Supported decision-making helps a person with Alzheimer's use trusted people and agreed supports to make and communicate their own decisions. For caregivers, the checklist starts with identifying the decision, asking what help the person wants, and recording their choice.
Do not treat a diagnosis as automatic loss of legal capacity, according to the U.S. Department of Justice's guardianship overview. This is a practical guide, not a validated Alzheimer's-specific instrument; the National Institute on Aging lists an adapted toolkit with anticipated completion in 2027 on its current studies page.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- Keep each decision in the person's hands
- Start planning conversations early
- Prepare for health-care decisions
- Separate financial and health authority
- Know when guardianship is—and is not—the next step
Keep each decision in the person's hands
supported decision-making can be informal or formal. The Justice Department describes it as a potentially less-restrictive alternative to guardianship.
The trusted person helps with understanding or communication but does not automatically become the decision-maker. Use these checks for each decision: If a helper begins answering without first inviting the person to respond, pause. Restate the question simply and ask what the person thinks or wants.
- Name one specific choice, such as accepting help at home.
- Ask whom the person wants involved.
- Ask how information should be presented.
- Separate each helper's advice from the person's preference.
- Let the person communicate by their preferred method.
Start planning conversations early
The National Institute on Aging advises caregivers to begin brief, repeated conversations early and use simple language. Discuss concerns, values, desired care, and whom the person would want making future decisions.
Useful prompts include: Write down the answers and review them in later conversations. If an answer changes, clarify the person's current wishes instead of assuming the earlier response still applies.
- What matters most to you if your health changes?
- Who helps you understand difficult information?
- Whom would you trust to speak for you?
- What care would you want—or not want?
- Which decisions do you still want to handle independently?
Prepare for health-care decisions
A health-care proxy typically speaks with clinicians only when the person cannot speak for themself. The durable health-care power of attorney should define that authority clearly, according to the National Institute on Aging's caregiver guidance.
Complete this health-care checklist: Being the main medical contact does not automatically transfer decision-making power. If the person can still express a choice about a test or treatment, support that communication before asking the proxy to decide.
- Confirm the chosen proxy is willing to serve.
- Document the person's treatment values and preferences.
- Check what authority the health-care document gives the proxy.
- Give advance-directive copies and proxy details to the care team and care setting.
- Designate one main medical contact.
Separate financial and health authority
A financial power of attorney appoints an agent to manage money or property. The Justice Department notes that its authorized actions can be tailored and that it is distinct from a health-care power of attorney.
Review these points before signing: A power of attorney does not allow an agent to override someone who retains legal capacity. Because signing requirements differ by document and jurisdiction, the Alzheimer's Association recommends consulting an elder-law attorney.
- List the financial tasks the person wants the agent to handle.
- Keep financial and health-care authority separate in the documents.
- Confirm when each authority begins.
- Check whether the financial authority continues after lost decision-making ability.
- Make sure the proposed agent understands the limits of the role.
Know when guardianship is—and is not—the next step
Guardianship removes legal rights, so it should be a last resort. The Justice Department says courts generally require evidence of legal incapacity, no workable alternative arrangement, and a risk of substantial harm without intervention. Before pursuing it, ask: If these questions remain unresolved, bring the person's documents, dated preference notes, and examples of attempted supports to an elder-law attorney.
- Can the person make this decision with trusted support or technology?
- Could a health-care proxy or financial agent address the problem?
- Is there a narrower arrangement that would reduce the risk?
- Is there evidence of legal incapacity rather than diagnosis alone?
- What substantial harm could occur without court intervention?
