Montana Dementia Care Checklist: What to Do After a Diagnosis

The Sequence Matters

When a parent is diagnosed with dementia, the instinct is to start researching memory care facilities. That is actually the wrong first move. Montana's care coordination process has dependencies — each step unlocks the next, and skipping ahead creates gaps that are expensive and time-consuming to fix later.

The checklist below follows the order Montana families actually need. Legal authority comes before financial planning because you cannot manage a parent's assets without it. Financial documentation comes before Medicaid applications because the 60-month look-back requires records you need to assemble in advance. Program enrollment comes before facility selection because Medicaid eligibility determines what you can afford.

Legal Authority (While Capacity Remains)

• Execute a Montana Durable Financial Power of Attorney (durable by default under MCA § 72-31-304)
• Execute a Durable Power of Attorney for Health Care
• Register the Health Care POA with the Montana DOJ End-of-Life Registry
• Designate one primary agent per document to avoid sibling deadlock on decisions
• If capacity is already lost: consult a Montana elder law attorney about guardianship and conservatorship petition through the District Court

The capacity window closes without warning. Every month you delay is a month closer to needing the $2,000 to $5,000 court process instead of the straightforward POA execution.

Financial Documentation

• Compile 60 months of bank statements for all accounts
• Gather property deeds, vehicle titles, and real estate records
• Document all insurance policies (life, long-term care, health)
• List retirement accounts, investment accounts, and pension income
• Record all gifts, transfers, or property changes in the past 5 years
• Note any jointly held assets — Montana's expanded estate recovery under MCA § 53-6-167 reaches non-probate assets including joint tenancies, TOD deeds, and life estates

This is the documentation Medicaid's look-back audit requires. Gathering it takes most families two to three months when they start from scratch.

State Program Enrollment

• Request a Level of Care assessment through Mountain Pacific Quality Health (MPQH) to establish Nursing Facility Level of Care (NFLOC) eligibility
• Apply for Community First Choice (CFC) — a Medicaid entitlement with no waitlist that covers personal care attendant services, including self-directed care where you hire the aide
• Apply for Big Sky Waiver (BSW) through your regional Area Agency on Aging — BSW is slot-limited with a waitlist, so apply early even if CFC covers current needs
• Complete a TCARE caregiver assessment through your AAA to access local respite programs
• Register your parent with local law enforcement for Silver Alert eligibility if wandering behaviors have started

Safety and Crisis Preparation

• Secure exits at the home if the parent wanders (door alarms, deadbolts that require keys from both sides)
• Remove or disable vehicle access if driving is no longer safe — document the physician's recommendation
• Set up a medication management system (pill organizer, pharmacy blister packs, or an automated dispenser)
• Post emergency contacts and the parent's medical summary in a visible location
• Identify the nearest Category C memory care facility and verify its DPHHS license through the QAD portal — even if placement is not imminent, knowing the option exists reduces crisis decision-making

Facility Evaluation (When the Time Comes)

• Verify Category C licensure through DPHHS QAD — not Category A or B, which lack memory care authorization
• Tour during different times of day and on weekends to assess actual staffing levels
• Ask for the staff-to-resident ratio and dementia-specific training credentials
• Review the facility's most recent DPHHS inspection report for deficiency patterns
• Confirm the 21-day Health Care Plan process and ask how care plans are updated as decline progresses
• Understand the facility's discharge policy — under what conditions will they transfer your parent out

Medicaid Application

• Confirm the parent's assets are at or below the individual limit of $2,000 (after spend-down)
• Calculate the Community Spouse Resource Allowance (CSRA) if the parent is married
• Verify that Montana's medically needy spend-down applies to monthly income over the limit — no Miller Trust needed
• Submit the application to the local Office of Public Assistance (OPA), online at apply.mt.gov or on paper
• Track the 45-day decision timeline for age-based applications (90 days for disability-based)

Ongoing Monitoring

• Attend or request updates from quarterly care plan reviews at the facility
• File annual guardianship/conservatorship reports with the District Court if applicable
• Track Medicaid renewal deadlines and respond to any requests for updated documentation
• Monitor for care quality issues and report concerns to DPHHS QAD or the Long-Term Care Ombudsman

If you want this entire sequence in one organized reference — with worksheets, templates, and Montana-specific program details — our Montana Dementia & Memory Care Guide covers every step from legal planning through facility placement and Medicaid enrollment.

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