As care costs rise and legal complexities deepen, families across the U.S. face severe financial and emotional risks by failing to plan for aging or disabled relatives. Attorney Matthew F. Erskine wrote for Forbes that without timely estate planning, families could jeopardize not only assets but also the safety, dignity, and autonomy of vulnerable members.
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Long-Term Care Costs Are Soaring
Private nursing home rooms now cost an average of $109,628 per year, according to the nationwide financial annual cost of care survey conducted by HealthView Services. In some states, such as Alaska, that figure can climb as high as $361,223.
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Assisted living facilities also saw a sharp increase, with median annual costs rising from $64,200 in 2023 to $70,800 in 2024, according to the Genworth and CareScout Cost of Care Survey. In-home care with a home health aide increased from $75,504 to $77,792 during the same period.
The total cost of dementia care is projected to hit $781 billion by 2025, according to data from the United States Cost of Dementia Project at the University of Southern California. This includes $232 billion in direct medical and long-term care expenses. As of 2025, 5.6 million Americans are living with dementia, including 5 million aged 65 or older.
Estate Planning Is About More Than Wealth
Erskine argued in Forbes that estate planning should be reframed not just as wealth management, but as a tool to preserve continuity, protect decision-making rights, and prepare families emotionally and financially. Without proper planning, common consequences include:
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- Medical Decision-Making Challenges: Without health care proxies or advance directives, families may be unable to act in medical emergencies.
- Financial Risk: Without durable powers of attorney, vulnerable individuals are exposed to financial exploitation, while families struggle to manage essential tasks like bill payments or benefits access.
- Emergency Housing Decisions: Inadequate planning can lead to last-minute, high-cost decisions about home modifications or facility placements.
- Medicaid Pitfalls: Failing to engage in proactive Medicaid planning can trigger “spend-down” scenarios, where families must exhaust savings to qualify for aid.
Why Most Families Delay — And Why That’s Dangerous
Erskine wrote in Forbes that many families delay estate planning due to fear, discomfort with legal terminology, or the false belief that it’s only for the wealthy. But delays have real costs: Legal capacity can deteriorate, leaving individuals unable to authorize essential documents.
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What Effective Planning Looks Like
According to Erskine, effective elder and disability planning should include:
- Legal Documentation: Ensure durable powers of attorney, health care proxies with Health Insurance Portability and Accountability Act authorization, and advance directives are in place while individuals retain decision-making capacity.
- Asset Protection Strategies: Establish irrevocable or special needs trusts and other long-term care funding mechanisms before crisis hits. Medicaid’s five-year look-back rule makes early planning essential.
- Safety and Care Coordination: Prepare home safety modifications, medication systems, and backup care plans in advance. Involving geriatric care managers early can provide tailored support and facility research.
Families should also inventory assets and liabilities, understand benefit eligibility, and evaluate family dynamics to prevent future conflicts.
Take Action Before Crisis Hits
Erskine recommends assembling a team that includes an elder law attorney, financial planner, and care manager. Annual reviews and family meetings can ensure that plans evolve as needs change.
The risks are not theoretical — families face the possibility of losing homes, savings, and peace of mind. “Estate planning is not just about passing on assets, but about protecting the people you love,” Erskine wrote.
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