B. Smith's Alzheimer's raises question: How to protect your wishes when incapacitated

The case of restaurateur and lifestyle guru B. Smith, who is battling Alzheimer’s, is drawing scrutiny from her fans and strangers alike, many of whom are dismayed by her husband’s decision to date a woman he calls his "life partner" and keep a room for her in the house he shares with Smith. 

Not surprisingly, the situation is prompting some uncomfortable questions, such as whether B. Smith would have agreed to the arrangement had she been asked before the disease progressed. But it’s also sparking discussions about Alzheimer’s, including how to ensure your family carries out your wishes if you become incapacitated from the disease.

These dilemmas are hitting more families every year due to the growing ranks of Alzheimer’s patients. More than 5.7 million Americans suffer from the disease, which has no cure and is most likely to affect senior citizens, women and African Americans, according to the Alzheimer’s Association. 

Without planning, it’s difficult to determine what a family member with Alzheimer’s would have wanted before they became incapacitated. Discussing those “what ifs” is important while you’re healthy and can communicate them to family members.

Would it be OK if you had Alzheimer's or dementia and your significant other moved on while you were still alive and in the house?Share your story with Janna Herron via email at JHerron@usatoday.com or on Twitter @JannaHerron

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Experts recommend a two-fold approach: Crafting legal documents that will protect your finances and health care decisions in case of incapacitation, as well as drafting a statement of values that can help family members understand your goals. 

These steps aren’t always easy, but they can help avoid later heartbreak – and legal problems. 

“It is a subject we find difficult to discuss because our brains don't want to go there,” says Keith Moeller, Northwestern Mutual wealth management adviser, who notes that he’s created an “incapacity plan” to provide guidance to his family if he becomes incapacitated. He says he recommends his clients create similar plans. 

Conveying those intentions to family members “creates a best-case scenario in a very stressful situation, making it easy for them to make those decisions,” he adds.

Essential documents

Step one is setting up legal documents that spell out who will take care of your financial and health care decisions in case you become incapacitated, experts say. Among them are:

• Durable power of attorney. This will allow a trusted family member or friend to make financial decisions on your behalf in case you are incapacitated. 
• Power of attorney for health care. This document will allow a family member or friend to make decisions about your treatment, in case you can no longer do so.
• A revocable trust. Also called a living trust, this document allows you to set conditions and directions about your assets in case you are incapacitated.
• A will. This determines the distribution of your assets after your death.

Only four of 10 Americans have wills or living trusts, with many dragging their feet because they don’t foresee themselves becoming incapacitated or mistakenly believing such documents are only for well-heeled people. 

“These are situations people run into regardless of how much money they have,” says Paul Kassabian, an attorney and senior product counsel at online legal services company LegalZoom. “It doesn't matter if you are rich and poor – everybody has bills to pay and medical decisions that need to be made.”

The revocable trust could help bypass messy situations by stipulating how you wish certain assets to be treated in case of Alzheimer’s, such as your home or car. Sole owners of a home could put their property in a trust that stipulates it could be sold to fund their stay in a memory-care facility or outline which family members are permitted to live in their home if they are incapacitated, for example. 

Gathering the family 

Aside from legal documents, experts recommend talking with family members about your wishes in case you become incapacitated. But it’s important to gather all family members in one place, says Alicia Waltenberger, an attorney and director of wealth planning strategies at TIAA.  

“Getting all those individuals together so they can hear our wishes cuts down on potential confusion,” she says. “If we are all together, we're hearing the same message at the same time.”

People who are already showing signs of dementia may forget what they told one family member versus another, potentially leading to conflict at a later point, she added. 

Get it down on paper

Lastly, create a signed and dated document that spells out your values and your hopes for your home or other assets, your care and treatment, experts say. This won’t be legally enforceable, but it may help family members deal with the thicket of decisions they’ll undoubtedly encounter if you become incapacitated. 

“Think about what your values are to share with people you entrust with your care,” says Kris Yamano, regional leader of wealth planning at U.S. BMO Private Bank. “While you can't account for every detail, the things that pop up may be the things that are most important to you, like that you remain around loved ones.”

The Alzheimer’s Association has a number of resources on its site aimed at helping patients and their families navigate legal planning. Early discussions, before the disease progresses, are crucial, says Beth A. Kallmyer, vice president of Care and Support for the Alzheimer’s Association. 

B. Smith’s case “raises the importance of having those early conversations about how you would want to handle the disease as it progresses,” she notes. “Who provides care is a huge issue. It’s a unique disease where the progression means they are no longer able to be a partner at the same level they had been.”