Dementia legal planning in Florida: what to do after a diagnosis

A diagnosis doesn't erase a person's right to make decisions. Florida presumes adults have capacity, the legal ability to understand a particular decision, and many people in the early stages can still sign their documents. That window closes. Once a person can't understand a document, they generally can't sign it, and guardianship, a court process, may be the only way left.

The core documents are explained in our guide to the five legal documents every Florida adult needs. After a dementia diagnosis, pay special attention to:

A durable power of attorney that is effective when signed. Florida no longer allows a new power of attorney that "springs" into effect on incapacity (s. 709.2108). It should include the powers that need separate initials, such as making gifts or creating a trust, if Medicaid planning may be needed later (s. 709.2202). A health care surrogate designation, with an alternate (s. 765.202). A living will covering feeding tubes, hospitalization and comfort care. A preneed guardian designation, naming the person you'd want if a court ever has to appoint a guardian (s. 744.3045).

For who should fill these roles, see Choosing who will decide for you.

Capacity isn't all or nothing. It depends on the decision and on the day. A person may be able to name a trusted daughter as health care surrogate but not follow a complex trust, and many people are clearer in the morning or less clear during an infection.

To sign a will, Florida requires a "sound mind" (s. 732.501). Courts generally look at whether the person understood, in a general way, what they own, who their family is, and what the document does.

Schedule signings at the person's clearest time of day, ask the doctor to document an exam close to the signing date, and let the lawyer meet with the person alone. A relative who benefits and arranges everything can invite later claims of undue influence.

If your parent signed a health care surrogate designation, the surrogate's authority usually begins when the attending physician finds and records in the chart that your parent can no longer make health care decisions (s. 765.204).

Without a surrogate, Florida sets a priority list for medical decisions, starting with a guardian, a spouse and then a majority of available adult children (s. 765.401).

There is no such list for money. Without a durable power of attorney or a revocable trust, nobody can manage your parent's accounts, sell the house or sign a Medicaid trust, and the family usually has to ask a court to appoint a guardian (s. 744.331). That is public, slower and costlier than signing a power of attorney now. If the family disagrees about who should be in charge, When siblings disagree can help.

Medicare doesn't pay for long-term custodial care (help with bathing, dressing and supervision) at home, in assisted living or in a nursing home (Medicare.gov). It may cover a short skilled nursing stay after a hospital stay, and hospice.

A diagnosis alone doesn't take away a Florida license. Watch for getting lost on familiar routes, new dents, missed signals and passengers who no longer feel safe. Start with the doctor, who may recommend a driving evaluation. If your parent keeps driving when it isn't safe, any person, including a family member, may report a driver's medical condition in writing to the Department of Highway Safety and Motor Vehicles. The report is confidential, and the person reporting is protected from lawsuits (s. 322.126; FLHSMV).

More: Taking the car keys: a family guide

If there are firearms in the home, talk about a safety plan early, while your parent can take part. Some families agree that a trusted relative will store them.

Under Florida's risk protection order law, a court can temporarily bar a person who poses a significant danger to themselves or others from having firearms. Only a law enforcement officer or agency can file the petition, not a family member. Families who are worried can call local law enforcement, who may consider information from relatives (s. 790.401). In an emergency, call 911.

Many people with dementia wander. Keep a recent photo handy, consider an ID bracelet or GPS device, and tell neighbors.

If your parent goes missing, call local police or the sheriff right away. Florida's Silver Alert helps find missing people with Alzheimer's disease or dementia, especially when they are driving. Only law enforcement can request one, so call them first. The FDLE missing persons line is 1-888-356-4774 (FDLE).

Dementia often affects money skills early. Watch for unpaid bills, new "friends", unusual withdrawals, gift card purchases and calls about prizes or a grandchild in trouble.

Set up account alerts, add a trusted contact at the bank and limit credit cards. Taking an older person's money by deception, or misusing authority as an agent or guardian, can be the crime of exploitation (s. 825.103). Report suspected exploitation to the Florida Abuse Hotline at 1-800-962-2873 (DCF).

Caregivers who never get a break often get sick themselves. Asking for help is part of the plan.

In Palm Beach, Martin and St. Lucie counties, Alzheimer's Community Care offers dementia-specific adult day centers and Family Navigators for caregivers at home. Its main number is (561) 683-2700. Florida funds memory disorder clinics, including at St. Mary's Medical Center and Florida Atlantic University (s. 430.502), and your Area Agency on Aging can explain respite programs (Florida Department of Elder Affairs). A family member giving up work to provide care should read Getting paid to care for a parent.