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Every day I receive questions from family caregivers and it’s remarkable how similar everyone’s questions and concerns are. Every two weeks I select one question and share the response with you.

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My mother, age 84, recently decided that she wants to move to an Assisted Living Facility. Together we have done a lot of “homework” to find a community that offered the type of activities and accommodations that she was searching for. It’s also within 30 minutes of my home, so our visits and family activities won’t miss a beat. A real bonus! She is scheduled to move in at the end of the next month, but now she is having second thoughts and jitters. She didn’t make the decision easily and spent a lot of time finding the best place for her. I think it’s just nerves…. Any thoughts?  Ellen J., Weston, FL.

 

Your mother sounds like a very strong and decisive woman. To make such a big change in her life took a lot of courage and planning and it’s understandable that as moving day approaches the reality of it is sinking in and she may be having second thoughts.

As with any transition, at any age, easing into a new situation can help to lessen anxieties. Here are some suggestions for making the change go smoother for her:

In the next few weeks, arrange to have a few lunches with her at the ALF and make an effort to help her meet some residents. The executive director should be able to facilitate these introductions with happy residents. Positivity is a good thing!

I help an elderly neighbor who is legally blind but incredibly sharp. The problem is his house. It’s not very tidy and he’s managed to accumulate an abundance of stuff over the years. He needs someone to help him clean it out, but as you can imagine he’s not very trusting of strangers. I can help but I know the job is too big for me to do by myself… Thanks in advance. Elizabeth T., Miami, FL. 

You are kind to be so helpful to your neighbor. I do have some suggestions to make this task a bit easier. 

My mother, age 88 has lived alone for 10 years and wants to keep it that way, despite her unsteady gait and uneasiness about driving.  She enjoys spending time with my brother, and me and with friends as long as someone provides the transportation.

She has agreed to have companion care for 15 hours a week and that has worked well for the past six months. But we're concerned about her being alone at night. She says she doesn’t want someone "hanging around" while she’s sleeping and quite frankly, the added expense is more than we can afford. Any suggestions?  Maria G., Fort Lauderdale, FL

Your mother sounds like she is at a turning point: she is still active and values her privacy, but without some support, her unsteadiness puts her at a high risk for a fall. Considering her immediate needs and the cost of additional hours of care, I suggest that your mother consider a live-in companion. That’s because, generally speaking, once you exceed 12 hours per day, it becomes more cost efficient to have companion care around the clock.

There are many benefits to live-in companion care that most people overlook, instead focusing on the lack of privacy and expense. However, I think the idea will appeal to your mother when she considers the following;

My mother, age 78, had a stroke 3 weeks ago. Yesterday she was transferred to a rehabilitation center where she will stay 2-3 weeks. Her doctors are confident that she will be able to resume a fairly active and independent lifestyle.

I’m prepared to get everything all set for my mother’s return to her home and fortunately, I have friends who have been in similar caregiving situations and they are giving me lots of advice. But I don’t know where or how to start getting things in order. Can you give me a list of what to do?  Julie R., Westwood, NJ.

A lot of what you need to know and prepare for will be included in a personalized discharge plan that the hospital or rehabilitation center prepares for patients and their caregivers when they’re ready to return home. Its purpose is to ensure that the patient is able to safely continue their physical improvement in their own residence, thus reducing the possibility of a hospital readmission. It’s a valuable service that should give you the specific guidance you need to help your mother continue her recovery in the weeks and months ahead.

My mother age, 76 has lived alone for several years and she’s decided that she would like to move to a retirement community so that she can socialize and be with other people on a daily basis. A recent assessment determined that while she can perform her own personal care tasks, she requires some individual supervision because she’s at high risk for falls and needs some medication reminders.

I’ve called a few assisted living facilities and all have been exceptionally professional in providing me detailed information about their facilities and prices. Some feel she can live in the independent side but with a little bit of help, while others recommend that she should reside in the assisted living section, utilizing the lowest level of care offered. We’re more comfortable with her being in assisted living and having the supervision she needs built in.

How do we decide which ones would be the best for her? Elyse H., Phila, PA.

I’m often asked by family caregivers to recommend an assisted living facility for their parent. But, as you have discovered, there isn’t a quick answer. A decision as important as this one requires a lot of homework to make sure that the ALF offers her the support she needs now and in the future and fulfills her expectations of a busy social life with lots of activities to participate in.

I think the real challenge for your mother will be finding an ALF that will Buttonsmeet her daily social needs since, at 76, she will be one of the younger residents. (Just over 25 percent of ALF residents are between 75 and 85 years of age.) With that in mind, here are three questions to ask the directors of the facilities you are considering:

My parents moved to be close to me eight years ago when they were in their mid eighties and moved into an independent living facility. I have two sisters whom I talk to often, but who live several hours away.

Everything went very smoothly, for the first five years. However, their health has declined a lot and they now reside in the assisted living section of the facility where they require considerable additional help and services. There isn’t a day when there isn’t a “crisis du jour.”  

My siblings visit a few times a year, but they seem to come for  “vacation” and when they leave I am more frazzled then before they came. It would be so much better if they came to help me and to give me a break.  I don’t seem to be able to get the message across. What can I do to get them to pitch in and give me some relief?  JoAnn G., Boca Raton, FL

It’s not unusual for one sibling to shoulder most of the responsibilities of caring for their aging parents. Often it’s because he or she lives closest to where the parents reside or has the most available time to devote to their ongoing care. But as you have learned, it can leave you feeling unappreciated and unsupported by those closest to you.

I have a hunch that because of your competence and generosity towards your parents, you might not have communicated to your sisters just how challenging the situation has become for your parents, now in their 90s, and for you, their primary caregiver.

My mother age, 76 has lived alone for several years and she’s decided that she would like to move to a retirement community so that she can socialize and be with other people on a daily basis. A recent assessment determined that while she can perform her own personal care tasks, she requires some individual supervision because she’s at high risk for falls and needs some medication reminders.

I’ve called a few assisted living facilities and all have been exceptionally professional in providing me detailed information about their facilities and prices. Some feel she can live in the independent side but with a little bit of help, while others recommend that she should reside in the assisted living section, utilizing the lowest level of care offered. We’re more comfortable with her being in Assisted Living and having the supervision she needs built in.

How do I decide which ones would be the best for her? Elyse H., Phila, PA.

I’m often asked by family caregivers to recommend an assisted living facility for their parent. But, as you have discovered, there isn’t a quick answer. A decision as important as this one requires a lot of homework to make sure that the ALF offers her the support she needs now and in the future and fulfills her expectations of a busy social life with lots of activities to participate in.

I think the real challenge for your mother will be finding an ALF that will Buttonsmeet her daily social needs since, at 76, she will be one of the younger residents. (Just over 25 percent of ALF residents are between 75 and 85 years of age.) With that in mind, here are three questions to ask the directors of the facilities you are considering:

My parents are in their late 70’s and live in Delray Beach. Though I don’t live near them, I speak to them a few times a week and see them several times a year- and my children go down on their own for visits during their winter breaks. Other than a little arthritis and a few aches and pains, they are perfectly fine and are thoroughly enjoying their retirement and family.

I secretly worry about them—Many of my friends are actively involved in their parents day-to day lives and I want to make sure I’m not in “denial” and overdoing it by sending my kids to visit them.

How do you know if things are “too much” or if they need a little help? Carrie G., Long Island, NY

You are fortunate to have parents who are both healthy and happy in their retirement. Perhaps you should take your cues from your parents and hold off worrying too much about their welfare before you have to. Your occasional visits and those of your children, offer numerous opportunities to observe first-hand any changes in their status, however slight, giving you ample time to ramp up your involvement. Your concern is certainly understandable. Typically, our parents don’t want us to know about health or aging problems for fear of us meddling in their lives and losing their independence. That’s understandable too. But there are some signs that we can pick up even over the phone.

My father, age 90 is the sole caregiver of my 83-year old mother who has Alzheimer’s disease. He does an amazing job, but he is clearly exhausted by the end of the day. I do what I can, but my full-time job limits my ability to help more.

My parents can afford to hire helpers, but my father insists that he can handle everything on his own. How can I convince him otherwise? My mother’s condition will only get worse with time. Gina F., Fort Lauderdale, FL

If I ranked the most common questions I hear from family members, the issue of a parent resisting much-needed help would rank right up there in first or second place. For many reasons -- maintaining privacy and independence, as well as pride of loyalty and caring for your loved one -- many seniors resist in-home help until the situation deteriorates so much that they no longer have a choice in the matter.

Nevertheless, it’s a challenge that often requires the professional intervention of a geriatric social worker or care manager who have experience in finding just the right words to “unlock” the stalemate.

My father suffers from Alzheimer’s disease. He and my mother live in their home and have required little outside help and support. Recently, however, my father has stopped sleeping and he becomes very agitated at night. I’m very concerned, not only for him but for my mother. I’ve done a lot of research on “Sundowning” as it’s called, and have spoken with professionals but none of their recommendations or the suggested remedies that I’ve read about have worked.

We’ve hired a caregiver to help at night time. This enables my mother to sleep but it’s expensive and does little or nothing for him. Does this ever go away? If not, what can we do to make it more livable? Carla B., New York, New York.

You’ve described a classic case of “sundowning,” a common problem in dementia patients, characterized by lack of sleep and high levels of anxiety and delirium. As you have observed, his behavior impacts the safety and well-being of your mother as well as family caregivers trying to help. You are smart to get additional help at night.

I’m very concerned about my 81-year old mother because she spends so much time at home alone, watching TV. Lately when I come by after work, she’s still in her nightgown. I can’t seem to interest her in anything. I’ve tried taking her to church for card games, to lectures at the local community center and I’ve even persuaded her to call a few friends for lunch. I know she enjoys herself when she finally does something but she won’t take any initiative herself. I have suggested she hire a companion to accompany her on errands or just take a walk together, but she flatly refuses. No matter how much we argue about this I don’t seem to be able to get her to come out of her shell. What can I do to help her get out more? Lisa S., Orlando, FL.

What you are observing in your mother’s behavior - her apathy and overall lack of motivation - is something I hear often from family caregivers. Unfortunately it is a common scenario among seniors and it has many potential causes.

While you continue to encourage your mother to participate in activities outside her home, I recommend that she be evaluated by a geriatric physician. I asked Dr. Marc Agronin, a geriatric psychiatrist and the Director of Mental Health and Clinical Research at the Miami Jewish Health Systems, how he would approach a patient like your mother. Here’s what he told me:

My father, age 87, has lived alone for many years. He’s recently had some health issues and though he remains pretty independent, he now has a live-in aide who helps him with his dinner, errands, transportation, and assists him a bit in the mornings. I live a few hours away by plane and am able to visit him often. I’ve tried to convince him to move near me, but he has many friends in his apartment building, and is comfortable and well situated with his healthcare.

I love visiting him, but when I go home I feel anxious, that I should be doing more for him. Any suggestions? Debbie G., Paramus, NJ

I too was a long-distance caregiver so I appreciate your feelings of anxiety or helplessness when you can’t be with your father as often as you would like. But you have described him as content, well cared for and surrounded by friends. A trifecta we should all aspire to in our senior years!

May I suggest that you splurge for a pair of tablets that you can use to communicate with each other regularly? Skyping with your father and his aide would allow you to see firsthand how he is doing and you would feel more present in his life.

A client of mine, faced with the same challenge of long-distance caregiving, told me that tablets turned out to be a “fabulous solution” for her family;

My mother has some hearing and memory loss, so I think it’s important that I or one of my siblings accompany her on her doctor appointments. Yet, because of my mother’s desire for privacy and independence, we always are relegated to the waiting room and her physician is not permitted to talk with us about her care. What can we do to convince her that we’re on her side and only want to help with her healthcare needs? Cindy D., New York, New York

I agree with you that it is can be very helpful, and in some cases essential, to accompany your parent, to a doctor’s appointment. This can be true even for a spouse or a friend who, at the time of an office visit, is feeling “fine, thank you” and can’t recall having experienced the very pain or discomfort that they’ve been complaining about. So they minimize the very problem for which they are seeking help.

When you add memory or hearing impairment to the equation, as is often the case for seniors, details about diagnosis, follow-up lab work or dosing instructions for prescription medicines can be misunderstood or quickly forgotten unless someone is taking notes.

My mother, age 92, who has always had a loving and sweet disposition, has turned into a rude and abusive woman. She shows early signs of dementia, but she is in relatively good health. She won’t leave the house and though she complains about being lonely at night she threatens to call the police if we suggest a nighttime companion. Her behavior is irrational and I don’t know what to do to help her. She refuses to see a geriatric psychiatrist and her physician is concerned that a calming medication could contribute to a fall. Can you give us any advice? Michael B., Miami, FL

 

This is indeed a very difficult and stressful situation for you but unfortunately, it is not uncommon, according to Dr. Leslie Kernisan, a board-certified geriatrician and a clinical instructor at the University of California, San Francisco, whom I contacted for some expert advice on your situation. Here is what she advised in an email to me;

My husband has dementia. He has some very good and lucid days. Yet there are times when he becomes confused. I have a signed a durable Power Of Attorney that we had done in 2009. One of my friends told me that my POA is "null and void" because the laws have changed. Is she right? And if so, what should I do? Lorraine G., Palm Beach, FLA

 

Your friend is partially correct. Prior to 2011, the Durable Power Of Attorney (POA) document simply had to state that your husband grants you the authority to make financial and other decisions on his behalf if and when he becomes too incapacitated to handle his own affairs. In 2011 a new law went into effect requiring each category that you are given POA over, such as directing his medical care or making financial decisions, to be enumerated and signed by your husband.

My mother is 89 years old with onset of dementia. She lives alone in a large house and my and I sister drop by several times a week to visit and check on her. She forgets to take her medications and does not eat like she should yet she refused help from anyone who is not family. Denial is her favorite defense. Any suggestions? Jon G., Miami, FL

It's always difficult to know what to do when a parent resists help they clearly need. Your mother's behavior will likely become even more challenging as her dementia progresses.  That's why it's so important for you and your sister perservere to put a plan in place that will ensure that your mother takes her medications regularly, eats well, and has the additional support that she needs so that she will remain healthy and safe.

I contacted Dr. Bonnie Levin, the Director of the Division of Neuropsychology, at the University Of Miami and relayed your question. She offered two strategies. 

My mother, age 86 lives alone in a high rise building, where she has several friends that she socializes with. None of them drive, but together they depend on car services or someone’s family member for errands, grocery shopping and other outings.

A few months ago she fell and fortunately she was only bruised. But now she’s become anxious about being alone. She can afford to get some help but the thought of interviewing a stranger in her home frightens her. I live in New York and I’ve tried to help her find a companion, but even I get overwhelmed after speaking by phone to the home health agencies. Any advice?  Jeremy S., New York, New York.

It’s understandable that your mother would be fearful of letting strangers in her home, even if they are there to help her. I can suggest several ways that you can help her get through this fear.

First, begin with some research and “strategic planning” from your home in New York so that you’re ready to implement a plan with your mother the next time you visit her.

Before making any calls to the agencies, talk with your mother to reassure her of your involvement in finding just the right person and to keep her focused on the end result. That is, she’ll be happier, more relaxed and able to live even more independently as she ages with a companion. Ask her what type of help she wants and the hours she thinks some extra support would be most helpful to her.

My husband has dementia. Recently he has lost a lot of weight —and I’m concerned. We went to a gastroenterologist and after a complete work-up it was determined that it is a direct result of the dementia. The doctor recommended that we consult a nutritionist who could make recommendations for dietary and behavior changes and suggest some supplements. I don’t want to irritate my husband with changes if they’re not going to do any good… Can this help?  Nancy F., Wellington, Florida

Your physician was wise to recommend a consultation with a nutrition expert, especially one who is experienced working with geriatric patients, such as Barbie Lazar MS, RD, CDN, Clinical Nutrition Manager at Miami Jewish Health Systems. She told me in an email that weight loss is a common challenge for people with dementia and the main culprit is usually undereating. She offered this advice:

My husband and I both have long term healthcare insurance which we have not had to use. But we will! He is 81 and I am 75. I want to contact the companies and ask questions about how and what to do to activate care when it becomes necessary. Do you have any suggestions?  Janice M., Miami, FL

In general, activating the policy is simple. The front page will identify the company and the phone number to call to initiate a claim. Most companies have a toll free number and the claims department will answer your questions. They can send you a claim form for you to keep for your files so that you’ll have them if the time comes to activate your policy. 

I am a 63-year-old, single woman who needs to get her estate documents in order and I want to have a health care surrogate to make my end of life decisions if I am incapacitated. However, I am concerned about burdening my two sisters with that responsibility. Is it ok to appoint an outsider as a health care surrogate, and if so should I appoint a professional or a friend?

I congratulate you for taking the time now to consider how you want your medical care to be handled in critical situations. Making your wishes known in a living will and designating a healthcare surrogate who understands your wishes are essential steps in estate planning.

The job of a healthcare surrogate is to communicate your previously expressed instructions to medical care providers and advocate for you if necessary. That is why it is so important that your conversations with the surrogate are thorough and explicit.

My mother is 87 years old and has full blown dementia. She cannot be left alone and requires daily assistance. She is awake a good part of the night and recently she has developed panic attacks. Every time I leave she wants to know if she can come with me. Since I work full time this is usually not an option.  She is being well cared for by her caregivers.

I know she can’t control her behavior- and that her lack of sleep doesn’t help. Her doctor suggested melatonin for the sleep, but that did not help. What can I do to keep her calm and keep the panic attacks to minimum?  Marla H., Miami, FL

Caring for a loved one with dementia can be very challenging and emotionally draining.  As you are learning, the disease is not just about memory loss: It also involves personality changes and impaired reasoning so that independent daily living is severely limited.  

To learn about the options available to your mother for her insomnia and anxiety, I contacted Dr. Leslie Kernisan, a geriatrician in the San Francisco Bay area and the physician behind the excellent website, Better Health While Aging. In her email response to my question, she described your mother’s situation as “tricky” to manage;

My mother is 87 years old and has full blown dementia. She cannot be left alone and requires daily assistance. She is awake a good part of the night and recently she has developed panic attacks. Every time I leave she wants to know if she can come with me. Since I work full time this is usually not an option.  She is being well cared for by her caregivers.

I know she can’t control her behavior- and that her lack of sleep doesn’t help. Her doctor suggested melatonin for the sleep, but that did not help. What can I do to keep her calm and keep the panic attacks to minimum?  Marla H., Miami, FL

Caring for a loved one with dementia can be very challenging and emotionally draining.  As you are learning, the disease is not just about memory loss: It also involves personality changes and impaired reasoning so that independent daily living is severely limited.  

To learn about the options available to your mother for her insomnia and anxiety, I contacted Dr. Leslie Kernisan, a geriatrician in the San Francisco Bay area and the physician behind the excellent website, Better Health While Aging. In her email response to my question, she described your mother’s situation as “tricky” to manage;

I am 85 years old. My husband died two years ago, after a 65-year marriage. I’m still very sad and lonely, and bored as well. I drive but do not like driving far or at night. My children live nearby and I see them regularly, but they’re very busy with their own children and careers. They’re concerned about me and have suggested that I move into an independent living facility. I’ve visited a few and have no interest. Can you advise me? — Sandy H., Aventura, FL

Thank you for reaching out. Your loss of your husband’s companionship, and perhaps close friends, can make this a sad time of your life.

But your question suggests that you want to do something about it and that is a wonderful place to start. Loneliness is one of the most common issues I hear about directly from seniors as well as from their adult family members who are concerned about them. It can lead to depression and apathy, which in turn can impact the quality of your sleep, consistency of good nutrition and ultimately result in impaired health. But loneliness doesn’t have to be your new set point. If you’re willing to make new connections and keep an open mind, you’ll likely be surprised at how many options you have to choose from.

I am a 72 year old “child.” My mother is 96 and is amazingly alert. She lives alone in my childhood home, very near where my husband and I live so I’m able to check in with her a few times a day and bring her meals. I love doing things with and for my mother, but I can’t be there 24/7 and she refuses extra help.  Last week she fell three times. Luckily there were no major injuries, but she was unable to get herself up and I found her three hours later. I need to do something, but what?  Janice W., Miami, FL.

Having already experienced several falls, your mother is indeed at a very high risk for a life changing injury should she fall again. You are right to be concerned about your mother’s unwillingness to allow helpers.

I do think you should talk to your mother again, focusing on her continuing risk for a fall and your concern about her safety. Be specific about the tasks that a companion could take care of to make things easier for your mother. For example, having a helper in the early evening would make her transition to nighttime and bedtime easier, and thus safer.

My mother has advanced Alzheimer's Disease along with several other chronic conditions that require medications. In addition to the eight prescribed medications that she takes every day, she also takes supplements. My father took care of organizing her meds until his own health challenges made that too difficult for him.   

My mother has 24/7 care from terrific aides provided by an agency, but they are not licensed to either set up or give her the medications. So, I have been going over to their home and organizing her meds so that the caregivers can place them in front of her at the appropriate times. It’s been a disaster! Between making sure she takes all of the medications at the right times and making sure she doesn’t run out, it's almost like a full-time job.

Any suggestions? Laura S., Miami FL.

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I live in Miami with my three teen-age children. My parents, ages 86 and 83 still live in my childhood home in Maine with my sister nearby. My mother is in the early stages of dementia, but with just a little extra help, my father is able to take care of her and provide the supervision that she requires. It has gotten exceedingly more difficult for them in the cold winter months when weather prevents them from getting out, taking care of the house and visiting friends.

My sister and I have convinced them to relocate to south Florida for the winters. Though I found communities and Assisted Living Facilities for them near where I live, they ultimately decided to purchase a home in a rural part of Florida well over an hour drive away from me (without traffic).

Having parents relocate at this age, even for half of the year, can be very challenging for all family members. I agree that their decision to come so far and not live close by to you has not accomplished as much as you would have liked. However, the steps that are needed to help them get established are the same as if they lived just next door, year-round.

My brother and I are long distance caregivers for our 88 year old mother, but because I live closer, I do more hands-on things for her.  During my last visit my mother told us that she needed to update her will. I called an estate planning attorney and was surprised that he wouldn’t give me an appointment. He told me to ask my mom to call to make the appointment, although I told him that she specifically asked me to do this for her. 

I'm trying to do as much for our mother as possible.  Is this normal, or should we find another attorney? Steven F., Chicago, IL

It appears that you received sound legal advice.

I have never been much of a conversationalist, but now that my mom has dementia, I find I am at a loss. I would like to keep pleasant conversation going, but often, I run out of things to say - especially when the conversation is so one-sided. I would appreciate if you could give me some conversation topics (we talk about the past a lot), and ways to keep it going. Marion S., Miami, FL

I know all too well how challenging it can be to keep the conversation going with someone who is cognitively impaired. I remember suggesting to my father that instead of watching television together, we just talk. His response?

My parents are in their mid-80s and live independently nearby. The other day I was at their home and answered their telephone. The gentleman on the other end asked for my father using his first name as if he knew him and proceeded to tell me about a fundraiser that his organization was doing and asked for a donation. He asked me to “verify” my father’s address numerous times. I told him to tell me what he had and I would verify it. He would not. After going through this several times I hung up.

Afterwards I wondered what would have happened had my father had picked up the phone and if he would have given him a donation. While my father does not appear to have any dementia I’m not certain that he would have exercised good judgment or given in to the caller’s persistent questions.

Sadly, your experience is not uncommon. I too intercepted several calls a day to my father from would-be scammers and telemarketers hired by organizations seeking donations over the phone.

Can you give me a book recommendation for a book club? We are a small group of women in our sixties. I'm familiar with books that are focused on caregiving for our aged parents. But we prefer one that deals with our aging selves and how to live a good and safe life as we live into our 80s and 90s - with or without various impairments related to aging.  Judy U., Fort Collins, CO

What a fabulous idea for a book club! Not only will your group learn and enjoy the book more by sharing insights, but as aging research has shown, just spending time with friends is a key ingredient of healthy aging and longevity.

My mother is 87. I have Power Of Attorney for Healthcare and can act as her Health Care Surrogate if she's unable to make her own decisions. I often accompany her to doctors' appointments where all of her medical information is openly shared with me. Recently, though, she was hospitalized and when I called to get test results they would not provide any information to me saying "I will tell your mother to tell you." Another time when I asked to see the list of her medications in her chart, they would not show it to me. These HIPAA regulations seem inconsistent and it's hard to figure out the rules. Why isn't there one standard? Alise, Miami, FL.

I know how frustrating it can be when you believe you have everything in order and have anticipated all potential hurdles. When it comes to HIPAA matters, the answers are not so simple.

My parents are elderly and frail and require a lot of help. I'm an "only-child" and find caregiving to be an overwhelming experience. I'm in desperate need of a support group. The few that I've found in my area are focused on a specific disease or cater to older individuals caring for an ailing spouse. I did find one that was neither age nor disease specific, but only a few individuals participated, and without regularity. I have even thought about starting my own group and finding a therapist to facilitate it, but I really don't know how to go about doing this.  Do you have any suggestions?  Shelley C., Palm Beach, FL.

I receive many requests from caregivers looking for support groups so I am aware of how difficult it is to find one that’s a good fit. It requires a lot research and telephone calls to qualify them.

My Husband is 67 years old and has dementia. I work full time, and must be available for meeting and have time to work at home. We have a caregiver who comes in a few days a week for just a few hours, but I need more help. Can you suggest ways to have full time assistance that isn't so expensive? Anna P., West Palm Beach, FL.

Have you considered Adult Day Care Services?

I’m turning 65 this year and work full time at a company that provides full health benefits. I'm confused about whether I should sign up for Medicare since I don’t need it. I checked with the Human Resource Department of my company and they told me that it was not necessary. However, several of my friends have told me that I could incur stiff penalties if I don’t. What should I do?  Robert L., Coral Gables, FL

Understanding Medicare, let alone signing up for it can be a daunting experience for anyone, even for the most seasoned healthcare professional.

My mother is showing signs of forgetfulness and confusion. She constantly repeats questions and is often very confused. It’s easy for my sisters and I to see that her short-term memory is declining and we’re worried that she lives alone without any assistance.

When we took her to her physician, a Mini Mental State Examination (MMSE) test was performed and we were very surprised to learn that she scored a 28/30 - indicating no impairment. Now my mother insists that she doesn’t need any help. How is this possible? Do doctors really rely on this test?  Wendy D., Richmond, VA.

You’re not the first one to be surprised about the results of a loved one’s MMSE and perhaps you should delve more deeply into your concerns. I contacted Dr.

My 87 -year-old father has put a long-time helper in charge of paying his household bills. When my brother and I ask her about his daily expenses, she refuses to speak to us, saying that she only works for my father and doesn't have to answer any of our questions. She has even locked up his checkbook so family members cannot access it. I am concerned about his being taken advantage of. He insists that she is trustworthy, but I have my doubts. What can I do?

You are right to be concerned. Her attitude is certainly a red flag that you should pay attention to. When it comes to financial matters, it's important for a family member to do what they can to safeguard their parent's savings.

My 85-year-old mom alternates between completely on-the-ball and totally confused by the details of daily life. I have gradually assumed responsibility for many things -- bills, doctors appointments, etc. -- that have proved difficult for her, and she is quite grateful. I am thrilled to be able to do this for her. However, in the moments when it dawns on her how much control she has ceded, she becomes angry and argumentative, feeling insulted and disrespected. On several occasions, I've given in to her demands to take back the reins on certain things -- only to have things go badly off track, creating more stress and anxiety for both of us. Which makes the whole process of caregiving emotionally exhausting -- even though the actual effort in "taking care of things" is not difficult to manage. Can you give some advice for navigating these issues of control that will help de-stress this situation?

Your question addresses many of the issues and emotions that family caregivers often experience.

I live a three hour plane ride from my parents, though we talk by phone nearly every day. Whenever I ask them how they’re feeling, they always respond with a one syllable word - usually “fine” or “great.” But when I recently visited,  I saw firsthand how much they had aged in only six months. I’m worried, but they insist they don’t need help. How do I know if my parents really need assistance or I’m just being over protective making myself feel better? Amy S., Englewood, NJ

It's understandable to want assurance that your parents are living safely and there are a pair of eyes watching over them when you can't be there. On your last visit, did they appear confused, poorly dressed, or noticeably thinner?

My mother is 88 and has had the same aide for the past three years. She is very fond of her. The other day I noticed that she had written a check to the caregiver for $1500. When I asked her about it, my mother replied that she and her husband needed some money for a house repair. When I asked her if she’d given her money previously, my mother couldn’t remember. The caregiver takes really good care of my mother, but for some reason this really bothers me and leaves me with a bad feeling. Should I just forget about it?  Marjorie F., Miami, FL

You should NOT forget about this. I can understand your mixed emotions and indecisiveness as to how to handle your situation.

My mother is still living independently at home but due to failing eye sight, she no longer drives. However, she needs to grocery shop and do other errands a few times a week. I don’t live nearby to take her regularly. Can you recommend a car service that can pick her up and take her to do these errands? I want to make sure it's a reputable company.  Barbara, Fort Lauderdale, FL

I don't think a car service is the best solution for your mother. Instead, I would hire someone for companion care.

My two siblings and I share caregiving responsibilities for our 85 year old mother, though I help with most of her day to day needs and manage her finances. Based on her current expenditures, she only has enough money to last another 2-3 years, but neither I nor my two siblings can afford to support her if she runs out of money. So every penny counts. The problem is my brother. He often asks her for money, and my mother, not appreciating her constrained financial situation, is only too happy to give it to him. I’ve tried talking with my brother, but it doesn't change anything.

There are two responses to this question: one pertaining your relationship with your brother, and the other pertaining to preserving your mothers’ assets.

I am 80 years old. My husband, age 84, has memory issues and while our life thus far remains largely unchanged, I am beginning to see changes in him that are evidence of dementia. I think we’ve prepared ourselves very well for what may come down the road. We have three adult children with whom are very close to but who all live far from us. My biggest concern is what should happen to my husband if something should happen to me first and I’m no longer able to help him myself, or manage his care. Jeanne N., Miami, FL.

It’s wise of you to think ahead, considering different scenarios that you should be prepared for and involving your husband in the decision-making while he is able.

I live in California and have a formerly independent, elderly father in Tamarac, Florida, who is deteriorating following a mild stroke and is becoming an increasing burden for his partner, who lives with him. He has an extensive support network of friends in South Florida and doesn't wish to relocate to California, where my brother and I could more easily support him. I need to find an Assisted Living Facility (ALF) for him in the Tamarac area. I certainly intend to travel to Tamarac and inspect the facilit(ies) personally, but it would help me a great deal to have a starting point.

Is there an online resource where I could read reviews of the available facilities and then obtain as much advance information as possible; so that my trip to Florida would be as fruitful as possible? Lawrence W., Los Angeles, CA.

I would strongly advise you not to rely upon reviews that are posted online nor websites that aggregate listings of ALFs.

My wife and I are in our 80’s and living in an Assisted Living Facility. My wife was recently diagnosed with early Stage Alzheimer’s Disease. We participate in many activities that keep us physically and socially engaged all day long. Our issues are in the evening, when it’s just the two of us. My wife is searching for “mind games” that we can play at night that may slow the progression of the Alzheimer’s. We are computer literate, that is we have an ipad (we skype with our grandchildren) and are able to navigate games and APPS.  There’s a lot of stuff out there. What do you recommend?

t’s wonderful to hear that, despite your wife’s memory problems, you both remain physically and socially engaged all day long.

My mother, age 83, has dementia. Sometimes she’s incredibly lucid and we can have cohesive conversations. But five minutes later she may not recall them at all. I have three siblings all of whom live nearby and we are all are spending extra time with mom. However, we’re reaching the point where she requires some assistance and supervision in her home over and beyond what the four of us can offer. We agree on that. But how to proceed with her care is another matter.

My brother wants to go ahead and engage the necessary services and health care aids without taking the time to consult our mother. I disagree and feel strongly that she should be part of the decision making, even though her judgement might be impaired. Does it matter which way we get going or am I just creating more work for us? Maria G., Miami, FL.

First of all, be grateful that your siblings are nearby and want to participate in your mother’s care. That’s a wonderful place to start and your mother is most fortunate to have her children's full support.

My mother is 75. She has a few ailments, but is totally independent - both physically and financially. My concern is that her money will run out if she should require a lot of assistance as she ages. I’d like for her to get long term care insurance but she refuses. I have read so much about it, and think it’s something she should have. Is this something I should be pushing? My husband and I don’t have enough money to help her should the need arise. Leslie S., Short Hills, N.J.

Long-term care insurance makes sense for many people who can afford the monthly premiums. However, your mother’s age puts her at the top limit for purchasing a policy.

We would like to tip our mother’s home health aide on a regular basis. Is there an accepted formula for this? Or does everyone just do their own thing? Jane L., Roslyn, NY

Your desire to “tip” your parent’s caregiver as a way to show your appreciation for their loyalty and hard work is a thoughtful gesture.

My mother has dementia and lives in an Assisted Living Facility. Nearly every time I visit with her she asks me many times when she will be going home. I’ve spoken with my friends who have parents with dementia who either live with them or who live in an Assisted Living Facility and they have the same experience with their parent.  What do we say to them?  Adrienne G. Plantation, FL.

Your question brings up an important issue that many family caregivers face: what is the best way to communicate with a parent who has dementia or Alzheimers?

My father, age 88 has periods of confusion, and when they occur my mother gets very angry and critical of him, which makes him all the more confused. While I realize she’s probably acting out of fear and frustration, it is extremely detrimental. How do I address this with her? Amy V., Princeton, NJ.

Your parent’s situation is not unusual, unfortunately. Many people express anger at their parent or spouse for behavior that is clearly not in their control.

My mom is 82. Her mobility has become limited in the past year and it has become difficult to take her to appointments with her doctor, who doesn't make house calls. Do you have a list of physicians who specialize in geriatric care and that make house calls? Perhaps you have other suggestions? Sonia G., Miami, FL

Getting an immobile parent to an appointment can be an exhausting outing. Certainly one solution to your problem would be to find, as you suggested, a physician who does make house calls.

My 85-year-old mother, who is still in pretty good mental and physical shape, has recently showed signs of confusion about her finances. She lives off the principle of her portfolio, and is sent a check every month from her financial advisor. Although she is not overly extravagant, I am concerned that she is over-spending. Last year she added me to her bank account. Do you think it would be wise for me to set her up with online banking so that I could monitor her spending?  Sarah G., Bethesda, MD.

I do think that’s a good idea for several reasons.

My next-door neighbors for the past thirty years are two elderly women in their eighties. One has COPD and is frequently hospitalized; the other has macular degeneration. They don’t seem to have family members to help them, nor is there any contact by a social worker as far as I know.

Though we’re not friends, I do help them from time to time by taking them grocery shopping and each time I grow more concerned about their safety. They also seem very forgetful but deny that they need any help. But I see that they need far more than a kindness once in a while from me.  

It does indeed sound like they need extra support and you are a kind neighbor to try to help them. There are many excellent resources in south Florida for at-home seniors to take advantage of.

My sister and I are constantly taking my 86 year-old mother to the doctor for her real and/or imagined problems, and the doctor will make suggestions or prescribe treatments. She either disagrees with what the doctor says and requests to see a different doctor or decides that she doesn’t want to do the treatment or take the medicine. How do we get her to comply with what the doctors prescribe? Debra B., New York, New York.

This sounds like a very frustrating situation for everyone concerned - you and your sister, your mother and her physician. In the meantime, her medical complaint, whether real or imagined, is not being properly addressed.

My parents live in Miami. We have begun noticing memory issues with my mother and we do have a family history of dementia. Even her friends have commented to me of changes they’ve noticed.

Obviously we’re all concerned, but don’t know how best to handle the early stages of a memory disorder. I am one of five children, and while we visit regularly and speak frequently none of us live in Miami. Any help is appreciated. William M., Pensacola, FL.

If your parents have a long-time physician, chances are he or she has already noticed these changes in your mother’s memory as well, and can recommend a specialist or a 

I'm wondering if you can suggest a Mother's Day gift for my 82-year old mother, who is still very active, likes to take classes, and has a nice social life with her small group of friends. She always says that she has everything she needs and doesn't want any more gifts and stuff in her life. Still, I'd like to give her something that she won't return. I'm stumped.  Gwen S., Plantation, FL

Have you considered buying a tablet or e-reader for your mother? Even if you insist she isn’t into computers, I have a hunch that this is one gift your mother would love. She wouldn’t be alone.

My parents are in their late 80’s and live nearby- I see them often. My father, though very active, requires a lot of daily assistance as he uses a walker and sometimes a wheelchair.

Fortunately my parents have a long-time, male caregiver who is able to help my father maintain his active schedule by helping him get ready in the morning and driving him to wherever he needs to go. He’s a huge help and his presence allows my mother to maintain her own active social life. The amount of assistance required increases slowly but surely.

What you described sounds like a case of caregiver burnout, an all-too familiar consequence of caring for someone who requires daily attentive care over a long period of time.

My mother has been referred to Hospice Care for end-stage COPD (Chronic Obstructive Pulmonary Disease). I understand that prescription medications related to this condition are covered by Hospice Medicare. But what about the other medications that she currently takes for conditions including high cholesterol, elevated blood pressure and low thyroid. Will these continue to be covered under her Medicare prescription plan? Allison W., Jacksonville, FL.

I receive a lot of questions about Hospice so your question offers me an opportunity to provide a more detailed explanation about how Hospice works.

My mother is 83 years young and fortunately, in excellent health. She’s incredibly active and socializes a lot. Recently, I noticed for the first time that her walk was a little slower and that she took a longer time getting in and out of the car. My mother lives alone and now I’m concerned about her falling. I’ve read so much about seniors falling. How do I know if she’s at risk for falling and how can I help to prevent it? Amy B., Boca Raton

You are right to be concerned because falls and fear of falling are very common among older adults. Research shows that nearly one in three people over the age of 65 has a fall in a given year. And while not all of these falls cause injuries, many do.

I’m an 85 year old widow, living alone. I have a few friends in the building with whom I do errands and play cards, and they include me on errands and shopping trips since I no longer drive. I take cabs if I need to get my hair done, or to visit friends. In short, I manage pretty well. Last week I fell. I didn’t break anything but I was a little shaken and I realized that if something happened to me I wouldn’t know how to get real help. I’m organized in other ways; I have long-term care insurance, and I’ve spoken with my children about my healthcare wishes. I’m petrified that if something happens to me no one will know. A contingency plan would put my mind at ease. What can you suggest? Roz F., Clearwater, FL

I hear from many readers like you, who are living well independently but fear the day when a fall or illness will sideline them without having contingency plans in place for assistance.