Planning for the Future
We have developed this section to help you in planning for today and in the future – we try to answer questions like:
- What does power of attorney mean? What are the different types?
- What steps do I need to think about for financial planning?
- How do I make sure my loved ones know what I want for my personal care?
- What kind of government programs exist to help us?
- How can advanced care planning ensure my wishes are known and respected as my symptoms progress?
- What can families do if their loved one’s dementia has progressed, and this planning hasn’t been done?
These are difficult things to think about, but it is important to begin these discussions with your loved ones early in the process, to make sure that the right planning is in place for you and your family. When families do not do this advance planning, and the person’s dementia has progressed to the point where they can no longer appoint someone to make financial or legal decisions on their behalf, caregivers often have to go through lengthy, expensive processes to manage finances and property. As well, families can struggle to know exactly what their loved one’s wishes are for their personal care.
Progressive dementias, like Alzheimer’s disease, ultimately interfere with decision making abilities involved in all aspects of life, including financial management and health care decisions. Because each person’s personal financial situation is different, the level of assistance needed can vary (i.e. no longer doing one’s taxes alone, forgetting to pay rare bills such as city taxes to regular bills such as rent on time). As dementia affects the ability to reason and make decisions, the person with dementia will need increasing assistance to manage their finances and personal health care decisions.
- Consider appointing someone you trust as your power of attorney for property and for personal care as soon as possible while you are still capable of doing so. The legal planning section explains power of attorney and the different types.
- Put together copies of all your important documents, and let your POA know where they are stored:
- Social Insurance Number
- Health Card
- Driver’s License
- Bank account numbers and locations
- Investment information
- Income sources
- Household bills and expenses
- Income tax returns
- Insurance policies
- Extended health policies
- Proof of citizenship
- Marriage, divorce papers
- Pre-planned funeral arrangements
- Powers of attorney, will
- Review and communicate advance care wishes
- Set up a banking power of attorney. If accounts and investments are jointly shared, the person living with dementia can continue to operate them without any change in arrangement but may need increasing supervision to monitor transactions. With a banking power of attorney (which has fewer rights and responsibilities than a Power of Attorney for Property), you can ensure that you have the authorization by the bank to administer the person’s accounts when it is needed. This is often the most practical step for ensuring the person’s accounts are managed soundly. You can work with the bank to set withdrawal limits, limit/monitor/cancel checks and other non-invasive strategies.
- Managing daily expenses, use direct deposit and direct payment arrangements for recurring bills to assist the person to remain independent.
- Simplifying daily transactions: Credit cards, debit cards and chequebooks are multi-step sequencing tools and are challenging for people who live with dementia and the risk factors are high around theft and fraud.
- Remove credit cards (or lower credit limits).
- Try switching out credit cards with prepaid ones in small amounts.
- Replace credit and debit cards requiring PIN numbers with some cash for simple transactions (losing $50 might be better than giving one’s PIN to a stranger at the cash).
- Manage the chequebook by watching for unrecorded or duplicate cheques.
- It may be necessary at one point to remove chequebooks, credit or debit cards or simply cancelling cheques, credit or debit cards rather than confront the person with dementia.
Putting financial and legal plans in place now allows the person living with dementia to express wishes for future care and future finance decisions to be made. The Alzheimer Societies in Champlain have put together a resource document to help you.
A Power of Attorney is a legal document that gives someone else the right to act on your behalf. There are three kinds of Power of Attorney in Ontario:
- A Continuing Power of Attorney for Property (CPOA) covers your financial affairs and allows the person you name to act for you even if you become mentally incapable. As discussed earlier, there is also a banking power of attorney option which has fewer rights and responsibilities that a POA for the property.
- A non-continuing Power of Attorney for Property covers your financial affairs but can’t be used if you become mentally incapable. You might give this Power of Attorney, for example, if you need someone to look after your financial transactions while you’re away from home for an extended period of time.-
- A Power of Attorney for Personal Care (POAPC) covers your personal decisions, such as housing and health care.
Making a Power of Attorney is voluntary. No one can be forced to make one, however, with progressive dementias such as Alzheimer’s disease, it is very strongly recommended to have this done while the person is still capable of appointing a (or shared) Power of Attorney. The Attorney General has put together a toolkit to help people in appointing their Power of Attorney. You can also speak to the Office of the Public Guardian and Trustee at 1-800-891-0506 or you can speak to your lawyer.
The law does not require you to use a lawyer’s services. However, you may wish to consider hiring a lawyer, especially if your affairs are complicated. The local resources section contains links to finding a lawyer, as well as how to access legal aid services.
Alternatively, some bookstores sell forms and there are also some forms on the Internet.
Obtaining legal advice in creating these documents is something you should seriously consider.
Consider legally appointing ‘someone you trust’ to sign for you, to manage your finances, your assets, your property, buying or selling goods while you are still alive and capable of deciding whom you trust.
- You can determine when your POA comes into effect.
- You can choose to limit the scope of the authority to certain finances
- You can direct that the POA come in to effect only when you are deemed incapable to manage it yourself.
- You must be capable of understanding the benefits and risks when assigning a POA therefore it is very strongly recommended to do this as early as possible as dementia will progress to a point when this is no longer possible to do.
Consider legally appointing someone to make personal care decisions on your health care, medical treatment, diet, housing, clothing, hygiene and safety on your behalf while you are still alive and capable to decide whom you trust.
No one can make you sign a power of attorney if you don't want to. But, if you don't choose one, the government may have to appoint someone to make certain decisions for you. It's better if you choose someone you feel you can really trust, who knows your wishes.
- Making a Power of Attorney for Personal Care lets you choose a person you trust to be your substitute decision-maker if you become mentally incapable in the future.
- Making a Power of Attorney for Personal Care is also a way to make sure your wishes about personal care decisions will be respected. It gives you a chance to say what you want and do not want. For example, if you do not want certain medical treatments if you get seriously ill, you can state this in your Power of Attorney.
Without a valid Power of Attorney for Property (whether done with or without a lawyer, both versions are valid as long as correctly completed):
- Someone would have to go to court and ask to be appointed as your “Guardian of Property” or
- The Office of the Public Guardian and Trustee (OPGT) would be appointed as guardian, or
- The family could apply to replace the OPGT and become statutory guardian.
These processes are not common as they are very lengthy, costly and can make paying daily expenses for the person with dementia very difficult, if not impossible, for caregivers that do not have Power of Attorney or guardianship.
Without a valid Power of Attorney for Personal Care, if you become mentally incapable of making personal care decisions, someone else must make them for you. This person is called your "substitute decision-maker" (SDM). The law says your doctor and other health care providers must get your substitute decision-maker's consent before taking action. The Health Care Consent Act identifies how the SDM is chosen when there isn’t a Power of Attorney and uses the following order: guardian, power of attorney, representative appointee by the Consent and Capacity Board, spouse, partner, child over 16 years, parent, sibling, any other relative, then the OPGT.
The law explicitly sets out the order of who your SDM will be, if you haven’t identified who you want this person to be under a Power of Attorney for Personal Care.
A Last Will and Testament covers the distribution of your property after you die and only takes effect upon your death. A Power of Attorney and a “living will” only apply while you are alive and cease to be effective upon your death. The Ontario government does not provide a “Will Kit” or similar forms as there are many diverse situations that people may want to reflect in their Wills.
Advance Care Planning:
Identifying who your Power of Attorney for Personal Care is only one part of planning for the future. Advance Care Plans (also known as a “living will”) give you a way to set out, in detail, your treatment and personal care wishes, what’s important to you as your symptoms progress, and does not need to name anyone or be written in any specific way. Should you become incapable, your substitute decision-maker will be able to confidently use the
preferences that you have communicated to make decisions that respect your wishes.
In Ontario, there is a helpful website that includes information about how to prepare an advance care plan and a template you can use to make up your own plan. You can also call the Seniors’ Secretariat (Government of Ontario) to get more information at 1.888.910.1999
Government Assistance Programs
It is important to maximize your income and benefits to assist you to make health care considerations for the person who is living with dementia. It is best if you consult with community professionals such as lawyers and financial consultants to help you plan for your benefits.
- Income Security Programs:
Old Age Security (OAS) pension is based on age, legal status and years of residence in Canada after age 18.
Guaranteed Income Supplement (GIS) provides a monthly non-taxable benefit to low income old Age Security (OAS) recipients living in Canada
Canada pension Plan (CPP): is an employment based contributory pension plan. Individuals may choose to receive this pension (at a reduced amount) starting at age 60-64. You must apply in writing 6 months prior to receiving the benefits.
Guaranteed Annual Income Supplement (GAINS): is provided by the Ontario Ministry of Finance to eligible low-income seniors who receive OAS and GIS. No application is required, you will automatically be assessed for eligibility if you are receiving OAS and GIS.
Ontario Disability Support Program
If you are younger than 65 years and are diagnosed with dementia, you can apply to the Ontario Disability Support Program for financial assistance with your living expenses.
Involuntary Separation: If you are over 65 years of age and are receiving (GIS) in addition to (OAS) pension, you may qualify for this benefit if one partner is living in a long term care home. The administrator of the long term care home can complete this application request for you.
- Low-income seniors
Essential Health and Social Supports (EHSS) program: Helps Ottawa residents who cannot afford to pay for items or services needed to maintain their housing and for health items that are not available through other programs. EHSS may help to pay for things like:
- Urgent dental care and dentures
- Eye exams and glasses
- Fuel/gas/hydro arrears, deposits and reconnection fees
- Rent arrears and deposits
- Assistive Devices Program (ADP) 25% consumer contribution
- Bathroom aids
- Surgical and diabetic supplies
- Cremations and burials
Call the City of Ottawa and ask for Essential Health and Social Services: 613-560-6000
- Income Tax Benefits:
Medical Expense Deductions: It is important to keep all receipts (medicine, attendant fees, health aids, safety devices). These are deductible
Attendant care expenses/deductions: If you are paying for a person to provide care, this may be deducted.
Disability Tax Credit: This provides additional tax help. It requires a medical doctor to complete a T22201 Form.
Caregiver tax deduction –line 315
If you and the person with dementia live in the same household, you may be able to claim a caregiver amount.