The hospital question is the cheapest test of an aging book

The first sign is a wire request that doesn't match the pattern, a client who has driven the same route to the office for a decade asking for directions, a name that used to arrive easily coming late — rarely a diagnosis. Jennifer Raess, product counsel and estate strategist at the estate planning platform Vanilla, puts that list of odd instructions, small forgettings, and lost bearings at the center of the work, because the advisor's advantage is proximity: someone who knows how a client normally behaves can hold a behavioral baseline, compare each conversation against it, and notice what is out of character, monitoring that costs nothing and catches what no dashboard will.

The stakes are actuarial as much as emotional: Alzheimer's was the fifth-leading cause of death among U.S. adults 65 and older in 2024, according to the Alzheimer's Association, while a University of Washington at Seattle study found more than three-quarters of adults with some diminished capacity still managing their own finances in 2022. Clients who are declining and still signing are the population that turns a planning relationship into a liability question.

Bryan Walls, of the Atlanta-headquartered firm HB Wealth, argues for raising the subject before a crisis forces it, treating the willingness to go there with a client as a differentiator — another tool in the toolkit, in his phrasing, and a way to show worth. The resistance is real, because money is already fraught with anxiety for most people and some clients would rather not discuss how their abilities may be changing; the default outcome of that discomfort is silence, with advisor and family each waiting for the other to speak first.

Megan Slatter, a wealth advisor at Crewe Advisors in Salt Lake City, doesn't open on dementia; she opens on logistics — if you were hospitalized tomorrow, who is going to continue to pay your bills? Her firm's book runs $3.1 billion across 1,985 accounts per WAD's records, an average of roughly $1.56 million an account, so one client's incapacity is a seven-figure decision about who can move money and whether anyone has the standing to.

That standing is where plans fail: if documents are not in line while the client is still sound in mind, the family's recourse is court involvement or a guardianship proceeding, which is slow, expensive, and public. An advisor who notices the forgetting in March and says nothing until the following fall has spent the window in which the client could still sign.

Staging the conversation rather than leading with the worst case lets a client who arrives at a review meeting already in a heightened state move through lower-stakes hypotheticals toward the harder questions. The sequence matters less than the record it produces: what a client says about who they trust with the checkbook, said in a calm meeting, becomes the instruction the family relies on later.

The industry is building products for the noticing half of the problem — Edward Jones has moved to offer financial monitoring through the fintech Carefull, a tool that watches accounts for unusual activity. Monitoring is useful and it is not authority; a dashboard can flag an unusual transfer, but it cannot stop one, and it holds no standing with the custodian. That standing lives in a durable power of attorney, a health-care proxy, and a successor trustee who has been named, informed, and handed the paperwork the custodian will accept. Documents drafted years ago may no longer satisfy an operations department that has changed its forms, which is a diligence question an advisor can answer in an afternoon of file review.

The rest of the work is administrative in the best sense: baseline notes belong in the CRM rather than the advisor's memory, so a colleague covering a vacation can read them; the hospital question belongs in the annual review, asked in year three of a relationship rather than the week a client's son calls; and the family meeting belongs on the calendar, since a Fidelity poll of investors 55 and older found that a completed plan buys less peace of mind than the industry assumes — we recast the heir conversation as a growth strategy on the strength of that finding, and the same meeting is where a client names, while still able, who steps in.

The client side of the book works the same way, and it is being underpriced. The succession wave is now a file-quality story, in which buyers will pay the premium only after the founder's own pay add-back is priced; a firm whose households all carry current powers of attorney, a named successor trustee, and a written baseline is holding an asset a buyer can diligence in a data room, while a firm that has never staged that conversation is holding relationships that will be tested one at a time by events nobody can schedule. The client who leaves when a guardian takes over is the one no model ever booked.

The scripts cost one question and the documents cost an afternoon. Slatter's opening line — who pays the bills if you are hospitalized tomorrow, with the answer written down while the client can still give it — is the cheapest test available, and everything that follows (the baseline, the proxy, the trustee, the family meeting) depends on a signature obtained before the reasoning fades. That is the one planning deadline that will not send a reminder.