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Financial Planning a Key but neglected
component of Alzheimer’s Care
Patients newly diagnosed with Alzheimer’s
disease or other dementias, and their
families, need better guidance from their
physicians on how to plan for the patient’s
progressive loss of ability to handle
finances, according to a study led by a
physician at the San Francisco VA Medical
Center and the University of California, San
Francisco. “When a patient is
diagnosed with Alzheimer’s disease or
dementia, the chance that their physician
will discuss advance planning for finances
is miniscule,” said lead author Eric Widera,
MD, a geriatrician at SFVAMC. “And yet when
family members and caregivers are asked
what’s important to them, finances are near
the top of the list.”
Writing in the February 16, 2011 issue of
the Journal of the American Medical
Association, the authors use a case study of
an Alzheimer’s patient who progressively
lost the ability to handle finances as a
springboard for a review of medical
literature on the topic of dementia and
financial impairment.
“The literature tells us that financial
incapacity occurs very early and very
rapidly in Alzheimer’s disease and other
dementias,” said Widera, who is also an
assistant clinical professor of medicine in
the Division of Geriatrics at UCSF.
“Patients start having difficulty managing
bank statements and paying bills in the
pre-dementia phase – mild cognitive
impairment – and then, often within a year,
lose more basic financial skills like
counting coins and paying with cash.”
This rapid progression of financial
incapacity, said Widera, makes it
“essential” that physicians proactively
counsel patients and their families on
financial planning “early in the disease,
while the patient still has the capacity to
make the decisions” that will allow trusted
caregivers to take over finances.
“This is about giving patients with
dementia a choice, respecting them as
individuals, and working to maintain their
autonomy even beyond the point where they
can’t make decisions anymore,” Widera said.
“Proper financial planning will leave both
the patient and the caregiver with more
financial resources to deal with the
consequences of the disease.”
As a first step in financial planning,
the authors recommend that early in the
course of the disease, the patient sign a
durable power of attorney authorizing a
family member or other trusted caregiver to
make financial decisions on the patient’s
behalf. “If you wait until it’s too late
for the patient to be involved in the
decision-making, you have to go to court,
which makes it much more difficult and
expensive” for the caregiver to take over
financial responsibilities for the patient,
warned Widera.
Another strategy is for the patient and a
trusted caregiver to open joint financial
accounts. “The caregiver can go online and
see where the money is going,” noted Widera.
“This can protect the patient’s autonomy
while giving the caregiver a bit of
oversight, and provide an early warning
system as the disease progresses.”
Co-authors of the paper are Veronika
Steenpass, MD, of UCSF, primary investigator
Daniel Marson, JD, PhD, of the University of
Alabama at Birmingham, and Rebecca Sudore,
MD, of SFVAMC and UCSF.
The study was supported by funds from the
Health Resources and Services
Administration, the Hartford Foundation, the
National Institute on Aging, the National
Institute of Child Health and Human
Development, the Department of Veterans
Affairs, and a Pfizer Fellowship in Clear
Health Communication.
SFVAMC has the largest medical research
program in the national VA system, with more
than 200 research scientists, all of whom
are faculty members at UCSF.
UCSF is a leading university dedicated to
promoting health worldwide through advanced
biomedical research, graduate-level
education in the life sciences and health
professions, and excellence in patient care.
