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.
Ask Nancy
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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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.
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?
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:
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.
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’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.
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.”
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.
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’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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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