Those of us in the financial planning space need to be acutely aware of the growing prevalence of dementia in our aging society. Approximately 7 million Americans currently have Alzheimer’s disease, with that figure projected to almost double by 2050, according to the Alzheimer’s Association. On a global level, Alzheimer’s Disease International provides even more sobering statistics that underscore the scale of this illness and its impact on families across the world.
This column will probably be the most difficult one I’ll ever write as I’m in one of those families. In April of this year, my mom, Beverly, passed away after suffering for more than 15 years with dementia. I share this with you in hope that it gives you some perspective while working with clients diagnosed with dementia or whose family members are developing this condition.
Ironically, Mom was trained as a geriatrics nurse, spent decades working for different nursing homes as we moved from place to place, and always joked, “When I get old, just stick me in a rocking chair on a porch by the ocean.” Never would she ever allow the idea of a nursing home being mooted—ever.
As a medical professional, she was well aware of the stages of dementia, and because of that, she was an expert at hiding it from my father, my sister, and myself. But after my dad passed away, it became more difficult for her to hide it—even her neighbors reported on our mom’s agitated behavior. We eventually hired home health care assistance, hoping the extra help would solve at least some of the problems of caring for her.
Of course, it all came to a head one year later when my sister visited my mom, and the house smelled of burnt plastic. Mom was cooking her wallet. She hid her wallet in the stove and turned it on (she couldn’t cook at this point), and after a few hours, the wallet caught fire. We got lucky.
Certified public accountants (CPAs) should be aware of this stage of Alzheimer’s or another dementia. They can direct family members to sites like Alzheimers.gov, a government-sponsored website that answers basic questions and offers a foundational perspective on what’s ahead and how to start planning.
At some point, many families will need to sit down and say, “Mom, we can’t manage this anymore, you’re endangering yourself, and we need to move you somewhere safer.” It’ll probably be one of the most difficult things for families to ever do. Speaking from experience, it’s best to lead with empathy and support during these conversations—just be there for them.
Each milestone with the disease is met with a lot of work, stress, and uncertainty. There’s no set timeline, and the disease’s condition advances when it damn well feels like it. Dementia only advances, it doesn’t regress.
Over the years leading up to my mom’s decline, we were fortunate to get a durable power of attorney for health care, a durable financial power of attorney, and a physician’s order for lifesustaining treatment. It was a fight, but they were completed and signed. We weren’t able to get an advance directive completed, but at least we got the fundamental documents. (My mom, as you can likely guess, was pretty stubborn.)
If you encounter clients who are more willing to face this condition and plan ahead for the inevitable challenges they’ll face, I recommend you take a look at the Dartmouth Dementia Directive. It’s an excellent resource for family members or other caregivers to learn more about the condition, stages of progression, and options available for care. The directive also goes into further detail regarding the type of care the signer may want to receive. There are rubrics to complete regarding medical interventions, location of care, and nutrition and hydration. There’s also the option to volunteer for different types of dementia research.
If the patient is amenable and willing to go through this exercise, I think it can bring great comfort to both the family and the patient in knowing that their wishes are fully understood.
Another difficult milestone for families facing dementia is when a relative doesn’t know who you are. In those moments, I suggest just having a conversation and letting them talk. Don’t challenge them and try to have them remember something—being present is enough. It’s important to keep in mind that experiencing good moments with your loved ones is still possible through this disease.
Our family went through this phase: When my wife, Amy, and I once visited, my mom kept commenting on a piece of clothing that Amy was wearing, repeating the comment every six minutes. So, it was a great visit for Amy because she received 10 compliments in an hour—that was a win.
Mom ultimately spent 10 years in assisted living, and in the last year, she declined physically to a point that she had to go to a skilled nursing facility. Thankfully, she had the financial resources to fund her care, but regardless, the financial burden was extreme.
For instance, part-time, in-home care (what we started with), starts at $3,500 per month, while $30,000 per month is the starting point for full-time in-home care. Memory care and skilled nursing facilities can start at $6,500 per month. The search for a proper fit can also be difficult, as there are a lot of options in a wide spectrum of prices.
Helping clients determine how to fund their long-term health care needs, especially in cases like dementia, is where CPAs can truly add value. In fact, CPAs should be having conversations about long-term care options with clients long before they’ll actually need it.
These are the three main options available to your clients:
There are pros and cons with each of these options, but CPAs can offer meaningful guidance by helping clients understand the potential costs, likely extended duration of care, and burdens it places on the rest of the family.
Finally, there comes the stage when the patient is unable to feed or hydrate themselves. This final stage can be, like all other stages of dementia, slow and uncomfortable to watch. But if proper plans have been made, there’s a certain comfort in knowing this cherished human’s care and well-being was the bottom-line focus through the experience.
My mom died at 3:30 a.m. on April 8, 2026. My wife, who’s an endof- life doula, reminded me that transitions like this can also be a release. In truth, I did feel a great sense of relief that my mom had been released from her debilitating condition.
As the earlier statistics claim, dementia isn’t going away. A good advisor will educate themselves on this slow-motion tragedy and find as many resources as possible to help families cope, find the best care solutions, and make the financial plans that work for them.
Rest in peace, Beverly Ann Kearns, RN.
