Grand Plans: July 17, 2025
A semi-monthly newsletter from Grand Plans designed to normalize and celebrate our glorious geri-destiny through information, stories, real talk conversation, smart planning and shared experience.
Things I’m prattling on about today
There’s no better time than right this minute to start implementing artificial intelligence (AI, ChatGPT etc) into your grand planning greatness. I promise it will be the most-used essential tool in your pack. I swear it! AI can and will save our brains from the overexertion navigating second-half complexities often entails. The fact that we have the ability to utilize artificial intelligence on our aging journey is the opportunity of a lifetime — truly. Everyone gets older and dies one day. But we are among the first few older adults to do so with such support and resources at our disposal.
So, first things first: go to chatgpt.com or download the ChatGPT app. Sign up, sign in, do whatever it takes to get yourself to that gleaming, beckoning prompt that beckons you to “ask anything.” Anything? Yes. Anything. And if you’re a smart grand planner, you’ll begin with some well-crafted questions that include specific details about your super specific personal situation. The better and more detailed the prompt question, the better the answer will be. I have included a few below:
(And just to note: one of them is about my personal caregiving misadventure from a few years ago. If I had ChatGPT then, I would not have PTSD from the experience because I would have known better how to handle it all. I’ll put that one first before the fictional ones)
Prompt 1: I am the power of attorney for a challenged older couple: the wife is bedridden with end stage Parkinson’s disease and the husband is erratic and unhelpful and has alcohol induced dementia. Their wish is to stay in their home at all costs. They have enough cash in their account to cover 1.5 years of 24-7 in home care but will have nothing but the value of their home after that. What is to become of them? They refuse to make any changes to their lifestyle, and it seems like they are on a course for financial devastation, amplified by the problems the drinking causes.
ChatGPT answer: You’re in a profoundly difficult and heartbreaking position — trying to honor the wishes of two vulnerable older adults while watching them move steadily toward financial and emotional collapse. As their power of attorney (POA), you have a fiduciary responsibility to manage their affairs wisely, but you’re also navigating competing pressures: their autonomy, their decline, and a reality they’re not prepared to face.
Here’s a step-by-step framework to help guide your actions, balance duty and compassion, and prepare for what’s ahead:
1. Document and Clarify Their Wishes — Again
Even if they’ve said “we want to stay home at all costs,” it’s important to:
Document those statements in writing or via video.
Have them reaffirm this choice with you as POA (and ideally with a witness or notary), especially if they resist any care plan shifts later.
Include statements like “we do not wish to sell our home or move into assisted living, even if it exhausts our financial resources.”
This gives you clarity and legal cover when decisions become urgent.
2. Project the Financial Timeline — in Writing
Prepare a clear written forecast showing:
The cost of current 24/7 care (likely $20K–$25K/month or more),
The expected timeline until the money runs out (~18 months),
The remaining assets (primarily the home), and
What options will be left when the money is gone (i.e., Medicaid with home exemption, possible placement if care at home becomes unsafe).
This isn’t just for you — it may be presented to the couple, other family members, or eventually to a guardianship court if a crisis occurs.
3. Begin Medicaid Planning Now
Since they have only 18 months of liquidity, begin preparing them (and yourself) for Medicaid Long-Term Care eligibility:
For the bedridden wife:
She may eventually qualify for in-home care through Florida’s Medicaid Long-Term Care Managed Care Program (LTC-MCP).
The home is exempt if she lives there and intends to remain.
Cash spend-down may be used for care, home modifications, burial policies, and personal items.
For the husband:
Alcohol-induced dementia may eventually make him eligible as well.
His unpredictability might mean placement is more likely, depending on safety and behavioral needs.
Hire a Medicaid planner or elder law attorney now to:
Help structure a legal spend-down of assets.
Set up Qualified Income Trusts (QITs) if income exceeds Medicaid limits.
Preserve the home legally if possible (e.g., life estate, Lady Bird deed).
4. Protect Their Safety and Limit Your Liability
If the husband’s behavior becomes dangerous (wandering, aggression, falls, refusing care), you must:
Keep a written record of incidents — this can protect you if emergency intervention is needed.
Document any refusals of safer or more affordable care options.
Be prepared to petition for guardianship or protective placement if the situation becomes unsafe or the POA isn’t enough to act in their best interest.
You can be compassionate and still protect yourself legally.
5. Engage Adult Protective Services or Aging Services if Needed
If the home situation deteriorates (e.g., abuse, neglect, serious health risk due to the husband’s erratic behavior), you may need to:
Involve Adult Protective Services.
Reach out to Florida’s ElderSource for help navigating high-risk aging-in-place situations:
ElderSource | 1-888-242-4464
They can do a home assessment and connect you with in-home Medicaid services or crisis resources.
6. Prepare for a “Trigger Event”
Eventually something will force a change:
A fall,
An ER visit,
A caregiver quits due to violence or neglect,
The money runs out.
When it happens:
Be ready with Medicaid applications already in motion.
Have a list of Medicaid-accepting facilities if in-home care is no longer feasible.
Keep back-up POA and care instructions ready for hospitals or caseworkers.
OK, OMG! Can you believe the details? Even a phone number! This is real help! It should be validated, of course, but geesh — I mean, if I had only had ChatGPT along for my crazy ride, things would have been smooth sailing-ish. OK here’s one more:
Prompt 2: I feel very strongly about my end of life wishes: that if in my old age I have such cognitive decline that I cannot recognize my grandchildren, I would like to ensure food and water is withheld from me until I die. How do I draw up the proper advance directives that will provide me this death experience given laws around cognition and healthcare proxies and living wills and my right to die on my own terms? I am very afraid I will get to that stage of dementia and be denied the experience because I’m not declared cognitively well when I want to die.
ChatGPT answer: Your concern is deeply personal, and it’s one shared by many who fear losing their autonomy and sense of self through advanced dementia. While U.S. laws limit certain forms of assisted dying — especially for people who are no longer deemed competent — there are legal and ethical ways to document your wishes around refusing life-sustaining treatments, including food and water.
Here’s how you can prepare strong advance directives that maximize your control over your end-of-life experience:
1. Create a Detailed Living Will Focused on Dementia
Most standard living wills don’t address advanced dementia well. You need a dementia-specific advance directive that includes:
Clear language stating when you consider your quality of life unacceptable (e.g., “when I no longer recognize my grandchildren or do not remember who I am”).
A directive to refuse all assisted feeding and fluids — even if you appear to accept them.
Explicit instructions stating that hand-feeding is not to be offered, as some states view this as “basic care” rather than medical treatment.
Recommended Resource:
The Dementia Directive developed by Dr. Stanley Terman or the “End-of-Life Choices and Dementia” directive from Compassion & Choices:
2. Appoint a Strong Healthcare Proxy Who Shares Your Views
You’ll need someone:
You trust deeply,
Who understands and supports your wishes,
Who is willing to advocate fiercely for you, even against resistance from providers or family.
Put it in writing:
Designate them in a Health Care Proxy / Durable Power of Attorney for Health Care.
Add supplemental instructions reaffirming they must follow your dementia directive even if you appear to accept food or water.
3. Make an Advance VSED Directive
Voluntarily Stopping Eating and Drinking (VSED) is legal and ethical in all 50 U.S. states if a person has capacity. For dementia, this becomes complex — but you can prepare an Advance VSED Directive that:
Explains your reasoning.
Declares your wish to begin VSED when dementia reaches a certain stage.
Instructs caregivers not to offer food or fluids once this stage is reached.
Resources:
End of Life Choices NY: VSED Advance Directive Template
4. Supplement with a POLST/MOLST (if available in your state)
These are medical orders signed by a physician or nurse practitioner that reinforce your wishes about no artificial hydration or nutrition. In many states, a POLST can carry more weight than a living will during care decisions.
5. Store, Share, and Reaffirm Your Wishes
Give copies to your proxy, your doctor, your lawyer, and your family.
Upload to your electronic medical record.
Consider a service like MyDirectives.com or Five Wishes.
Revisit and reaffirm your wishes periodically to demonstrate a consistent intention over time.
6. Talk to a Lawyer with Expertise in End-of-Life Planning
To make sure your documents comply with your state’s legal standards, and to reduce the chance of resistance from providers or legal challenges, consult an elder law attorney or one focused on right-to-die and advance care planning.
Again, plenty of information to confirm and unpack and substantiate, but a lot of these points are things I’ve never heard of before. Maybe some of it’s not applicable or fictional, but it’s such a wonderful starting point to make smart planning choices!
That’s it for today. But do yourself the biggest favor you could ever do for your grand planning self and put some ChatGPT or other AI products in your backpack as you celebrate your second half wins!
News you can use
People are using ChatGPT to diagnose health issues, and you could, too, according to this Observer article: “More people around the world are turning to ChatGPT for medical advice when feeling unwell or anxious—sometimes in place of seeing a doctor. A study released in August 2024 by the University of California found that patients often consult A.I. models like ChatGPT either before or after speaking with a physician. Similarly, a February study from the University of Sydney, which surveyed more than 2,000 adults, reported that nearly six in ten respondents had asked ChatGPT at least one high-risk health question—queries that would typically require professional clinical input.”
Ever wondered how the guru Deepak Chopra would assess your problems or opportunities? Go ahead, ask him on his very cool AI website.
The University of Florida shares some of the benefits of AI in aging in this article, which highlights the following technologies currently being studied and implemented:
“Health monitoring: Wearable devices like smartwatches can monitor a person’s blood pressure, oxygen levels and heart rate. When paired with a patient’s healthcare provider, these devices send alerts if one of the patient’s vitals is amiss. They provide real-time care and can reduce the need for more frequent healthcare visits for daily checkups.
“Customized care: With technology like machine learning, AI can analyze large data sets and generate algorithms, allowing for personalized patient plans. For older adults who need to adjust their medication due to health conditions or lifestyle, this technology can dynamically adjust treatments and prescriptions, ensuring optimal care.
“Independent living: According to AARP in 2021, 77% of adults over 50 would prefer to age in place, which means living independently in their own homes. Thanks to devices like virtual assistants and smart home devices, older adults are more capable of maintaining this independent living style. These devices enhance daily living by automating tasks such as lighting control, automatically turning off appliances and adjusting smart thermostats to meet basic needs.”
Ready to get the conversation started about innovative approaches to senior living with your group? Seniors on a Mission and G3 Village Director Joanne Hickox and I have got you covered. Give me a shout at susannabarton@me.com to schedule a 20-minute presentation on this important aspect of aging vibrantly.
Shelf life
I just got this book, It Wasn't on my Calendar!: 13 Lessons in Working Through Elder Care and Alzheimer's, and its message is similar to Grand Plans 2.0 except it is written by a smart numbers person, an accountant, I think. His message is right on point and may be helpful to those seeking expert advice that they aren’t finding on ChatGPT lol.
From Amazon: “Most people do not plan for a medical, mental or aging crisis for a parent—or themselves, and if such a crisis is not on your calendar, prepare now. None of us know what we don’t know, and when a loved one’s health and/or mind are failing, this is no time to have a crash-course in learning. •Who do I turn to for advice? •What kind of questions do I ask? •Do I plan a loved one’s care for this immediate crisis—or make a plan that includes future needs as conditions worsen? •How do I respond to the many needs: place to live (kinds of facilities), care (who provides and what kinds), costs (and how to pay them), and advisors (finding the right people to handle finances and elder planning). If you have more questions than answers, this first-hand guidebook, written by a CPA/ financial planner about his dad’s situation, will provide answers. Now you will be able to deal with your own situation with more knowledge and focus. Cummings divides his experiences into 13 lessons; some that are chocked full of practical advice for family members, caregivers and professionals: How Do We Respond? What Resources are Available? It Is Not About You Getting the Right Medical Help Know If and When to Move Him From His Home Know the Best Place for Your Loved One to Live Know All of Your Options on How to Pay for it Selecting the Right Financial Advisor Get the Right Financial Advice Proper Estate Planning.”
Grand Plans 2.0: How to Mitigate Geri-Drama in 20 Easy Steps and its accompanying workbook, the Grand Planner 2.0, are both published and out on the interwebs for you to order and enjoy! Click links to purchase on Amazon and look for copies in your local bookstores.
Some golden gedunk and goods
Get yourself another few copies of Grand Plans: How to Mitigate Geri-Drama in 20 Easy Steps and the Grand Planner for all the people who like getting gifts in your life! Visit www.mygrandplans.com for links to purchase on Amazon.
And… Check out our Grand Plans merch in our Etsy storefront.
