Planning Ahead

Preparing for the future isn’t just about paperwork. It’s about protecting dignity, autonomy, and peace of mind, especially as life becomes less predictable with age. Health changes, memory concerns, or sudden crises can make decisions feel urgent and overwhelming. Planning ahead isn’t about expecting the worst; it’s about ensuring your values, and your voice, stay at the center of your care.

When wishes are documented early and trusted decision-makers are clearly named, families have a roadmap to follow in difficult moments. Clear plans reduce stress, prevent misunderstandings, and can help avoid more complex processes, such as capacity evaluations or court involvement, when there’s uncertainty about who can make decisions or what those decisions should be.

On this page, you’ll find two coordinated roadmaps, your health care roadmap and financial/legal roadmap, as well as a practical glossary of key terms, roles, and common “big decisions,” including housing options. These pieces work best when considered together.

Building Your Health & Care Roadmap

  • Before diving into documents and logistics, take a moment to reflect on what matters most to you, now and in the future. These reflections become the foundation for every health care decision that follows. Your values also help guide others if you’re ever unable to speak for yourself and can make later choices about treatments, care settings, and support feel clearer and more aligned, even during stressful moments.

    Below are a few prompts to help you get organized. You may find it helpful to write down your thoughts and talk them through with family members, trusted friends, or members of your health care team.

    • What does “quality of life” mean to you?

    • What brings meaning, comfort, or dignity to your life right now?

    • How do you balance independence, comfort, longevity, and minimizing burden on others?

    • Are there outcomes you would find unacceptable, even if they prolonged life?

    • Who do you trust to make medical decisions on your behalf if needed?

    • How much flexibility do you want that person to have if circumstances change?

    • Do you prefer decisions to follow your wishes exactly, or be adapted based on the situation?

    • Who else should be included in conversations with your medical team?

    • Do you have current medical, neurological, or cognitive conditions that may affect future decisions?

    • How would you want decisions handled if you could participate partially, but not fully?

    • Are there specific treatments or interventions you would want to receive—or avoid?

    • Where would you prefer to receive care if possible (home, hospital, facility)?

    • Are there cultural, spiritual, or religious beliefs that should guide your care?

1 - CLARIFY WHAT MATTERS

  • No health care plan works in isolation. Even the clearest values and documents rely on real people to carry them out. This step focuses on identifying the individuals who will speak for you, advocate for you, and help navigate medical decisions if you’re unable to do so yourself.

    These are the people who know you best and can step in if you’re unable to make medical decisions yourself.

    • Health Care Proxy / Medical Power of Attorney: The person legally authorized to make medical decisions on your behalf

    • Backup decision-makers: One or more trusted individuals if your primary decision-maker is unavailable

    • Trusted family members or friends: People you want informed, consulted, or included in discussions

    • Emergency contacts: Individuals to be reached quickly in urgent situations

  • These professionals provide medical care, monitor changes over time, and support day-to-day functioning and safety.

    PHYSICIANS & PRESCRIBING PROVIDERS

    • Primary Care Provider (PCP): Often the central coordinator of your overall medical care

    • Neurologist: Evaluates and manages conditions affecting the brain and nervous system

    • Cardiologist: Manages heart health and cardiovascular conditions

    • Psychiatrist: Addresses mood, behavioral, and psychiatric conditions and medication management

    • Neuropsychologist / Cognitive Specialist: Assesses cognition, decision-making capacity, and functional changes over time

    HOME-BASED & REHABILITATIVE CARE

    • Home health services‍ (nursing, aides): Provide medical and personal care support in the home

    • Therapy services (physical, occupational, speech): Support mobility, daily functioning, communication, and safety

  • These individuals help bridge gaps between providers, systems, and family members, especially when care becomes more complex.

    • Geriatric care managers: Coordinate care plans, services, and transitions across settings

    • Medical social workers: Provide psychosocial support, resource navigation, and system guidance

    • Care coordinators or case managers: Help align recommendations and communication across providers

    • Family members or trusted advocates: Assist with communication, scheduling, and follow-through across teams

    • Professional liaisons (when applicable): Bridge medical, legal, financial, and caregiving systems

2 - BUILD YOUR HEALTH CARE DECISION-MAKING TEAM

3 - YOUR HEALTH CARE PLANNING DOCUMENTS

The following health care documents form the foundation of an effective health care plan. Each serves a distinct purpose—naming decision-makers, outlining preferences, and guiding care in real-time medical situations. Together, they help your health care team act with clarity and confidence.

  • ‘Advance Directive’ is an umbrella term for medical planning documents, which includes the Living will and Durable Power of Attorney for Health Care, both of which are described separately

    They are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes due to disease or severe injury.

    Advance directives do not address financial decisions, property or asset management, legal matters or post-death wishes, which fall under financial powers of attorney, wills, and trusts, not advance directives.

  • A Living Will is a written legal document that tells doctors and caregivers what kinds of medical care you want if you can no longer make or communicate decisions for yourself. It is part of your advance health care planning and helps ensure your treatment preferences for comfort, life-sustaining care, and quality of life are known and honored during serious or unexpected medical situations, including advanced illness, serious injury, Alzheimer’s disease and other dementias, or other conditions that impair decision-making capacity.

    A living will helps ensure that your preferences for treatment, comfort, and quality of life are known and respected. It provides clarity and direction at times when you can no longer speak for yourself, easing the emotional burden on family members and helping clinicians act with confidence and consistency. Through this documentation, you can specify which medical treatments you would or would not want, and under what circumstances those choices should apply.

    Common areas addressed in a living will include:

    • Life-Sustaining Treatments: Directives on whether to use ventilators, artificial nutrition and hydration, dialysis or other life-prolonging interventions.

    • Resuscitation Preferences: Documentation of your wishes for use of CPR if your heart stops. Note that this is not a medical order and additional documentation, such as DNR, POLST, or MOLST would be required to ensure compliance by medical staff during emergencies. See Additional Medical Documentation below for more information about these documents.

    • Comfort Care: Your wishes about palliative or hospice care to manage pain and symptoms.

    • Specific Conditions: The situations under which your instructions should apply, such as terminal illness or permanent unconsciousness.

    • Organ Donation: Whether you wish to donate your organs or tissues.

    What a Living Will Is Not

    A living will is not a ‘last will and testament’ (which governs property, finances, guardianship of minors, or funeral arrangements). It also does not by itself create standing medical orders like a DNR; those normally require a physician’s signature on a specific form.

  • This document can also be called: Health Care Proxy / Medical POA / Advance Health Care Directive

    This is a legal document that names your health care proxy (the person who can make health care decisions for you if you are unable to communicate these yourself).

    Some people are reluctant to put specific health decisions in writing and it can be difficult to anticipate future treatment decisions. For these reasons, naming a health care proxy is often a good approach, especially if there is someone you feel comfortable talking with about your values and preferences.

    Names the person you trust to make medical decisions if you are unable to speak for yourself. This will be your primary decision-maker (although, ideally you will also include a backup).

  • Some end-of-life and emergency treatment decisions require formal medical orders, not just written preferences. These orders are tell providers what to do in an emergency, especially regarding: cardiopulmonary resuscitation (CPR), intubation and mechanical ventilation, and other life-sustaining treatments

    They are different from a living will and are typically required for emergency responders to follow your wishes.

    DNR / DNI Orders
    A DNR (Do Not Resuscitate) or DNI (Do Not Intubate) order is an order stating that CPR and/or intubation should not be performed if your heart or breathing stops. It requires a doctor’s signature and becomes part of your medical record. It is often used in out-of-hospital settings, such as at home or in assisted living.

    NOTE: DNR/DNIs apply ONLY to CPR and/or intubation. This is not a “do not treat” order, other medical care can still be provided.

    POLST / MOLST Forms
    POLST (Physician Orders for Life-Sustaining Treatment) and MOLST (Medical Orders for Life-Sustaining Treatment) go beyond CPR alone and outline more detailed treatment preferences. These forms are medical orders, completed with a clinician and are generally intended for people with serious illness, advanced frailty, or complex medical needs. They travel with you across care settings (home, hospital, skilled nursing, hospice). These are meant to translate your wishes into clear, actionable instructions for medical teams.

    Coming soon: more information about CPR

  • Allows your chosen individuals to receive medical information. Without this form, even loved ones may have difficulty getting updates or speaking with your clinicians. Many institutions have their own HIPAA Release Forms but you may consider completing a universal one to keep with your documents

  • Financial and legal planning is most effective when information is organized, accessible, and shared with the right people. Even well-drafted documents can fall short if no one knows where to find them or how to act on them when needed.

    This step focuses on making your plan practical—so it can be used confidently during real-life situations, transitions, or emergencies.

  • Conversations matter just as much as paperwork. Talking through scenarios helps your decision-makers understand how to apply your values if circumstances change.

    • Hospitalization or sudden illness

    • Changes in memory, judgment, or decision-making capacity

    • Short-term vs long-term care needs

    • When to prioritize comfort, function, or longevity

    • What “quality of life” means to you in different situations

    These conversations can evolve over time and don’t need to happen all at once.

    • Make sure key people know where documents are stored (physical and digital)

    • Share summaries with those who may need quick access

    • Review and update information periodically, especially after health changes, moves, or major life events

4 - MAKE YOUR PLAN CLEAR, ACCESSIBLE & USABLE

Review and Update

Health care planning is an ongoing process, not a one-time task. As your health, relationships, or circumstances change, it’s important to revisit your plan to be sure it still reflects your wishes and that the right people are prepared to support you. A brief check-in—often once a year, or after a significant health or life change (such as a new medical diagnosis, cognitive changes, hospitalization, marriage, divorce, births, deaths, or a move)—can help ensure your decision-makers are still accurate, your documents are up to date, and key information is easy to find.

You don’t need to start from scratch each time. Even small updates, such as confirming who is serving in key roles, refreshing your health care one-pager, or revisiting conversations about preferences, can make a meaningful difference. Keeping your plan current helps your care team act with clarity and confidence if decisions need to be made.

Building Your Financial & Legal Roadmap

Many people assume this planning is only about end-of-life or wealth transfer. In reality, it’s about continuity, protection, and reducing stress during periods of illness, cognitive change, or transition. When roles and authority are clearly defined, families can focus on care and support rather than navigating uncertainty or court involvement.

This roadmap provides a practical framework to help you understand the key decisions, documents, and players involved. While working with trusted professionals, such as estate-planning or elder law attorneys, fiduciaries, financial advisors, and accountants, is often essential, this overview helps you approach those conversations informed and prepared.

1 - CLARIFY YOUR FINANCIAL PRIORITIES & VALUES

  • Before reviewing documents or account details, it’s helpful to reflect on what matters most to you financially and legally. These priorities shape how resources are managed, protected, and distributed—especially if you’re unable to oversee them yourself.

    • What does financial security mean to you at this stage of life?

    • What expenses or supports are most important to protect?

    • Are there specific people or causes you want to prioritize?

    • How do you balance independence, generosity, and long-term sustainability?

    • How would you want bills, banking, and accounts handled if you’re unable to manage them yourself—and who do you trust to take on that role if needed?

      Consider whether you prefer a family member, a professional fiduciary, or a shared/co-management arrangement, as well as how much authority that person should have and when it should begin.

      Would you like oversight or safeguards built in?

      Are there specific decisions you would want handled differently under certain circumstances?

    • How should finances be managed if health or cognition changes?

    • What level of support would you want for bill paying, hiring help, or managing care costs?

    • Are there protections you want in place to reduce risk of financial exploitation?

    • What you want to protect (home, savings, valuables)

2 - IDENTIFY YOUR FINANCIAL / LEGAL TEAM AND KEY PLAYERS

  • These individuals are granted legal authority to act on your behalf.

    • Durable Power of Attorney (Financial Agent): Manages finances, pays bills, and handles financial decisions if you’re unable to do so

    • Backup agents: Step in if your primary agent is unavailable or unable to serve

    • Trustee (if applicable): Manages assets held in trust according to your wishes

    • Executor (for after death): Carries out the instructions in your will

  • These professionals provide guidance, structure, and oversight.

    • Estate-planning or elder law attorney: Drafts and updates legal documents and advises on planning strategies

    • Professional fiduciary: Serves as a neutral financial decision-maker or co-agent when appropriate

    • Financial advisor: Helps manage investments and long-term financial planning

    • CPA or tax professional: Addresses tax planning, compliance, and reporting

  • These individuals help ensure information is shared and decisions are implemented smoothly.

    • Family members or trusted advocates: Assist with communication and coordination

3 - FINANCIAL & LEGAL PLANNING DOCUMENTS

  • A Last Will and Testament is a written legal document that directs how your property and assets are distributed after death. It also allows you to name an executor, the person responsible for carrying out your wishes, and, when relevant, to name guardians for minor children.

    A will helps ensure your intentions are clearly documented and legally recognized, reducing confusion and conflict for loved ones during an already difficult time. Without a valid will, state law determines how assets are distributed, which may not reflect your wishes.

    What a Will Commonly Addresses

    • Distribution of assets and personal property

    • Naming an executor

    • Guardianship of minor children (if applicable)

    • Instructions for settling your estate

    What a Will Is Not
    A last will and testament should not be confused with a ‘living will,’ an advance directive that governs health care decisions and takes effect during your lifetime.

  • This is the legal document that formally gives authority to the financial decision-maker you identified earlier in your planning. It can allow your agent to pay bills, manage accounts, sign documents, and handle financial transactions during periods of illness, cognitive change, or incapacity.

    Some people choose to make this authority effective immediately; others prefer it to begin only under specific circumstances. These choices can be tailored with the guidance of a qualified professional.

    Common Areas Covered

    • Banking and bill payment

    • Managing investments or accounts

    • Handling insurance matters

    • Signing contracts or legal documents

    • Managing property or business interests (if applicable)

    Why This Document Matters
    Without a durable power of attorney, loved ones may need to pursue court involvement to manage finances, even if everyone agrees on what should be done.

  • A trust is a legal arrangement documented through trust agreements that allows assets to be held and managed by a trustee according to your instructions. Trusts are often used to provide ongoing management, avoid probate, or plan for incapacity or long-term care needs.

    Trust documents specify how assets should be managed during your lifetime, how they should be distributed, and who is responsible for overseeing the process.

    Trusts May Be Used To

    • Provide continuity if you become unable to manage assets

    • Avoid or streamline probate

    • Support long-term care or special needs planning

    • Manage assets for beneficiaries over time

    What a Trust Is Not
    A trust does not replace a durable power of attorney or health care documents. It is one component of a broader financial and legal plan.

  • Apply to retirement accounts, pensions, insurance policies, and banking products.

    These override wills so keeping them updated is essential.

  • In addition to core legal documents, having key financial and ownership records organized helps ensure assets are managed smoothly and according to your intentions. These records provide clarity, reduce delays, and support the individuals and professionals responsible for carrying out your plan.

    This category does not grant decision-making authority, but it plays a critical role in implementation.

    What This Includes

    • Beneficiary Designations: Documentation naming who receives assets such as retirement accounts, life insurance policies, and payable-on-death accounts. These designations often override a will, making it important to keep them current and aligned with your broader plan.

    • Property & Ownership Records: Deeds, titles, and related documents that establish legal ownership of real estate or other significant assets. Clear records help prevent disputes and simplify transfers.

    • Insurance Policies: Active policies and coverage information (health, life, long-term care, property, etc.), which may be needed quickly during illness, transitions, or after death.

    • Account Summaries & Access Information: Organized records of financial accounts, along with instructions for access when appropriate. This may include banking, investment, and digital assets, as well as guidance on passwords or account management tools.

    When these records are easy to find and up to date, your plan is easier to carry out—and less stressful for those supporting you.

4 - ORGANIZE, COMMUNICATE & MAKE IT USABLE

  • Financial and legal planning is most effective when information is organized, accessible, and shared with the right people. Even well-drafted documents can fall short if no one knows where to find them or how to act on them when needed.

    This step focuses on making your plan practical—so it can be used confidently during real-life situations, transitions, or emergencies.

    A concise summary that gives decision-makers and professionals quick access to essential information.

    • Key financial decision-makers and professional contacts

    • List of core legal documents and where they are stored

    • Bank and investment institutions

    • Insurance coverage

    • Important account or reference numbers (as appropriate)

  • Conversations help ensure your values guide decisions when circumstances change.

    • Managing bills or accounts during illness or hospitalization

    • Paying for care or home support

    • Housing transitions or property decisions

    • When to involve professional support

    • Safeguards against financial exploitation or misuse

    • Make sure the right people know where documents are stored (physical and digital)

    • Share summaries with those who may need timely access

    • Revisit information periodically, especially after financial, legal, or life changes

Review and Update Over Time

Financial and legal planning is not a one-time task. Periodic check-ins, often annually or after a major life change, help ensure your wishes are still reflected and the right people and documents are in place. Updates do not need to be extensive; even small reviews, such as confirming decision-makers, beneficiaries, or document locations, can prevent gaps and reduce stress for loved ones.

Terms & Definitions
Understanding Care Roles & Living Options

This section houses definitions and glossaries that explain the roles of professionals, organizations, and care options commonly involved in aging, future planning, and care coordination. It is designed to help you understand who does what, clarify common terms, and make informed decisions as needs change. State-specific referral directories are housed separately and offer curated listings by location

Our state-specific referral directories are housed separately and offer curated listings by location. Click HERE to find your local hub.

Planning & Care Providers: Who’s Who and How They Help

These are the professionals who support future planning and care coordination. These definitions should help you understand who does what so you can make informed decisions and know when additional support may be helpful. Go to your local hub to connect with professionals in your community.

Geriatric Care Managers: Professionals who help older adults and families coordinate medical care, navigate services, assess safety, and plan for changing needs. They act as guides and advocates, offering support with appointments, care transitions, and long-term planning.

Fiduciary & Financial Specialists: Licensed professionals who help manage finances, bills, benefits, and financial safety for older adults. They can assist with budgeting, organizing documents, preventing exploitation, and making sure financial affairs stay secure and transparent.

Real Estate & Senior Transition Specialists: Real estate professionals trained to support older adults through home sales, downsizing, relocations, or exploring housing options. Some also provide guidance on aging-in-place modifications or reverse mortgages, helping families make informed housing decisions.

Care Navigation & Support Programs: Organizations that help families understand available services, coordinate resources, and plan next steps related to health, safety, and long-term care. These programs offer education and practical guidance during transitions or increasing care needs.

Benefits & Long-Term Care Advisors: Professionals who help individuals understand Medicare, Medi-Cal, long-term care insurance, elder benefits, and available financial supports. They guide families through complex systems to reduce confusion and ensure access to needed services.

Medicare, Medicaid (Title 19) & Long-Term Care Advisors: Experts who help individuals understand Medicare coverage, Connecticut or NY Medicaid/Title 19 eligibility, long-term care insurance, pooled trusts, spend-down planning, long-term care insurance, and available financial supports.

Care Navigation & Aging Support Programs (NY): Programs offered through community organizations, senior centers, JCCs, NORCs (Naturally Occurring Retirement Communities), and Area Agencies on Aging that help older adults understand services, connect with benefits, and plan next steps.

Elder Law & Estate Planning Attorneys: Specialists in legal issues related to aging, including estate planning, wills, trusts, advance directives, capacity, conservatorship, and long-term care planning. They help protect rights, assets, and decision-making during later life and cognitive change.

Residential Living Options: Definitions & Care Levels

This section provides descriptions of common residential living options for older adults, ranging from in-home and community-based supports to settings that offer increasing levels of care. Understanding how these options differ can help individuals and families plan proactively and make informed decisions as needs change.

Whether the priority is independence, daily support, or specialized memory care, this overview is designed to clarify what each option offers and when it may be appropriate, without assuming any single path.

Community-Based Living

Many older adults prefer to remain at home, and community-based supports can make that possible. As needs change with age, additional services, such as in-home care, adult day programs, or companion support, can be added to maintain safety, connection, and comfort in familiar surroundings.

Independent Living Communities

Ideal for active older adults who want a maintenance-free lifestyle with built-in social opportunities. Residents are generally independent, with or without early memory changes, and can enjoy the convenience and community these settings provide, such as dining, social activities, and housekeeping.

New York also offers Enhanced Assisted Living and Special Needs Assisted Living for residents with greater physical or cognitive needs, though not as intensive as memory care environments.

Assisted Living Facilities

A good fit for adults who need daily support but still value independence. Provides housing and daily support (bathing, dressing, medication management) along with meals, activities, and social engagement. Some communities can support those with dementia, offering 24/7 staff, personal care, structure, and meaningful social engagement.

Continuing Care Retirement Communities (CCRCs)

CCRCs offer several levels of care on one campus, from independent living to assisted living, memory care, and skilled nursing. They provide continuity and peace of mind as residents’ needs change over time.

Memory Care Communities

Specialized residential settings designed for those with Alzheimer’s or other dementias, offering secure settings and trained staff that support memory, safety, and emotional well-being. These communities are designed for individuals who need consistent supervision and personalized daily support.

Nursing Homes / Skilled Nursing Facilities

Designed for individuals who need round-the-clock medical care, rehabilitation services, or support for advanced dementia. These settings offer the highest level of supervision and hands-on assistance for complex health needs.

Connect & Next Steps

We’re continually growing our elder-care network to make support more accessible, coordinated, and person-centered. If you’d like help finding the right provider or program, or if you’re a professional hoping to collaborate, I’d be delighted to connect.

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