“My mother is trying to sell her home, but she is having difficulty understanding the process. She has never had trouble managing her financial life before. How can I help her?”

At Donohue, O’Connell and Riley, we hear questions like this every day. As estate planning and elder law attorneys serving families across the Northeast, we see firsthand how cognitive decline can quietly shift the landscape of a family’s life.

Disability induced by cognitive dysfunction remains one of the most significant challenges we face as we age—either for ourselves or as caregivers for those we love. While modern medicine allows us to live longer, that longevity increases the prevalence of conditions like dementia, Alzheimer’s, Parkinson’s, and stroke. In fact, an estimated two-thirds of Americans will experience some level of cognitive impairment in their lifetime, with an average onset age of 70.

Understanding the “Staircase” of Decline

Cognitive impairment often affects memory, focus, reasoning, or decision -making. Unlike a smooth slope, the onset of impairment frequently resembles a staircase. An individual may experience a sudden loss in function, followed by a plateau where things seem stable for a time. Then, another “step down” occurs, followed by another plateau. Because this progression is so common, recognizing the signs early allows you to take proactive steps to ensure the next phase of life is handled with security and dignity.

Phase 1: The Medical Action Plan

The first step is always medical. Research continues to yield promising advances in treating age-related diseases, and early intervention is key. A comprehensive checkup with a physician can provide valuable insight into potential causes of decline and help establish a treatment plan. Modern pharmaceuticals may slow the onset of cognitive impairment, buying precious time for families to plan.

Moreover, recent medical studies indicate that several negative lifestyle factors can contribute to the development of impairment. Focus on “brain-healthy” habits such as:

• • Physical Activity: Regular walking or swimming to improve blood flow.

  • Social Engagement: Combating isolation through community groups or family gatherings.

  • Dietary Choices: Prioritizing heart-healthy diets like the Mediterranean or MIND diet.

  • Sleep Hygiene: Addressing sleep apnea or chronic insomnia  which can mimic or worsen cognitive symptoms.
    
    

Phase 2: Protecting Your Finances

Now that a medical action plan is in place, the next step is strategic financial planning. Thoughtful asset management ensures the safety of a compromised person’s financial life while preserving their dignity. Managing a mortgage, utilities, credit cards, and medical bills can quickly become overwhelming for someone experiencing decline, and the added stress of investment decisions only complicates matters. Additionally, those with cognitive decline are prime targets for scammers.

Check out our article, 8 Strategies to Avoid Senior Scammers, to learn how to safeguard your family’s finances. 

There may come a time when a person experiencing cognitive decline should no longer have direct access to their primary finances. Prior to this time, bank and investment accounts should be consolidated. While a financial power of attorney will be able to access accounts and sign contracts, finances should ideally be consolidated under a trust with a trusted loved one serving as trustee. To help the individual maintain a sense of autonomy, we often recommend giving them access to a separate bank account with a small balance and a debit card for daily personal spending.

Phase 3: Adapting Living Arrangements

As one ages and loses physical or mental function, the proper living arrangement becomes a dynamic consideration. As losses in function become apparent, we must consider when extra care is necessary—whether a home health aide is sufficient or if more substantial care is required. It is also the time to have the difficult conversation regarding when it is no longer safe for the individual to maintain a driver’s license.

As we move through the aging process, the appropriate living situation will inevitably change. Household items that were previously innocuous can become hazards, such as a gas range or a sunken living room. Home modifications can make the environment more accessible and safer. It is wise to assess the home for risks such as stairs, tools, loose pavers, and driveway cracks. Additionally, hiring help for cleaning, snow removal, and yard maintenance can keep the home in livable condition while easing the burden on family members.

Check out our comprehensive Guide to Aging in Place and tips for welcoming a senior family member into your home.

In addition to home modifications, a home health aide may increase the time one can age in place. If resources and local zoning codes allow, building an Accessory Dwelling Unit (an “ADU”) on a younger family member’s property is a great option. These units can be attached to the primary dwelling or detached as a separate structure, allowing an aging relative to stay close for ease of care while maintaining privacy for everyone involved.

Phase 4: The Legal Foundation

Even though legal steps may seem ancillary compared to medical or financial items, the legal framework is actually the foundation of your plan. You must have the capacity to communicate your wishes and sign documents, so meeting with an attorney is essential while you are healthy, or as soon as initial signs of decline become apparent.

A complete basic estate plan should contain a health care proxy (known as a durable power of attorney for healthcare in some states), a living will, a HIPAA release, and a durable general financial power of attorney. These “incapacity documents” are vital for lifetime planning. While a Last Will and Testament provides guidance for managing assets after death, these documents provide for the lifetime support of your health and finances. A trust is another excellent tool for lifetime management, allowing a trustee to manage assets seamlessly if you are no longer able to do so.

Want to know which path is right for your family? Read our guide: Will vs. Trust: Understanding the Difference.

Conclusion

We have worked with thousands of clients to make the transition to their golden years more manageable. Our popular Make Your Estate Easier to Manage worksheet has ten specific steps you can take proactively to organize your life.

Cognitive decline will affect most of us in some way, but medical advances and proper preparation continue to mitigate the difficulty of these transitions. With the right combination of medical care and legal planning, we can ensure that the trip down the cognitive staircase is safe, slow, and dignified.