Feb52026
Guardianship Q&A Series

What legal paperwork is usually needed to make medical and financial decisions for a relative with dementia? – North Carolina

Short Answer

In North Carolina, the paperwork most commonly used to allow someone else to make decisions for a relative with dementia is (1) a Health Care Power of Attorney for medical decisions and (2) a Durable (Financial) Power of Attorney for money and property decisions. Many families also use a Living Will (Advance Directive for a Natural Death) to document end-of-life wishes. If the person no longer has enough capacity to sign these documents (or if institutions refuse to honor them), a court guardianship through the Clerk of Superior Court may be needed.

Understanding the Problem

In North Carolina guardianship situations involving dementia, the key question is what paperwork allows a trusted family member to legally act for an older relative when the relative cannot reliably understand, communicate, or manage medical and financial decisions. The decision point is whether the relative can still sign valid decision-making documents now, or whether a court process is required because capacity has declined too far. This issue often comes up when an older adult is moving and will be admitted to a memory care facility, where staff may require clear legal authority for consent, records access, and payment arrangements.

Apply the Law

North Carolina generally recognizes two separate lanes of decision-making authority: health care decisions and financial/property decisions. A Health Care Power of Attorney can appoint a health care agent to make medical decisions when the principal lacks capacity, but it does not give broad authority over money or property. A separate durable financial power of attorney is usually needed to manage finances, sign contracts, deal with banks, and handle property-related tasks. If the person cannot execute valid powers of attorney (or if there is conflict, suspected exploitation, or a need for court supervision), guardianship proceedings before the Clerk of Superior Court under Chapter 35A may be the practical solution.

Key Requirements

  • Medical decision authority (Health Care Power of Attorney): A written document naming a health care agent, properly signed with the required formalities, so providers and facilities know who can consent to treatment and access information.
  • Financial decision authority (Durable Power of Attorney): A separate written document naming an agent for finances and property, used for banking, paying bills, handling insurance, and managing assets.
  • Back-up court authority (Guardianship): If capacity is too limited to sign documents (or the situation requires court oversight), a guardianship case can authorize a guardian of the person, guardian of the estate, or a general guardian through the Clerk of Superior Court.

What the Statutes Say

Analysis

Apply the Rule to the Facts: The facts involve moving older relatives into North Carolina and placing one relative with dementia into a memory care facility. That setting usually requires clear medical decision authority for admissions, care planning, and consent, which is commonly handled by a Health Care Power of Attorney if the relative can still sign it with proper formalities. It also commonly requires financial authority to sign facility contracts and manage payment and assets, which is usually handled by a durable financial power of attorney. If dementia has progressed to the point that the relative cannot understand and sign these documents, a guardianship case before the Clerk of Superior Court is often the next step to obtain legally recognized authority.

In practice, families often discover that “informal” authority (being a spouse or adult child) is not enough for banks, insurance companies, or facilities, especially when the person cannot consistently communicate choices. A second common issue is that a health care document alone does not solve financial problems; North Carolina law treats health care authority and financial authority as separate, and the paperwork should match the decision that needs to be made.

For readers comparing options, it can help to review the difference between powers of attorney and court guardianship. This firm has discussed related issues in the difference between a medical power of attorney and guardianship and in whether old documents still avoid guardianship.

Process & Timing

  1. Who signs or files: If the relative still has capacity, the relative signs the Health Care Power of Attorney and the Durable (Financial) Power of Attorney. If capacity is too limited, an interested person files for guardianship. Where: Guardianship is handled through the Clerk of Superior Court in the North Carolina county with jurisdiction. What: A petition to adjudicate incompetence and an application to appoint the appropriate guardian (person, estate, or general). When: As early as possible before admission, contract signing, or urgent medical decision-making is needed.
  2. Facility and provider intake: Memory care facilities and medical providers typically request copies of the Health Care Power of Attorney (and often the Living Will, if one exists) during intake so they can document who has authority to consent and who should be contacted for decisions.
  3. Ongoing authority: If powers of attorney are in place and accepted, the agent uses them as needed. If guardianship is required, the guardian’s authority comes from the clerk’s order and remains subject to court supervision and reporting requirements.

Exceptions & Pitfalls

  • Assuming a Health Care Power of Attorney covers finances: North Carolina law limits health care agent authority to health care matters, so a separate financial document is usually needed for banking, contracts, and property.
  • Documents signed too late: Dementia does not automatically mean incapacity, but if the person cannot understand the document at signing, the paperwork can be challenged or rejected, which can force a guardianship filing.
  • Out-of-state documents: North Carolina can recognize a health care power of attorney executed in another jurisdiction if it appears properly executed under that jurisdiction’s law or North Carolina’s law. See N.C. Gen. Stat. § 32A-27. Even when valid, facilities sometimes ask for updated North Carolina forms, so planning ahead helps.
  • End-of-life wishes not documented: A Living Will can reduce conflict and uncertainty about life-prolonging measures in advanced dementia scenarios. See N.C. Gen. Stat. § 90-321.

Conclusion

In North Carolina, the paperwork most often used to make decisions for a relative with dementia is a Health Care Power of Attorney for medical decisions and a separate durable financial power of attorney for money and property decisions, often paired with a Living Will to document end-of-life preferences. If the person cannot validly sign these documents due to declining capacity, a guardianship case through the Clerk of Superior Court may be required. The next step is to confirm capacity promptly and, if needed, file the guardianship petition and application with the clerk as soon as possible.

Talk to a Guardianship Attorney

If a family is dealing with dementia-related decision-making during a move to a memory care facility, our firm has experienced attorneys who can help clarify what documents are needed, what a facility is likely to require, and when a North Carolina guardianship filing may be necessary. Call us today at [919-341-7055].

Disclaimer: This article provides general information about North Carolina law based on the single question stated above. It is not legal advice for your specific situation and does not create an attorney-client relationship. Laws, procedures, and local practice can change and may vary by county. If you have a deadline, act promptly and speak with a licensed North Carolina attorney.

Category: Guardianship Q&A Series

Author: Pierce Law

Pierce Law Group is a North Carolina law firm focused on probate administration, real estate partition matters, and surplus funds claims across North Carolina. We know these situations often come with stress, family dynamics, and time-sensitive decisions—so we prioritize clear communication, steady guidance, and a practical plan from day one. Our goal is to make a complicated process feel manageable, while protecting what matters most to you.