By Ronald Fatoullah, Esq., CELA
Introduction
As parents grow older, adult children often find themselves helping with bills, doctor’s appointments, and plans for future care. What many families don’t realize is that these responsibilities become much more difficult when important legal documents are missing, outdated, or inconsistent with a parent’s wishes.
A sudden hospitalization, a diagnosis of dementia, or the need for long-term care can force families to confront difficult decisions under tremendous pressure. Without proper planning, even a devoted son or daughter may not have the legal authority to assist when needed.
The goal of advance planning is to help parents express their own wishes, make informed decisions, and choose the individuals they trust to act on their behalf if the need arises. Adult children can play an important supporting role by helping to locate documents, facilitating conversations, and arranging professional legal guidance when requested.
1. Start with an Honest Conversation
Begin by inviting your parents to discuss their wishes and concerns about the future. The conversation should be guided by what matters to them, not by what you or other family members believe they should do.
Questions might include:
- Where would you prefer to live if you could no longer safely remain at home?
- Who would you trust to handle financial and health care decisions if you became unable to make them yourself?
- What are your wishes regarding life-sustaining medical treatment?
- Have you considered how you would pay for chronic long-term care?
These conversations can be difficult, but having them while your parents can comfortably and clearly express their wishes may help avoid confusion and unnecessary family stress later.
The objective is to support your parents’ independence and help ensure that future decisions reflect their wishes and preferences.
2. Locate Existing Legal Documents
With your parents’ consent, help locate any existing legal documents and encourage them to review all of their documents.
Look for:
- Elder Care/Estate Planning Power of Attorney
- Health Care Proxy
- Living Will or other Advance Directives
- Last Will and Testament
- Revocable and Irrevocable Trusts
- Real estate deeds
- Cooperative Apartment Documentation
- Insurance information and other important ownership records
Help your parents identify where the original documents are stored and, if they consent, arrange for an elder law attorney to review them and explain whether any changes may be appropriate.
3. Make Sure an Estate Planning Power of Attorney Is in Place
The power of attorney allows parents to appoint someone else, an agent(s), to handle specified financial and legal matters on their behalf. Depending on the authority granted, the appointed agent may be able to pay bills, manage bank and investment accounts, handle certain property transactions, make gifts, effectuate Medicaid and long-term care planning, and even effectuate an estate tax elimination strategy, if needed.
What to consider: Your parents may wish to consult an attorney about whether a power of attorney is appropriate, whom to appoint, and what authority to grant. The document should reflect your parents’ own decisions and be properly executed while they have the necessary legal capacity. For most cohesive families, a broad power of attorney drafted by an elder law professional is key. Without an effective broad power of attorney, family members may need to seek a court-appointed guardianship to obtain authority to manage certain financial affairs and to perform needed Medicaid, long-term care and estate planning.
4. Put Medical Decision-Making Documents in Place
Parents may wish to consider several documents to communicate their medical preferences and identify individuals they trust to make their health care decisions if they can no longer do so.
Health Care Proxy: Allows parents to appoint someone else to make medical decisions when the parents can no longer make them.
Living Will: Communicates the parents’ wishes regarding life-sustaining treatment and other health care and end-of-life decisions.
5. Review the Will and Consider Whether Living Trusts Are Appropriate
A Last Will & Testament (Will) directs how property covered by the Will should be distributed after death. The Will does not authorize anyone to manage their parents’ finances or to make medical decisions during their lifetime.
Parents should review their Wills every 5 years and after major life changes and consider whether the Will continues to reflect their wishes.
A Revocable Living Trust can help manage your parents’ assets during their lifetimes and will allow properly funded assets to pass outside probate. But beware, a Revocable Living Trust will not protect assets from long-term care costs or Medicaid.
An Irrevocable Trust, such as a Medicaid Asset Protection Trust, when properly designed and implemented, may help protect assets as part of long-term care and Medicaid plan. An Irrevocable Trust may also play a role in reducing or even eliminating federal and New York State estate taxes.
Whether a trust is appropriate depends on your parents’ goals, financial circumstances, and desire to retain access to and control over assets. The elder law attorney will explain the available options so your parents can make informed decisions.
6. Review of Beneficiary Designations and How Assets Are Owned
With your parents’ permission, help them identify beneficiary designations on all accounts, such as retirement accounts, life insurance policies, brokerage accounts, bank accounts and any accounts with Payable-on-Death or Transfer-on-Death designations. Beneficiary designations will take precedence over the terms in a Will.
Your parents should review these designations to ensure that they remain consistent with their intentions. An attorney or financial professional can explain the consequences of any proposed changes, including potential effects on inheritance, taxes, and Medicaid eligibility.
7. Determine Whether Estate Tax Planning Is Necessary
If your parents’ estate is at or near the New York State estate tax exemption, $7.35 Million for 2026, professional estate tax planning will be important.
New York has an estate tax “cliff” that can result in significantly greater tax liability when an estate exceeds the exemption threshold. The value of an estate includes real estate, investments, retirement assets, life insurance, artwork, and other property.
The federal exemption, which is a unified gift and estate tax exemption, went up in January 2026 to $15 Million.
Your parents may wish to consult an estate planning or elder law attorney to understand potential estate, gift and capital gains tax consequences and determine whether strategies involving trusts, lifetime gifts, or other arrangements fit their goals.
Any planning should be based on your parents’ informed decisions and should take into account the possible effects on their financial security, access to assets, and long-term care eligibility.
8. Organize Financial Records Before They’re Needed
With your parents’ consent, help organize a list of financial accounts, real estate, income sources, insurance policies, debts, and important financial records.
Your parents can decide which information to share and with whom. Records should be stored securely, and access should be limited to people who are authorized by your parents to receive them.
Being organized can make it easier for your parents or an authorized representative to respond to an emergency or begin a Medicaid application or an application for other benefits.
9. Don’t Wait to Explore Medicaid Planning
The cost of long-term care can consume a substantial portion of a person’s savings. The cost of nursing home care in the New York City/Long Island area can exceed $20,000 per month. Understanding potential care costs and payment options before care becomes urgent can help a parent make informed choices.
Medicaid can help pay for qualifying long-term care for individuals who meet the applicable financial and other eligibility requirements. Advance planning can preserve assets and protect a spouse’s financial security and avoid costly mistakes.
In New York, nursing home Medicaid eligibility generally provides for a 60-month look-back period for certain asset transfers (gifts). Please note that there currently is no look-back for Medicaid community-based care.
Parents who are concerned about future care costs should consult an elder law attorney well in advance. The attorney will explain available strategies, their risks and limitations, and how these strategies will affect the parent’s access to assets and future care options.
Adult children can help by facilitating the consultation with an elder law attorney and by gathering needed information at their parents’ direction. Decisions about gifts, transfers, trusts, and other planning arrangements should be made by the parents, with appropriate professional advice, while the parent has the necessary legal capacity.
10. Protect Against Financial Exploitation
Discuss practical safeguards with your parents, such as account alerts, secure passwords, and caution when responding to unsolicited requests for money or personal information.
If you have concerns about possible exploitation, coercion, or undue influence, seek professional legal guidance.
11. Prepare an Emergency Information Sheet
Your parents may find it helpful to maintain a secure, accessible record of emergency contacts, physicians’ information, medications, insurance details, and the location of important legal documents. Ask where your parents would like this information kept and whom they would like to share this information with.
12. Implementing all of the Above
Consult with an elder law attorney who can help your parents understand their existing documents and implement and coordinate a cohesive plan to meet all of their needs, including powers of attorney, health care documents, wills, trusts, Medicaid planning, and estate tax planning. You can assist by helping to identify questions, organizing records, and arranging an appointment.
What If a Crisis Has Already Occurred?
If your parents are hospitalized, need immediate long-term care, or are experiencing significant cognitive decline, seek professional guidance promptly.
Help locate existing legal documents and gather relevant information, with your parents’ consent or with a power of attorney. The attorney will explain what legal options are available and will determine whether your parents retain the legal capacity to execute or amend documents.
The best time to prepare for a crisis is before it happens. The attorneys in the Elder Law Practice Group at Meltzer, Lippe, Goldstein & Breitstone, LLP can help your parents plan ahead, preserve their wishes, protect their assets, and provide greater peace of mind for the entire family
Ronald Fatoullah, Esq. Chairs the firm’s Elder Law Practice Group and is a Partner of the firm’s Trusts & Estates Practice Group.
This blog posting is for informational and educational purposes only. It is general in nature and not person or circumstance specific. This blog posting is not intended, nor should it be construed as rendering independent investment, legal or tax advice. It may but does not necessarily constitute attorney advertising.