The Hard Conversations

Driving, Money, and Medical Decisions in Dementia Care

When the Keys Become the Battle: Rethinking the Driving Conversation

He’d driven the same roads for forty years and could probably find his way blind. That was exactly the problem — the roads hadn’t changed, but he had.

For many families, the driving conversation arrives before the diagnosis has even fully sunk in. It’s often the first visible sign that the person you love isn’t quite who they were behind the wheel, and it’s frequently the first real fight of this whole journey. I remember watching my father’s world grow smaller by inches long before dementia took the rest of it. His car wasn’t just transportation — it was the last unquestioned proof that he was still capable, still himself. Watching that go felt like grief with no funeral to mark it.

This issue takes on three conversations caregivers dread most: driving, money, and end-of-life medical decisions. None of them are easy. All of them are necessary. And every one of them goes better with a plan, which is what we’ll build together here.

When They Won’t Stop Driving

Here’s something that helps explain the resistance: many people living with dementia experience anosognosia, a genuine inability to perceive their own decline. Your loved one isn’t lying to you or being stubborn for sport — in their own mind, they’re still a perfectly safe driver. That’s why logic and confrontation so rarely work. What does work is paying attention to the signs: getting lost on familiar routes, new dents or scrapes with no explanation, confusion at intersections, or friends and neighbors quietly mentioning close calls. Once you see a pattern, the goal isn’t to win an argument. It’s to get an outside authority involved.

A doctor’s recommendation to stop driving carries a weight that family requests simply don’t. Ask your loved one’s physician to raise it directly, and know that most states also allow a medical review referral to the DMV, which can result in a re-testing requirement or license suspension without you having to be the one who says no.

Practical Strategies for Car Removal

Families find their own way through this, and there’s no single right approach — only the one that keeps everyone safest with the least conflict. Some relocate the car “for repairs” and let that excuse run for weeks. Some disable it quietly, removing a part a trusted mechanic can explain away. Others sell the car outright and redirect the money toward rides. A few, as a last resort, simply manage the keys. Whatever the method, a united family message helps enormously — and letting a doctor or care manager be the one who delivers the final word means you don’t have to carry the blame alone.

Alternative Transportation Solutions

The transportation gap is real, and filling it before you take the keys away makes the whole conversation easier. Look into rideshare accounts set up with a caregiver as account holder, senior transportation programs through your local Area Agency on Aging, volunteer driver networks through faith communities or nonprofits, and paratransit services for medical appointments. Grocery, meal, and pharmacy delivery can also quietly reduce how often driving even comes up.

Maintaining Mobility and Independence

The goal was never to strip independence away — it’s to redirect it somewhere safer. Involve your loved one in choosing the new routine rather than simply announcing it. And look for other places to hand back some control: what to eat, what to wear, how the day is scheduled. Small choices matter more after a big one has been taken away.

Losing the keys is never just about the car. It’s often the first big goodbye to independence — and grieving that loss doesn’t mean you’re doing something wrong.

This is one of the hardest early milestones in dementia caregiving, and it’s okay to grieve it right alongside your loved one. Lean on your doctor, your care team, and your community. Safety and dignity can, and should, coexist.

This Week

● Document specific driving incidents or concerns to share with the physician

● Research your state’s DMV medical review or reporting process

● Identify one backup transportation option to test out this week

This Month

● Schedule a doctor’s appointment specifically to discuss driving safety

● Set up at least one recurring transportation solution — a rideshare account, a volunteer driver, or a family schedule

● Hold a family conversation together and present a united message

Ongoing

● Revisit transportation needs as mobility and cognition change

● Watch for isolation and proactively schedule outings using the new transportation plan

● Keep looking for ways to preserve independence in other areas of daily life

The Money Talk Nobody Wants to Have (Until It’s Too Late)

Somewhere between the diagnosis and the daily work of caregiving, most families forget to ask a hard question: who else has access to Mom’s bank account?

Financial exploitation of older adults with cognitive impairment is far more common than most families realize, and it’s most often carried out by someone close to the family — not a stranger. Dementia changes how a person evaluates risk, pressure, and trust, which can make someone vulnerable to undue influence or outright theft years before anyone recognizes a diagnosis. This conversation is uncomfortable because it can feel like accusing someone you love, or like taking away one more piece of independence. But putting safeguards in place early prevents a much bigger crisis later.

Recognizing Financial Abuse Signs

Watch for unusual or unexplained withdrawals, unpaid bills despite adequate funds, a new “friend” or caregiver who suddenly seems very involved in financial matters, sudden changes to a will or beneficiaries, missing valuables or property, uncharacteristic confusion or anxiety about money, and new credit cards or loans your loved one doesn’t remember opening. None of these alone is proof of exploitation, but a pattern is worth taking seriously.

Protecting Vulnerable Adults

Set up a durable power of attorney while your loved one still has the capacity to participate in that decision — this single document makes almost everything else easier. Add a trusted contact designation to bank accounts, which allows the bank to reach a family member with concerns without granting that person account access. Set up alerts for large transactions, freeze credit with the three major bureaus, and where appropriate, limit access to checkbooks or cards while preserving as much dignity as possible. A second trusted family member reviewing finances alongside the primary caregiver adds an important check.

Legal Interventions Available

Adult Protective Services (APS) should be your first call if you suspect abuse is already happening. Local law enforcement can get involved for outright theft, and an elder law attorney can walk you through your options. Guardianship or conservatorship exists as a legal intervention of last resort, used when capacity has been lost and no power of attorney was ever established. If someone with access to the home is the suspected exploiter, a protective order may also be necessary.

Prevention Strategies

The best protection happens early, while your loved one can still take part in the planning. Build financial safeguards into estate planning conversations, keep finances transparent among family members to reduce both opportunity and suspicion, and consider a professional fiduciary or daily money manager for an added layer of oversight. Document decisions and conversations in writing as you go — it protects everyone, including you.

Financial exploitation of people with dementia happens quietly, and often by someone the family trusts completely.

Don’t feel embarrassed bringing this up early. The sooner the safeguards are in place, the less painful the eventual transition of financial control becomes for everyone involved.

This Week

● Review recent bank and credit card statements together for anything unusual

● Make a list of everyone who currently has access to accounts, cards, or the checkbook

● Save the phone number for your local Adult Protective Services office

This Month

● Meet with an elder law attorney to establish or review power of attorney documents

● Set up transaction alerts and a trusted contact designation on financial accounts

● Have a family conversation about who will oversee finances going forward

Ongoing

● Review accounts together on a regular schedule

● Watch for new relationships or “friends” who show unusual interest in finances

● Keep financial decisions transparent among family to reduce both risk and mistrust

Writing It Down Before the Words Are Gone: Advance Directives in Dementia Care

When my husband was diagnosed with early-onset dementia at fifty-five, we found ourselves having conversations most couples don’t have until decades later — if ever.

Advance directives can feel like paperwork for “someday.” But with dementia, someday tends to arrive faster than expected, and the window for your loved one to genuinely weigh in on their own care shrinks with time. Getting these documents in place early, while the person can still participate fully in the conversation, is one of the greatest gifts a family can give itself. Sitting down with my husband to do this while he could still tell me clearly what mattered to him didn’t feel morbid — it felt like making sure his voice would stay in the room long after the disease made it harder for him to use it.

Understanding Medical Choices Ahead

A living will documents preferences around life-sustaining treatment. A healthcare power of attorney names who will make decisions when your loved one no longer can. A DNR order specifically addresses resuscitation. And a POLST or MOLST form translates those wishes into an active medical order that travels with the patient across care settings, distinct from the general “someday” documents. Understanding the difference matters — one sets intentions, the other directs immediate medical action.

When Directives Need Revisiting

A directive written before diagnosis may not have anticipated dementia-specific scenarios: feeding tubes, hospitalization for infections, or how aggressively to treat a health crisis versus prioritizing comfort. Revisit these documents after any major health change, at key points as the disease progresses through its stages, and any time the named healthcare proxy is no longer able to serve. Treat this as a living conversation, not a one-time form.

Honoring Wishes vs. Medical Reality

There’s a real tension between what someone wrote years ago and what they seem to want or need in a given moment when they can no longer clearly communicate. Quality-of-life questions get harder, not easier, as the disease progresses. Lean on the medical team, and don’t hesitate to request a hospital ethics consult when a decision feels genuinely unclear. Trust the written wishes even when honoring them is emotionally difficult — that’s exactly what they were written for.

Family Disagreements About Care

Siblings and spouses often disagree about how aggressively to treat, and guilt can push people toward more intervention rather than less. Naming one clear decision-maker in the healthcare power of attorney document, rather than leaving it to consensus, prevents deadlock at the moments that matter most. A family meeting facilitated by a palliative care team or social worker can help everyone move toward the same page, and keeping your loved one’s own words and previously stated values at the center of the discussion gives the family a tiebreaker that isn’t anyone’s personal opinion.

An advance directive is a gift you give your family before you can no longer speak for yourself.

Have these conversations now, not later. Framing them as an act of love rather than defeat changes how the whole family carries them.

This Week

● Locate any existing advance directive, healthcare power of attorney, or DNR documents

● Write down what you remember your loved one expressing about end-of-life wishes in the past

● Schedule a conversation with the primary doctor about POLST or MOLST forms

This Month

● Complete or update a healthcare power of attorney and living will with an elder law attorney

● Share copies of all documents with every family member and the medical team

● Talk openly with siblings or co-caregivers about roles and expectations

Ongoing

● Revisit directives after any hospitalization or major health change

● Keep documents accessible, not locked away, for emergencies

● Continue conversations about wishes as the disease progresses

Learn more about dementia caregiving on my website:

Dementia Care Clarity™