Dementia Planning When You Don’t Have a Decision-Making Support Person
Written by Dr. Hao Huang
Updated at August 20th, 2026
Table of Contents
Planning for Future Decision-Making When You Have Dementia
A California guide to elder-law attorneys, professional fiduciaries, and conservators
If you have dementia but still have the ability to make your own decisions, now is the best time to plan for the possibility that you may need help in the future.
If you do not have a family member or friend who can serve as your decision-maker, you may be able to arrange for a professional fiduciary. If you eventually lose capacity and your existing legal arrangements are not sufficient, a court-appointed conservator may become necessary.
As with most matters when it comes to future planning in dementia, the best place to start is generally an elder-law attorney.
Professional Fiduciary vs. Conservator
These terms are related but are not the same thing.
A professional fiduciary is a professional who can serve in different legal roles. Depending on the arrangement, they may manage health care, finances, property, or other affairs.
A conservator is someone who has been appointed by a court to manage specific aspects of another person's affairs.
| Professional Fiduciary | Conservator | |
|---|---|---|
| Who appoints them? | Potentially you, through appropriate legal documents | A judge |
| Court required? | Not necessarily | Yes |
| Can they be a professional? | Yes | Yes |
| Medical decisions? | Yes, if properly authorized | Yes, if appointed as conservator of the person and given appropriate authority |
| Financial decisions? | Yes, if properly authorized | Yes, if appointed as conservator of the estate |
| Can you arrange it while you have capacity? | Potentially yes | Generally requires a court proceeding |
| Court oversight | Generally no conservatorship oversight | Yes |
Important: "Professional fiduciary" describes the person/professional; "conservator" describes a legal role created by court appointment. A professional fiduciary can potentially become your conservator if a court appoints them.
California regulates professional fiduciaries, including those who serve as agents under powers of attorney and as conservators.
California Professional Fiduciaries Bureau
Medical and Financial Decisions Are Separate
You should plan for these separately, even if you ultimately use the same professional fiduciary for both.
Medical decisions
The primary document is an Advance Health Care Directive. It can appoint a health care agent to make medical decisions if you become unable to make them yourself.
Financial decisions
The primary document is generally a Durable Power of Attorney for Finances. It can authorize someone to manage your financial affairs.
The same professional fiduciary can potentially serve in both roles, but the appropriate legal documents should specifically authorize each role.
Step 1: See an Elder-Law Attorney First
This should generally be your starting point.
Tell the attorney:
"I have dementia, I currently have capacity, and I have no family member or friend who can serve as my future decision-maker. I want to establish a plan using a professional fiduciary if I lose capacity."
The attorney can help determine what legal structure makes sense before you choose a fiduciary.
Ask about:
- Advance Health Care Directive and appointment of a professional health-care agent
- Durable Power of Attorney for Finances
- Whether the professional fiduciary can handle both medical and financial matters
- Whether you should nominate the professional fiduciary as your preferred future conservator
- Whether the plan could avoid a conservatorship if you later lose capacity
- Recommendations for professional fiduciaries who are well versed in dementia
State Bar of California — Legal Resources
Step 2: Find a Professional Fiduciary
Once you know what role you need, look for a professional fiduciary who is qualified and willing to serve.
California's Professional Fiduciaries Bureau regulates professional fiduciaries, including those who serve as agents under powers of attorney and as conservators.
https://www.fiduciary.ca.gov/licensees/license_verification.shtml
The site isn't super intuitive, so follow these instructions to search.
Go to “Advanced search.”
Use Ctrl+F and type in ”fiduciaries"
In “Board and Bureau”, click on “Professional fiduciaries licensing bureau”
In “License type”, click on “Professional fiduciary”
Click your city or county
In “Primary status”, click on “Active”
You can also verify a person's California license and check their disciplinary history on this site.
Ask potential fiduciaries:
- Do you work with people with dementia?
- Do you serve as health care agents?
- Do you serve as financial agents under powers of attorney?
- Do you serve as conservators?
- Can you handle both medical and financial matters?
- What are your fees?
- Could you potentially continue serving if I later require a conservatorship?
Interview several before choosing one.
If you are a veteran, note that the VA also has a fiduciary program:
VA Fiduciary Program
Step 3: Have the Attorney and Fiduciary Work Together
Once you have selected a fiduciary, the attorney can prepare the appropriate legal documents.
Depending on your situation, this may include:
Advance Health Care Directive
→ Professional fiduciary becomes your health care agent
Durable Power of Attorney for Finances
→ Professional fiduciary becomes your financial agent
Nomination of future conservator
→ Identifies the professional fiduciary you would prefer if a conservatorship later becomes necessary
The exact documents and timing should be determined with your attorney.
Step 4: Have a Backup Plan for Conservatorship
A professional fiduciary arrangement may allow you to avoid a conservatorship, but it does not guarantee that a conservatorship will never be necessary.
If you eventually lose capacity and your existing legal authority is inadequate, a court may need to become involved.
Conservator of the person
Generally deals with personal care and well-being, which can include medical decisions and living arrangements depending on the authority granted by the court.
Conservator of the estate
Deals with money and property, including finances, investments, bills, and real estate.
The same professional can potentially serve as both.
California Courts — Conservatorships
Can You Choose Your Future Conservator?
You can discuss with your attorney whether your legal documents should nominate your preferred professional fiduciary to serve as conservator if one becomes necessary.
This does not automatically create a conservatorship. The court ultimately decides whether a conservatorship is necessary and who should serve.
Your Step-by-Step Plan
If you have dementia, still have capacity, and have no one available to help you:
1. See an elder-law attorney
Explain your situation and that you have no family member or friend available to serve.
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2. Develop the legal plan
Determine what you need for medical decisions, financial decisions, and potential future conservatorship.
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3. Find a professional fiduciary
Interview licensed fiduciaries who are qualified to perform the specific roles you need.
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4. Execute the appropriate documents
Complete an Advance Health Care Directive and/or Durable Power of Attorney for Finances, as appropriate.
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5. Establish the backup plan
Consider nominating the professional fiduciary as your preferred future conservator.
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6. If you later lose capacity
If the existing documents are sufficient → the professional fiduciary acts under those documents.
If they are not sufficient → a conservatorship may be pursued.
This is general California information and not individualized legal advice. An elder-law attorney can determine which documents and arrangements are appropriate for your particular circumstances.