic financial authority
May not be recognized for medical decisions
Are often excluded unless no closer relatives exist
Siblings often face the same roadblock as adult children: hospitals and financial institutions insisting on court-appointed guardianship, even when the sibling is clearly the most involved caregiver.
How Planning Can Prevent These Roadblocks
The same core documents can protect spouses, children, and siblings—but they must be signed before capacity is lost.
Durable Financial Power of Attorney
This allows a trusted person to manage money, including:
Paying bills and care expenses
Accessing and managing accounts
Selling property
Applying for benefits
Protecting assets for long-term care
This is especially critical when accounts are individually titled.
Durable Healthcare Power of Attorney
This designates who can:
Speak with doctors
Access medical records
Consent to or decline treatments
Make care decisions if capacity is lost
Without it, medical providers may be legally limited in what they can discuss or allow.
Advance Directive with Dementia-Specific Language
Most people know an advance directive is used to document what type of life-saving medical care you do, or don’t want. But, what’s often overlooked is that dementia-specific guidance can also be addressed.
It can provide clear instructions for dementia progression, such as:
Preferences for remaining at home as long as safely possible
When memory care should be considered
Wishes regarding feeding tubes or hospitalization
Comfort-focused care vs. aggressive treatment
Pain management preferences if communication is limited
Authority to prioritize dignity and quality of life
Sample language may include:
“If I am diagnosed with advanced dementia and am no longer able to recognize loved ones or make informed decisions, I direct that my care focus on comfort, dignity, and quality of life rather than life-prolonging treatments”; or
“I authorize my healthcare agent to make decisions regarding memory-care placement when my safety or the safety of others is at risk.”
These statements give families confidence, direction, and legal backing when emotions run high and decisions are difficult.
Obtaining Court-Appointed Conservatorship or Guardianship
Once dementia progresses to the lack of capacity, it becomes too late for an individual to sign the documents I’ve discussed. As noted above, there may be situations where a family member’s only option is to apply to the court to be appointed as a conservator - for financial management - or guardian – for personal and healthcare decisions. This process can take many stressful months during an already difficult time, along with having to deal with:
Guardianship or conservatorship proceedings
Ongoing court oversight
Annual reporting and legal fees
Loss of privacy
Court involvement doesn’t just cost money—it can often worsen family conflict and add to emotional exhaustion.
Statistics
I recently read that approximately 500,000 to 900,000 new cases of dementia are diagnosed each year in the U.S. Like many of you, I personally know many people who have been touched by this disease.
In January 2025, the results of a medical study appeared in Nature Medicine. The researchers of this study came up with the following estimates for a lifetime risk of dementia:
The risk to be 42% after age 55
The risk to be 4% by age 75
The risk to be 20% by age 85, with the majority of risk occurring after age 85
Women have a higher risk than men, with a rate of 48% versus 35%. This is because they typically live longer than men
They project that new cases of dementia will reach 1 million annually by 2060 as our population ages
If dementia were part of your future, would your family know:
Who can access your money?
Who can make medical decisions?
What kind of care you would want?
If the answer is “I’m not sure,” now is the right time to start the conversation—before the law decides for you.
In addition, ask yourself:
If my spouse became incapacitated, could I legally act?
If my parent needed care tomorrow, could I help without court approval?
Would my siblings agree on decisions—or fight over them?
If the answers are uncertain, that uncertainty becomes a crisis once dementia enters the picture.
Planning Is a Gift to the People Who Love You
Putting these documents in place early:
Protects finances
Prevents family conflict
Keeps decisions private
Honors personal wishes
Relieves loved ones of impossible choices
Dementia and caregiving is difficult enough. Don’t let legal roadblocks make it harder.
If you’d like a free template for dementia-specific language for an advance directive, connect with me here.
