Estate Planning Is Built Around Death. But What About Everything That Comes Before It?

A recent Forbes article by John Samuels, founder and CEO of the healthcare advisory firm Wellworth, makes a case that the estate planning industry has a blind spot. The traditional plan, the will, the trust, the beneficiary designations, the tax strategy, is built around a single event: death. What it does not address, the piece argues, is everything that arrives before it. The illness. The cognitive decline. The years of caregiving. The family decisions that get made while everyone is still very much alive and the consequences are real.

It is a fair critique. It is also a description of a gap that good elder law and estate planning firms have been working to close for a long time.

You can read the full Forbes article here.

Estate planning and health planning: what the Forbes piece gets right

The Forbes article describes what happens when a stroke, a dementia diagnosis, or a Parkinson’s progression arrives in a family that has documents but no framework for what comes next. The trust is funded. The beneficiary designations are current. And then the questions begin. Who coordinates the care? Which specialists do we trust? Can a parent safely stay at home? What happens when family members disagree about treatment?

None of those questions are answered by a will. They are the questions that can consume families for years, sometimes decades, long before the provisions governing inheritance ever come into play. The piece calls what is missing a health continuity plan: a framework that identifies decision-makers, clarifies treatment preferences, and establishes how care will be coordinated before the crisis makes those conversations impossible.

What the article is reaching toward is a planning conversation that starts with the person, not the paperwork. That is a different kind of appointment than most people have ever had with an estate planning attorney.

The financial cost of skipping that conversation

The Forbes article puts figures on what the gap costs. According to the Alzheimer’s Association, the lifetime cost of dementia care alone now exceeds $400,000 per person. The value of unpaid family caregiving in the United States now exceeds $1 trillion annually according to a 2026 AARP report, a figure that surpasses total Medicaid spending. CDC data cited in the piece shows that nearly two in ten employed caregivers leave the workforce entirely to provide care, while four in ten reduce their working hours.

These numbers do not belong to wealthy families with complicated estates. They belong to ordinary families across New Jersey and New York who spent decades building something, did what they were told to do by getting a will and a trust, and never had anyone sit down with them to talk about what would happen if a parent spent three years in a memory care facility before the estate plan ever came into play.

A plan that addresses death but not the years that precede it leaves real gaps. The cost of those gaps shows up in depleted savings, family conflict, and the particular exhaustion of managing a health crisis without the legal and financial infrastructure to handle it. Families may be better positioned to navigate those challenges when the planning conversation happens before a crisis, while there is still time to evaluate options and put appropriate legal and financial tools in place.

A document is not a plan

A will is a document. A trust is a document. A power of attorney is a document. Signed, witnessed, and filed, each of them does a specific legal job. But a collection of documents is not a plan, any more than a set of blueprints is a house. The documents have to be built around something real: a person’s actual health picture, actual family dynamics, actual sense of what the people they love should experience when things get hard.

The Forbes piece cites an attorney who notes that financial powers of attorney are either too broad or too limited, and that by the time a family notices cognitive decline, the window to fix them has often already closed. That happens when documents are drafted without the conversation that should come first. The drafting reflects what the attorney assumed rather than what the client actually needed, and those two things are not always the same.

Getting it right requires asking. It requires sitting with someone long enough to understand that they have a specific life, specific relationships, and specific fears about what the future looks like for the people they care about. That conversation can lead to documents that are more closely tailored to the client’s circumstances, priorities, family relationships, and anticipated needs.

What the planning conversation should actually cover

A planning process that accounts for the years before death starts in a different place than most estate planning appointments do.

It starts with health. Not just what conditions exist today, but what the next decade might realistically look like and whether long-term care is something to plan for rather than hope against. Having counsel who understands Medicaid and long-term care planning can help a family evaluate the financial picture, understand which assets and income may affect planning options, and consider strategies that may be available under applicable law and program rules.

It moves through finances. Not just what someone owns, but how those assets are titled, how they may be affected by future care needs, and what planning structures may be appropriate under different scenarios, including the ones where care costs arrive years before anyone inherits anything.

It addresses family. Who the people are, how they actually get along, where the pressure points are, and who should be holding authority when decisions need to be made under stress. A document that puts the wrong person in the wrong role does not protect anyone. It creates the next problem.

And it covers what matters underneath all of it. What someone has spent their life building, who they built it for, and what they want the people they love to actually experience, not just legally receive. That is a different conversation than most people expect to have with an estate planning attorney. It is also the one that produces a plan worth having.

What peace of mind actually looks like

People walk into estate planning appointments expecting to leave with documents. The ones who leave with something more than that had a different kind of conversation first.

Peace of mind is not a binder. It is the absence of a specific set of fears. The fear that a spouse will not be able to access accounts. That children will spend years fighting over something that should have been clear. That no one will know who to call or what to do or what was actually wanted. A thoughtful plan can reduce some of those uncertainties, but it does not do so through paperwork alone. It does it by being built around the actual people involved, their actual relationships, their actual health, and their actual life.

The Forbes article ends by asking whether estate planning can truly be complete without health planning. The more useful question is whether a family can afford to find out the hard way that it was not.

Plan Well. Live Better.

A plan built around health, finances, and the realities of aging, one that takes the years of living seriously and not just the moment of death, is not a more complicated version of estate planning. It is just a more honest one. And it is the kind that actually does what people hope their documents will do when the moment comes.

At Milvidskiy Law Group, that kind of conversation is where every plan starts. Learn more about our estate planning and elder law services or reach out to schedule a consultation.

This article is for informational purposes only and does not constitute legal advice. Please consult a qualified estate planning or elder law attorney for guidance specific to your situation.