A strategic guide to long-term care planning for high-net-worth families

As America’s wealthiest families approach retirement in record numbers, an often-overlooked question lingers behind estate plans and trust structures: What happens if you lose the ability to make decisions or become incapable of self-care later in life?

While longer lifespans and better healthcare are extending retirement years, they also bring increased risks of cognitive decline, chronic illness, and long-term care needs. Yet many affluent individuals lack a formal plan for managing their affairs during periods of incapacity, including identifying who will make care decisions, manage their day-to-day affairs, and oversee funding.

Only 24% of Americans have a will, and even fewer have incapacity directives in place. Among high-net-worth families, the gap between financial complexity and care preparedness is widening, posing risks to liquidity, family harmony, and legacy goals.

Even with the right documents in place, many families overlook a critical piece of the puzzle: the people who will be asked to step in. How confident are you that your proxies are prepared to assume the responsibilities you’re expecting of them?

By 2030, one in five Americans will be over 65. Without proactive planning, families may face rushed asset sales, caregiver burnout, and internal conflict.

Why Long-Term Care Planning Matters

Consider this scenario: A retired widow with three adult children had taken what she believed were the right steps to plan for her later years. She created a robust estate plan, complete with a trust, a will, and a detailed binder from her estate attorney documenting everything for her estate administrator. She thought she had checked every box to plan for her later years.

When her memory started to slip, however, none of it helped. Her children scrambled to find appropriate care, struggled with finances, and argued over medical decisions. There was no care plan, no cash flow strategy, and no clear delegation of authority. She assumed they’d “just figure it out.”

They didn’t.

Across the country, numerous families are encountering a similar situation, often with incapacity plans that are vague, outdated, or missing altogether. A healthcare proxy signed decades ago may no longer reflect current relationships or care preferences. Estate plans alone don’t address the day-to-day realities of long-term care.

The real question isn’t if you’ll need care, but whether anyone will be ready when you do.

Building a Long-Term Care Plan: Where to Start

Effective planning starts long before a diagnosis. It begins with assembling the right team, which typically includes a financial planner, estate attorney, and CPA. Together, they can help you:

• Define your care preferences
• Determine what you’re willing to spend
• Identify how you’ll fund care (e.g., savings, retirement accounts, other assets)

As you age, it’s wise to include your proxies (those designated to make decisions on your behalf) in annual reviews so they stay informed and prepared.

Key Documents and Decisions for Long-Term Care Planning

Planning early and revisiting annually gives families the flexibility to adapt over time, integrate healthcare considerations with legal and financial strategies, and build a care plan that matches your lifestyle and your legacy wishes.

At the center of any care plan are the documents that grant decision-making authority: durable powers of attorney and healthcare proxies. Without them, families risk court-appointed guardianship, delays in care, and loss of control.

A sustainable plan also requires:

• Cash flow and tax planning
• Asset consolidation
• Regular updates as your health, family, and priorities evolve

What feels right at 60 may look very different at 70. That’s why long-term care planning should be treated as an ongoing discussion and not a one-time event.

Planning Checklist: Are You Ready for Long-Term Care?

Use this checklist to spot gaps, start conversations, and keep your plan in sync with your changing health, family dynamics, and financial goals.

Legal Authority

• Healthcare: Do you have a current healthcare power of attorney naming someone you trust to speak for you?
• Financial: Do you have an up-to-date durable power of attorney for financial decisions?

Financial Map

• Inventory: Have you listed all bank, brokerage, retirement, insurance, and real estate holdings in one place?
• Retirement Accounts: Do you know where your retirement accounts are held, such as a 401(k) from your first job or legacy IRAs?
• Consolidation: Are your assets spread across multiple institutions when they could be consolidated into one or two?
• Proxy Burden: Have you taken steps to simplify your financial structure to reduce the burden on your proxy?
• Legacy: Which assets do you want to leave untouched for heirs or legacy goals?
• Care Funding: Have you considered how you would fund future care needs, whether by drawing from an IRA, selling assets, or using other liquid funds?
• Longevity Planning: Do you know how many years your resources could cover your preferred level of care?
• Contingency: Have you set aside contingency funds or insurance in case you live longer than projected?

Care Options

• Care Provider: Have you researched and toured facilities or in-home providers that match your lifestyle and location preferences?
• Save a Spot: Is a deposit or reservation in place at your first-choice community?
• Budget: Have you compared the cost of private in-home care versus facility-based care to see which aligns with your budget and wishes?

Family & Proxies

• Hard Conversations: Have you discussed your care preferences with your children, proxies, and advisory team?
• Detailed Instructions: Do your proxies know where to find key documents and account information?
• Charitable Giving: Have you clearly communicated your philanthropic goals, including whether to continue annual charitable contributions during a period of incapacity?
• Cash Flow: Are proxies aware of how your giving strategy aligns with your overall cash flow and tax plan?
• Stay Informed: Are proxies invited to annual reviews to help keep them updated and comfortable with future responsibilities?
• Clear Path: Have you eliminated assumptions by documenting roles, preferences, and financial strategies in writing?

Backup Plans

• Cost Increases: What steps will you take if care costs rise faster than expected?
• Proxy Changes: Who will manage decisions if a named proxy becomes unavailable?
• Life Updates: Do you have a process to review and adjust this plan every year and make more extensive updates every 7-10 years?

We Can Help

Proactive, integrated planning is one of the most effective ways to protect your lifestyle, legacy, and loved ones as you age. By bringing together financial planning, tax strategy, and legal coordination, you gain a dedicated team to help you prepare for life’s transitions.

At Elliott Davis, we work with high-net-worth families to consolidate assets and develop personalized approaches to cash flow and tax management that reflect your values and priorities. Planning for long-term care is a gift to your future self and to those who may one day step in on your behalf.

Let’s start the conversation. Contact us today to begin building a long-term care plan that grows with you, safeguards your resources, and supports the people and causes you care about most.

The information provided in this communication is of a general nature and should not be considered professional advice.  You should not act upon the information provided without obtaining specific professional advice.  The information above is subject to change.