A daughter calls her mother’s physician. She is worried. Over the past two years, her mother has become increasingly withdrawn. She misses appointments, forgets to pay bills and has given money to people she met online. The house is becoming cluttered. Food expires in the refrigerator. Friends no longer visit.
“Can you help?” she asks. The physician listens carefully and shares her concerns. However, her mother remains capable of making her own health-care decisions.
The daughter calls a lawyer. Her mother has a power of attorney in place, but her children disagree with her choices. She continues to meet the legal standard for capacity.
She calls the bank. Privacy legislation limits what can be discussed. She contacts community resources. There are concerns, but no immediate crisis.
Everyone is acting appropriately. The physician respects patient autonomy. The lawyer is upholding the law. The bank is complying with privacy obligations. Each participant is operating within their professional responsibilities, which leaves the family without a solution.
Their mother is not incapable. She is not in immediate danger. She does not meet the threshold for involuntary intervention. But it is increasingly clear that she is struggling. Many families have lived this experience.
I have come to believe that this is one of the most significant challenges facing families, and one that receives far less attention than it deserves. The most difficult situations are rarely those in which a person is clearly capable or clearly incapable. They arise during the years in between, when vulnerability increases but existing systems remain organized primarily around legal, medical and administrative thresholds.
People are living longer than ever before. Medical advances have transformed many acute illnesses into chronic conditions. Families are smaller and more geographically dispersed. Social isolation is becoming increasingly common, among Canadians of all ages.
Meanwhile, daily life grows ever more complex. Banking, health care, government services, communication and commerce are increasingly conducted online. Technology has created tremendous opportunities, but it has also introduced new barriers and new risks. Fraud schemes have become more sophisticated, and AI is making impersonation and financial scams increasingly difficult to detect.
As a result, many people are spending years, and sometimes decades, navigating varying degrees of vulnerability while continuing to live independently. This reality does not fit neatly within many of the systems that were designed to support them. Many of our health care, legal and social frameworks were developed at a time when life expectancy was shorter, periods of dependency were often brief and family support networks were more readily available.
Today, we see people spending years managing mild cognitive impairment, chronic mental illness, addiction, grief, social isolation or increasing functional limitations while remaining legally capable of directing their own affairs.
Between capacity and vulnerability
One of the most important distinctions a family encounters is the difference between capacity and vulnerability. Capacity is a legal concept. It determines whether an individual can make their own decisions and direct their own affairs. Vulnerability is broader and more difficult to define. A person can be vulnerable, but still capable.
A recently widowed spouse may understand financial concepts perfectly well while feeling overwhelmed by responsibilities that were once shared. An older adult may continue living independently while struggling with medications, technology, transportation and social isolation.
A person living with depression may understand the consequences of refusing treatment while lacking the motivation, energy or support necessary to care for themselves effectively. A retired executive with mild cognitive impairment may remain capable of discussing investment strategies and financial concepts while becoming increasingly susceptible to financial exploitation.
Family members may recognize subtle changes in judgment years before any formal finding of incapacity would ever be considered.
These situations are increasingly common. Yet many of our systems are designed to respond to incapacity rather than vulnerability. If vulnerability can exist long before incapacity, are we asking the right questions of our health-care, legal and social systems?
The challenges associated with vulnerability extend beyond aging and cognitive decline. Consider the aging parents of an adult son struggling with substance use. For years, they move between periods of hope and despair. There are stretches of stability followed by relapses that undo months of progress.
During periods of active addiction, their son drains savings, refuses treatment, disappears from contact and places himself at risk. During periods of stability, he remains fully capable of making his own decisions.
His parents spend years searching for answers. They consult health-care providers, explore treatment options and seek legal advice. The emotional burden is immense. They are caught between respecting his right to make his own choices and fearing for his safety. They experience a form of anticipatory grief, watching someone they love struggle while feeling powerless to intervene.
The circumstances are unlike those facing the widow or retired executive, but the challenge is similar. All three occupy a space where vulnerability is evident, yet meaningful intervention remains difficult.
Event-driven systems
Many of our health-care, legal and social systems are organized around events. Health-care systems respond to diagnoses, hospitalizations and acute medical concerns. Legal frameworks focus on capacity assessments, substitute decision-makers, powers of attorney, representation agreements and other identifiable legal thresholds. Mental health legislation is often triggered by concerns related to safety, deterioration or risk.
These frameworks serve important purposes. They protect autonomy, individual rights and personal freedom. The challenge is that human vulnerability rarely emerges as a single event.
Families do not experience decline through legal tests and statutory definitions. They experience it through countless small observations that accumulate over time. A parent repeats the same story several times in a single conversation. A spouse becomes increasingly isolated after a loss. A loved one starts missing appointments. Bills are left unpaid. The refrigerator is empty. Trusted friendships disappear.
Human decline is a process. Family members begin worrying long before a legal or medical threshold is reached.
Many families find themselves waiting while an aging parent becomes increasingly isolated, a spouse’s cognitive decline progresses or a loved one cycles through addiction, mental illness or periods of instability. By the time intervention becomes available, opportunities for earlier support may have already been lost.
We encourage preventive medicine, preventive financial planning and preventive public health measures. Yet many of the systems surrounding aging, vulnerability and decision-making remain largely reactive.
What might be possible if we focused more attention on the years before crisis occurs?
Advisors can help
It is not a financial advisor’s role to diagnose medical conditions or provide legal opinions. However, we occupy a unique position in a client’s life. We maintain relationships that span decades. We witness retirement, widowhood, caregiving transitions, business sales, inheritances, family conflict, illness and eventual estate settlement. We frequently collaborate with lawyers, accountants, trustees and family members who form part of a client’s support network.
This long-term perspective allows us to observe gradual changes that may not be visible during a single medical appointment or legal consultation. More importantly, it creates opportunities to start conversations before a crisis occurs.
Powers of attorney, representation agreements, trusted contacts, family meetings, advance care planning and discussions about future support systems are often viewed as planning documents. They are really tools that help preserve autonomy by creating structures of support before they become urgently needed.
Their greatest value may not lie in what happens after capacity is lost, but in helping families navigate the years when vulnerability is increasing and difficult decisions are beginning to emerge.
Recognizing that gap is the first step. The more important question is what we do about it.
The challenges facing vulnerable people cannot be addressed by any one professional acting alone. But there are opportunities to improve how advisors support individuals and families.
- Shift the conversation from capacity to vulnerability. Families want to know how to support someone who is becoming increasingly vulnerable while preserving their autonomy and dignity. Recognizing vulnerability earlier creates opportunities for support before a situation reaches a crisis point and encourages a more nuanced understanding of the challenges people face.
- Embrace supported decision-making. For many people, the goal is to help their loved one continue making decisions safely for as long as possible. They need trusted people to help them understand information, evaluate options, coordinate care and navigate increasingly complex systems.
- Build stronger bridges between professions. Greater collaboration could help identify risks earlier, reduce gaps in communication and create more coordinated support plans. The families who navigate these situations most successfully are often those supported by a team of professionals working toward a shared objective rather than operating in isolation.
- Recognize social isolation as a significant risk factor. Some of the most vulnerable people are not experiencing severe medical or cognitive decline. They are simply alone. Isolation affects physical health, mental health, financial vulnerability and overall quality of life. It can increase susceptibility to scams, worsen depression, accelerate cognitive decline, contribute to substance use disorders and make it more difficult to access support when challenges arise.
- Expand our definition of planning. As professionals, we often focus on legal documents, financial plans and health-care directives. These are important, but they are only part of the picture. We should also be asking who would notice if this person stopped answering the phone, who checks in regularly, who is part of their support network and who will advocate for them if they cannot advocate for themselves.
For generations, we have built systems around independence and incapacity, as though they are the only two states that matter. Increasingly, it is the space between them that deserves our attention. That is where families struggle. That is where professionals often feel powerless. And that is where some of the greatest opportunities to preserve dignity, autonomy and quality of life still exist.
Alysha Tse FEA, CFP, TEP, MTI, CLU, CHS, MFA-P, CIM, is a wealth advisor and associate portfolio manager with Chernick James Tse & Associates Wealth Counsel, a team at Richardson Wealth Limited, in Vancouver.