What can a hired caregiver do about a woman who threatens her grandmother -- who has Alzheimer's -- that the family will send her away if she doesn't take her medicines?

Carol O'Dell — Mon, 30 Jun 2008 16:38:52 -0000

I have been a part-time caregiver to a woman with Alzheimer's for about six weeks. Her granddaughter is also a caregiver to her. The young woman is in her early 20s and grandma is in her 80s. The lady's doctors have changed some of her medicine due to side effects, and she is becoming less social, wants to stay in bed, and doesn't want to get dressed or take her morning medicines. But the granddaughter is very impatient with her. She feels that she needs to force her grandma to get dressed, and she chases her from room to room, threatening that the family will send her away if she doesn't take her medication. This truly distresses the older woman -- she gets very agitated -- and it upsets me too, as you can imagine.

I am at a loss for what to do. I have discussed this with the girl's mother, and she agrees that the medicine change is causing this new mood and that it's best not to force matters when the grandma feels this way. I play music for her and give her some snacks and visit with her a little, if she lets me. We do fine. But the granddaughter is there quite a bit and she has different ideas. She's a nice young lady, but she gets very upset if Grandma doesn't do as she thinks she should.

First, I'd like to commend you for taking such an interest in this family. Professional caregivers are a vital bridge to families. People like you keep our elders safe and assist us in providing them with quality care.

Your role as a professional caregiver is one that requires a delicate touch, as I'm sure your past experiences have taught you. As a new caregiver, there's just so much you can say or do -- if you appear judgmental, the family may shut down to you. But as you gain their trust and respect, they'll find your insights and experience invaluable. That may take some patience on your part.

It seems that the family wants what's best for the grandmother but is overwhelmed and uneducated about the disease. If you're able to steer them toward what's truly important and will make the biggest impact in the grandmother's life -- such as changing her meds and getting her on an even keel -- and then gently guiding the granddaughter toward a more positive approach to care giving, they'll be able to enjoy (or at least appreciate) these last years with her. Just take it one step at a time.

First, I'd focus on the grandmother's medicines. Since the daughter already agrees with you that the new medication seems to have altered her mood, this is a good place to start. Are you comfortable encouraging the daughter to talk to the grandmother's doctor about the effects of the new medicine? If she works all day, you might even offer to take Grandma to the doctor yourself, so that you can share what you've observed about the changes in her mood and behavior. You should also make sure the grandmother can still swallow easily. If not, there are therapies that can help with swallowing, and the doctor can advise on those.

In terms of getting the grandmother to take her medicine, the most important thing is to keep that time of day consistent, pleasant, and nonconfrontational. I'd also suggest that the same person administer the pills each day. Ideally, the grandmother will willingly pick up the pill and swallow it, rather than having it forced on her, but her mood may fluctuate, so you have to be prepared with alternate plans.

You might suggest ways to deliver the pills that are easier to swallow, so to speak. When my mother had Alzheimer's, she would drink a shake that contained liquid vitamins, and that was one less thing for us to fight about.

Since you've already registered the granddaughter's threats with the daughter, you could now try educating the young woman about Alzheimer's in some subtle, nonthreatening ways. Here are a few suggestions:

Encourage the daughter or granddaughter to contact the local Alzheimer's chapter or a care-giving organization that offers workshops or support groups. Or go online and get some information that you can share with them or leave around the house. That could help both of them understand more about the disease and how best to care for someone with it.
Let the granddaughter know that, as a young person, she has much to offer her grandmother, but that you also sympathize with how difficult this is for someone her age to go through. If she's receptive to talking about it with you, suggest she visit Caring.com’s Alzheimer’s support groups or the Alzheimer's Association's online caregiver boards -- there are other granddaughters and grandsons who talk about the unique challenges of care giving when you are young. She'll see that she's not alone.
Subtly offer hints as to what her grandmother likes or responds to. Focus on the positive, because if the granddaughter starts to feel defensive, she may close down or even pressure her mother or other family members involved in the decision making to seek a less "aggressive" caregiver. If this happens, you may lose your job, and the family may end up with someone who doesn't look out for the grandmother's best interests, as you do.
Let the granddaughter know that care giving for someone with Alzheimer's can be extremely frustrating and difficult at any age, and that you're there to help. If she is threatening to send the grandmother away out of sheer frustration, she may feel relieved to hand off some more of the burden to you.

Other than that, the best thing you can do is to quietly teach by example. Take care of the grandmother as consistently as you can. Realize there are days that the granddaughter or others may throw you off your routine, and that it may take a while to get things back on track. Your ideas of playing music and finding other mood lifters for Grandma will help lift everyone's mood and educate them -- and it's a great example of how to influence the situation without being preachy or judgmental.

This family needs your wisdom and watchful eye. The granddaughter is young and she doesn't have the experience or education you have acquired. Her exuberance, youth, and connections to the outside world can ultimately add a nice dimension to the grandmother's care, but she needs to learn how to communicate with her. She may also be torn about her loyalty to her family and her desire to move on with her own life. Her mother is older and more mature, and she will grow to respect your opinion and input, if she doesn't already. Once these two women see you as part of the team, they'll begin to view each person's contribution as necessary and unique. That will not only create a more caring atmosphere -- it will make your job easier and more rewarding.

My mother says she's lonely, and it's heartbreaking for me to hear her crying at night. What can I do to help her?

Carol O'Dell — Mon, 23 Jun 2008 07:00:00 -0000

My father died seven years ago, and for quite some time my mother -- who is 90 years old and has a heart condition -- seemed to be coping pretty well. But since she was sick for two months last year, she has seemed lonelier. For the last two to three months, she has been crying frequently and saying how lonely and tired she feels. I don't know what to do except to sympathize. I'm reluctant to try to medicate her feelings away, but I hear her crying at night two or three times a week. She lives in her own house with a hired caregiver during the week, and I'm there from Friday to Monday. The caregiver has also noted her distress. Any insights or suggestions would be welcome.

Unfortunately, elder depression is a sad reality. Your mom has sustained a lot of losses, and her age and physical condition make it especially hard for her to cope. There really is no easy fix to this situation, but here are a few ideas that may help.

Your mom sounds like a good candidate for adult daycare or an assisted-living facility. As wonderful as it is that you spend your weekends with her, seeing only you and a caregiver may not be enough stimulation for her, nor is it a substitute for making new friends and being active. By meeting other people her age, she could strike up new friendships and get involved in new activities. Many assisted-living facilities have different levels of assistance, so she could live with people who have similar issues and capacities, which might also make her feel less lonely.

There's no guarantee that she will take well to either of those environments, but don't give up if she resists at first. Take her several times to places that she shows any interest in -- it may just take her time to get over her fears and feel comfortable in a social environment again.

While getting your mom involved with people and activities may be preferable to getting her to take antidepressants, they can also be a big help. Antidepressants don't have the stigma they used to, and alleviating her depression may be the push she needs to reengage with the world around her. See a gerontologist or psychiatrist who is familiar with how various antidepressants interact with the medications she is taking; this doctor may do better at fine-tuning her dosage than a general practitioner. Also ask about the side effects of the medications she's currently taking -- depression might be one of them. Go with her to her doctors' appointments as her advocate, in case she forgets or is too timid to talk about her feelings.

When you're with your mom, pay attention to what makes her perk up. And if you can visit her on a weekday, try to get a feel for how she and her caregiver interact. The caregiver may be meeting her physical needs, but that isn't the same as having a relationship with her. Conversation, joking, and sharing pleasures are things we need at any age! You might need to encourage the caregiver to take a more active, cheery role in your mom's care and brainstorm with her about how to lift your mom's spirits. If she isn't willing or able to help with this, find someone who is.

Your mom needs to feel that in some way she's part of the life that's going on around her. Dressing and eating three meals a day isn't enough. Are there other family members (especially children) who can visit her as well? Have you planned her next birthday party or family reunion? Is she religious? Maybe she has been unable to attend services since your father's death. If religion was part of her life in the past, consider making it part of her life again, as older people often miss attending religious services.

Change and stimulation are also important. As caregivers, we tend to zone out into routines that become too familiar. Try changing your weekend routine. Get her out for a walk or a drive, put on music, bring her fresh flowers. Can you take a short weekend trip or bring her to your house for a change? How about doing a simple home makeover with new paint colors, throw pillows, and other easy changes that will freshen up the place? Does she get her hair done weekly? Would she like to? How about treating her to a manicure or pedicure?

I know that all this sounds like work, and it is. But if you try not to look at it as "one more thing to do," and if your mom is receptive, it won't feel that way. Most people are lonelier than they want to admit. By making your mom's life more interesting, colorful, and fun, you'll be improving your life with her and your satisfaction as a caregiver.

In the meantime, be on the lookout for danger signs. If she says she feels hopeless and helpless, stockpiles pills, withdraws more, or exhibits bizarre behavior, she may have truly lost her will to live and could be a danger to herself. Then it's time to seek help immediately.

In the end, you might need to accept that even your best efforts can't stop her downhill descent. Sometimes people can't bounce back. Although it's painful to watch, you can't make your mother's choices for her. Understanding this now will prevent you from being wracked with guilt if she doesn't respond to your efforts. In the meantime, keep your own life on track. Learn from your mother. Sometimes our parents teach us about life by showing us what not to do.

My mother gave power of attorney to her new husband, who is putting her life in danger. How can we get it away from him?

Carol O'Dell — Mon, 16 Jun 2008 19:06:33 -0000

My mother started dating a man about six months after my father died in 2000. She didn't mention it to the family until shortly before she decided to marry him. We urged her to slow down, but she wasn't having any of it. She said to me, "Your father always told me what to do, and you are not about to start." She accused me of just being concerned that she'll spend the large sum of money my father left her, but this was the furthest thing from my mind.

She married the man about three months after they met. I just couldn't attend the wedding, especially after losing my father less than a year before. This put stress on our relationship, and it's gotten worse and worse. Phone conversations are impossible -- she tries to end the conversation as soon as she can, and her husband tries to listen in.

Recently my mother's health issues have landed her in the hospital, close to death, several times. During each hospitalization, she has asked me not to visit or call because it makes her husband uncomfortable.

After coming home from the hospital one time, she fell ill and asked to be taken back. He waited until 3:30 the next morning before he called the ambulance. At that point, her blood pressure was 60/40 and she was near death, according to my aunt. She has confided to my aunt her fear that her new husband will put her in a nursing home if her health deteriorates.

The most unfortunate part of this whole scenario is that her husband has power of attorney. My aunt, cousins, and brother have encouraged her several times to change this, but she won't budge. Do you see any avenue of recourse to save our relationship or at least get her to change the power of attorney?

Your goal must be to keep your mom safe, first, and then try to build a foundation on which everyone involved is respected and acting in her best interest. Begin by talking about your mother's situation to someone at your state's abuse hotline for elder care. Unfortunately, abusive situations (and this includes neglect) are far too common when loneliness and longing for companionship make our loved ones more vulnerable. The abuse hotline can give you advice and discuss your legal options.

You should know that if your mom will publicly back up her husband regarding his care, it will be up to you or your brother to prove abuse or neglect. You will have to report this to the elder abuse agency in your state, which is part of the Department of Children and Family Services. The agency will then assess the situation and determine whether it considers your mother in danger.

If you decide not to report the situation at this point, you need to get close enough to your mom to monitor her situation. To do this, you're going to need to create a dual plan of action: Try to settle the matter peacefully with her husband, but also be prepared to seek legal council if necessary.

First, make an attempt to clear the air with him. Explain to him that you missed your dad so much that you had a hard time attending their wedding (which is true), and you feel that this got your relationship off on the wrong foot. Emphasize how much you love your mom and just want her to be happy. Try to get him to open up to you enough that you'll have more access to your mother. This may sound manipulative, but if it works out, it's the best thing that could happen for her.

At the same time, try to document the decisions your mother and her husband make. You need to see if things are escalating, if she's falling more, if she has mysterious bruises, if she's becoming increasingly dizzy or disoriented (a sign that she may not be taking her meds). Try to get a sense of how she spends her days and when she goes to the doctor. Enlist the eyes and ears of your aunts, brother, and cousins as well. Drop in unexpectedly when you're in the neighborhood or just because you feel like seeing your mom. Remember that her safety comes first. Be willing to cause a scene if you have reason to believe she's not safe.

Your mother seems to confide in her sister, so encourage your aunt to keep the channels of communication open and active. A sister is less threatening than a child -- and your mother may feel especially humiliated to talk to you about this since she made such a point of telling you not to tell her what to do. Gentle coaxing from her sister may help her make a decision to rename a health surrogate or power of attorney. Your aunt can stress to her that no one else would need to know that she does this.

Then be ready if your mom decides to act. Have everything in place so that she can do it in an afternoon. Perhaps your aunt or cousin could take her -- she needs to feel safe and not threatened. She also needs to feel that she didn't make a terrible mistake. She needs to keep her dignity but also know there's a way out if she needs it.

Shannon Martin, director of community relations at Florida's Aging Wisely, also suggests asking someone your mother trusts -- her attorney, financial planner, family friend, chaplain, or rabbi -- to mediate a family discussion in which everyone involved can state their concerns without being confrontational. Or you could bring in a geriatric care manager for a fair and impartial voice. Hopefully, such a setting would be a more neutral and less threatening place for convincing your mother that it's in her best interest to have a blood relative, and someone who's younger and healthier than her husband, to act as power of attorney for her.

If your mother's health deteriorates further and she isn't competent to make health and financial decisions, you could go the legal route and get a guardianship (some states call it conservatorship) appointed. This is quite costly, however. So first try to offer help in a positive manner. It's in her best interest if all of you can feel comfortable enough to communicate regularly.

My mother, who suffers from dementia and alcoholism, wants my sister and me to be her caregivers, so she keeps sending away the one we've hired.

Carol O'Dell — Mon, 09 Jun 2008 07:00:00 -0000

My sister and I hired a caregiver to come into our mom's home once a week to cook, clean, drive, and generally keep things going. We have taken over the management of our mom's money, as she couldn't cope with it anymore, and we did a careful budget so that we could afford this. However, my mother is very upset about it and keeps sending the caregiver away when she arrives. Sometimes this is because she's just confused and upset or drunk, but last time she was shouting at the caregiver that she couldn't afford to pay her.

I think the problem is that my mother wants my sister and me to do the care giving ourselves because it's more comfortable for her and keeps us coming to her house. At first we tried, but we have full-time jobs and families and couldn't manage. Plus, my mother is a very difficult person, and it's hard to be around her. We hired the caregiver in desperation. How do we get our mom to accept that she needs (and can afford) a caregiver once a week?

As difficult as it may be, you must insist that your mother allow the caregiver into her home. Don't budge on this. On some level, she needs to grasp that you and your sister simply can't do her household shopping and chores. When you're there, don't pick up the slack or do work that a caregiver could be doing. If you do, she'll keep this up. Given her issues, you can't reason with her, so don't try.

You also need to find a caregiver your mother can't push around. There are caregivers and Certified Nursing Assistants with years of experience who can handle your mom with humor, kindness, and a good dose of firmness. The caregiver works for you and your sister, so it doesn't matter if your mother sends her away -- it's her responsibility to stay and do her job. Go through a reputable agency so you know that the caregiver is bonded and insured. It's worth the money.

Some caregivers just have a knack for winning someone's heart. It may take time to find the right one, and that person will need to have a thick skin and enough patience to let your mother rant until she settles down, but it will be worth the time you all put into it. A good caregiver will also have tricks to diffuse the situation and distract your mother with food, television, or a conversation about her life, career, or children.

You or your sister should plan to take off a couple of days and be there the first few times the caregiver comes. You can help her get acclimated and help your mother get comfortable with a new person coming into her home. You may also need to be there to unlock the door if your mother doesn't answer it.

In the meantime, consider the possibility that, whether it's rational or not, your mother may fear that you'll visit her less if she accepts a caregiver. While you don't need to spend your time attending to her household needs, I hope you do still plan to spend time with her. You might even point out to her that hiring a caregiver allows you two to spend your time together doing something you both enjoy. Hopefully, she'll even become less difficult if she can be at ease with this setup. If not, just know that you're loving her by doing what's right for all of you, and by taking good care of yourself.

I constantly feel guilty because no matter how much I do for my parents, I know it's never enough.

Carol O'Dell — Mon, 02 Jun 2008 07:00:00 -0000

My mom has advanced Alzheimer's and my dad is 92 and bedridden. They live at home with round-the-clock caregivers. I do all the grocery shopping, doctor's appointments, and various errands. I pay the bills and deal with financial matters -- and see them once a week. (They live an hour away). I'm so busy doing all these things that there's no time to just sit and visit. I know Dad's terribly lonely because he has no friends (and due to language barriers and his deafness, he doesn't really talk to the hired caregivers much). He probably wonders why I haven't moved them in with me, since I do have the room. (Because I'd go nuts -- that's why.) Any thoughts on how to better serve their needs and still enjoy my life?

It sounds like you're doing as much as any parent could hope for. Even if you only did half of what you describe as a caregiver, you'd hardly qualify as a deadbeat daughter. But I do have some ideas on how you can ease the burden and have more time to relax -- even with your parents.

First, though, let's talk a bit more about you: As far as I can tell, you are the only one who thinks you never do enough. Guilt is very common in family caregivers -- maybe because guilt is very common in families. But you've got to get off that train if you want to have a life and be an effective caregiver. In fact, guilt won't make you a better daughter, just a frustrated one (giving you another reason to feel guilty).

I say this out of experience. I wanted to make sure my mom, who also suffered from Alzheimer's, was happy, or at least happy enough with her living circumstances. I felt guilty that there wasn't enough of me to go around, like I was always letting someone down.

One day my mother shuffled into the kitchen, slammed her hand down on the counter, and announced, "I'm not happy!" I had done everything I could to make her happy: bought and cooked all her favorite foods, made sure she got to see the TV shows she preferred, asked that she get the hairdresser she preferred, washed her clothes in the laundry detergent she liked -- you name it. But she just stood there staring at me, demanding that I "fix" this problem.

At that point, I had an epiphany: I realized that I could do a lot of things for her, but making her happy was not one of them. I smiled at her, gave her a hug, and distracted her with a Klondike bar. And I decided that the only person I could even attempt to make happy was myself.

I say all this to remind you that although it's great that you care about your parents' social and emotional lives, you can't make them happy and fulfilled. They need to find the happiness for themselves, just as you need to do it for yourself.

Although your dad certainly did not choose his hearing loss, it sounds like he may have chosen not to make the effort to try to socialize with his caregivers. Readjusting to life's changes is tough, and as people grow older, it's often easier just to cling to the status quo, even if having companionship would make them happier. Your dad may not even be as miserable as you think. Older adults can be quite content putzing around the house and running errands. Your dad can't do those things while he's bedridden, but he could still enjoy simple things such as bird-watching or seeing a favorite TV show.

As much as you can, I would try not to rush in your parents' door and get right down to business when you visit. It's important to maintain a relationship that's not based on a to-do list. Spend at least 15 or so minutes just being with them. Watch a TV show together, sit outside if it's a nice day, shoot videos of them telling stories. Bring them a favorite treat -- flowers, some music, a pint of Ben and Jerry's -- and sit down and talk. Tell them about your day. Have you tried filling your father in on some of your activities? Some men like to hear about work and business and how the washer broke and the repairman came to fix it. Likewise, always try to have something to tell your mom. Even if she doesn't respond or know what you're talking about, she may just pick up on the upbeat cues in your voice and body language.

For your part, don't look at the dimly lit house, the groceries that need putting away, the disarray of bills stacked up on the desk. Just be with them, especially at the beginning and end of each visit. This is part of care giving. You won't just be making their day -- you'll feel happier and more fulfilled when it's time to say good-bye.

Consider if there any chores you're doing that someone else could do. Could you put away the perishable shopping items, but let one of the caregivers or helpers put away the rest of the groceries the next day? Can you take the bills and paperwork with you to do at home? Is it crucial that you take your parents to all their doctor's appointments? A visit to the podiatrist or eye doctor might be more routine than appointments with the neurologist or cardiologist. If so, a community van might be helpful, or one of their caregivers could take them to the visits you don't need to attend. Be sure to check their community resources and explore options to lighten your load. There might be more than you think.

Above all, pace yourself and enjoy where you are right now. This is stressful, but it's also doable. Your parents' lives sound manageable (thanks to you), and if they can live at home with the assistance of caregivers and your weekly input, then be grateful and enjoy this living arrangement while you can. All the to-dos won't matter after they're gone. The time you spent together will.

My mother's caregiver is too controlling and won't take direction from us.

Carol O'Dell — Mon, 26 May 2008 07:00:00 -0000

My mother has Alzheimer's and has had a live-in caregiver for seven years. He has been excellent with her, but he's quite eccentric and has put demands on our family that have become more and more restrictive. Recently he added a "no talking" rule, meaning that we're not allowed to talk to him in her apartment unless it's necessary to discuss something important. And, no, I'm not kidding.

My sister is staying there helping out, and he banishes her to her bedroom in the evening because he says she "distracts" my mother. He won't let us have any say in our mom's care. As I type this, I realize it sounds ridiculous. We've let it go on far too long because we felt that he was providing very good care to Mom, but this has gotten outrageous. What should we do?

You're right. No caregiver should go this far, and it's good that you recognize this. It sounds like he's not only taken over your mother's care -- he's taken over her home and her life. In fact, he seems to be in a power struggle with your family over what's best for your mother. You need to have a frank talk with him about it, and that means you have to accept that you may need to let him go -- or that he'll walk out.

First, though, I suggest that you make sure he doesn't have access to your mother's finances. I don't mean to suggest that he's stealing from her, but you need to make sure your mother is safe on all levels. If you end up needing to terminate him and he's disgruntled, you want to know that he doesn't have a way of taking it out on your family or your mother.

Then set up a time to talk to him about the situation. Plan it with him ahead of time and make sure you have help for your mother, if necessary, so that he's relaxed and not distracted. It would be good for you to have support, too -- your sister or husband, for example.

Most important, you need to let him know who's boss. If he has sensed your reluctance to fire him, he may have taken advantage of it to assert more control. While making it clear that you greatly appreciate all he has done for your mother, strongly remind him that he works for the family. You can do this in a firm, nonthreatening way, but you shouldn't back down, even if he threatens to quit.

Start with the no-talking rule. Tell him that this simply won't work; it's essential that he communicate with you and your sister on a regular basis. If he'd prefer to have a regular check-in time to discuss issues, set up a time that's convenient for him and you. But he needs to know that you will still call him, and your sister will ask him questions, whenever either of you wishes to. If he's very busy with your mother and it's not a good time for him to talk, he can get back to you as soon as possible.

Let him know that your mother's home is her home, and you want it to be a place that's comfortable for the entire family. As long as your sister is there, it's her home too, and she's free to move about and see your mother as she wishes. If seeing her gets your mom more stimulated than he'd like, or even fidgety, that's okay. That's part of family life. Remind him that your days with your mother are limited, and you and your sister both intend to be with her whenever you can.

If you wish, you could encourage him to talk about his frustrations or needs. Ask him why he thinks your mother shouldn't see your sister in the evening. He does spend more time with your mother than anyone else, and he may feel that following certain protocols are in your mother's best interest. Discuss with him whether there are other ways to handle these issues. You may choose to agree to some rules or boundaries, but that's your decision, not his.

As any family caregiver to a parent with Alzheimer's knows, it's an extremely difficult job. He may have instituted certain rules and schedules to make his life easier. Having lived with your mother for several years, he may also have come to feel that he's more family to her than her real family. This is understandable, but not acceptable. If you really value the kind of care he provides, it might help to juggle his schedule or make some other provisions that allow him some breathing space. Think about what might be best for all of you. With your sister there, for example, perhaps he doesn't need to live in your mother's apartment.

On the other hand, there are caregivers who take advantage of their situation, and his behavior may merit closer scrutiny. It may just be a case of him spreading out and feeling like he's in charge -- or it could be something more alarming. It's good that your sister is also living at your mother's apartment, because she can monitor what's going on. This and your conversation with him can help you better ascertain the situation.

I hope that you'll be able to resolve this issue with a firm conversation, but if he chooses to leave, that's OK. I know how hard it is to find the caregiver who is "just right" for both our parents and us, but if he can't abide by your wishes, he's not the right one. Don't let anyone push you out of your mother's life.

My mother has asked not to be resuscitated if she has a medical crisis, but my siblings disagree on what constitutes a medical crisis.

Carol O'Dell — Mon, 19 May 2008 07:00:00 -0000

Before she showed signs of dementia, my mother decided she didn't want extreme measures to be taken to save her life, and she authorized a Do Not Resuscitate order. Now my siblings can't agree about when we should honor it. Some don't want to call 911 if my mother becomes unconscious or shows signs of stroke or heart attack, because DNRs are notoriously difficult to enforce. Others are adamant that she be taken to the hospital for the staff there to determine if her problem is life threatening, and then we should deal with the DNR order.

Talking with my mother about this would only cause more trouble. Her dementia has advanced, her logic is not always great, and she changes her mind a lot. If she changes her mind about the DNR, at least a couple of my siblings will question her mental capacity, which could stir up a legal (and emotional) mess. Can you offer advice?

I applaud you for wanting to clarify this issue now. It sounds as if there are more than a few siblings in your family, and it's probably difficult for you all to agree on many things -- especially on something as difficult as this. But if not everyone in the family knows about or supports your mother's DNR, you may end up arguing about it when it's time to make a decision. Under those circumstances, many doctors and hospitals will opt for aggressive care -- the opposite of what your mother wanted -- as the "safest" alternative.

Your siblings' opinions probably vary based on their history, fears, moral beliefs, and relationships with your mom. An in-person meeting among all of you, if that's possible, would provide a good opportunity for everyone to get out all their thoughts and feelings. Hopefully, no matter what your personal differences are, you can all agree that your mother's wishes should be honored.

Most people don't want their loved ones to die and they're hoping that things can get better -- but dementia and many other illnesses don't get better. If your mother has chosen not to live this way if a medical crisis arises, that should be respected. It may take someone who isn't a family member -- such as a social worker, chaplain, or hospice mediator -- to help you to come to a decision everyone can honor.

First, I suggest that your family pick a health surrogate (also called a health care agent), the person who has the power to make medical decisions for your mother if she can't make them on her own. If you're involved with a home health agency, a social worker can meet with you to help you determine the best person for this role. Usually it's the family member who's most involved, lives nearby, and is willing to make these decisions under stress and uncertainty. You can designate a line of succession in case the first person chosen is unavailable when a medical crisis arises. All family members must respect the decision of the health surrogate.

Second, does your mother just have dementia, or are there other health-related issues involved? Is her condition far enough along that it's time for hospice to get involved? If it is that time, hospice can help mediate a family discussion and help you come to agreement on a health surrogate.

In general, DNR orders apply to situations in which a person's heart or breathing has stopped. Each state has its own parameters for DNRs and other Advance Health Care Directives, based on state law. You can get a better idea of the laws where your mother lives by searching the terms statutes outline and advance health care directive for your state on the Internet. Or request a list of the statutes from a local hospice organization in her area. You'll also find out what her state honors -- some states require people living at home to wear DNR bracelets that indicate their wishes, for example. In any event, it's wise to make sure that your mother's doctor, health surrogate, other family members, and anyone else who may be involved have a copy of her DNR.

Since you took the initiative to ask this question, it seems that you're willing to be involved and want this settled so that you can do right by your mom. You might use your peacemaker role to bring everyone together and hash out some agreements.

After the issues are resolved, I hope that your family members can focus more on your mother at this time than on how her death is to be handled. Whether she dies in weeks, months, or years is a moot point compared to the time you spend with her now.

Taking responsibility for another person's life is a sobering experience. I had to take that role with my mother, and it was scary. It's a role that's best suited for loving, involved family members. If that person is you, don't allow guilt, regret, or fear to overtake you. Make the best decision you can, and spend the time you have with your mom in peace.

My dad wants to double-date with me!

Carol O'Dell — Mon, 12 May 2008 07:00:00 -0000

Mom died about a year ago, and in the last couple of months, my 80-year-old dad has gotten more and more flirtatious with women, everywhere we go. It's kind of funny, but it's also embarrassing. Last week we were at his optician's, and he asked out a woman right in front of me. He'd known her for years, and she said, "Yes." And then he said, "Let's double-date with my son and his wife."

I was floored! I mumbled "OK," but since then, I've realized he only asked me along because he no longer drives. I'm not sure I feel comfortable with this, and I feel used. I'm OK with Dad wanting to date, but I'm not sure I want to be a part of it.

Also, I mentioned it to my sister and she's really upset. She says it's too soon, and she's mad at me for agreeing. What do I do now?

Sounds like it might be time for the old son-to-father talk. Whether you like it or not, you're now involved in this new phase of your dad's life and you're going to have to continue to be, if only from a distance.

It's the ultimate payback for what we put our parents through when we started dating and discovered sex, isn't it? Now we find ourselves worrying about their safety, hoping they won't get their hearts broken, and wishing they'd find someone who truly cares for them. And we can only hope our parents don't turn out to be as difficult as many of us were!

Before you do anything, consider whether your dad is physically, mentally, and emotionally healthy enough to date. Is he cognitively healthy enough not to be taken advantage of? He may not be acting like the dad you always knew, but that's different from being unsafe.

Then set up healthy father-son guidelines and boundaries now, as it will save you many headaches later. It sounds as if you don't wish to be directly involved, and that's probably best. Relationships don't always work out, and it may be uncomfortable for you to see your dad with someone -- or several other women -- other than your mom. You can tell him that, while still letting him know that you think it's OK for him to date. Keeping a distance may also be useful if you need to intervene at some future date.

Because your dad can't drive, you can help him plan for alternative transportation. Suggest a taxi or offer to drop him off at a convenient restaurant or movie theater. This may feel a little like you're dropping your 15-year-old off at the movies. And Dad may balk at it, but if he wants to date badly enough, he'll deal with it. Reassure him that older women aren't necessarily "turned off" when a man doesn't drive -- many are grateful for the male company and attention.

Is your dad's suggestion that you double-date a way of using you? Maybe, though I doubt it's intentional. To him, it may not feel that different than relying on you to take him to the eye doctor or grocery store. And he may just want you there in the beginning until he regains his confidence. It's a big transition for both of you: He's figuring out who he is now, and you're learning how to have a relationship with him without your mom.

You probably need to give Dad a few pointers on senior dating, and maybe suggest that he tone it down a bit if you think he's coming on to every woman he meets. Like everyone else, seniors can contract sexually transmitted diseases, and someone who's been in a stable, monogamous relationship might need an update on what's "going around." You also want to make sure that your dad isn't being taken advantage of financially. Even if you don't double-date, you should meet anyone he's seeing regularly. If she doesn't want to get to know his family, that's a good indication that she might have ulterior motives.

Your father is no doubt lonely and bored, but he should also know that dating isn't the only way to fix that. He could get involved with a senior group or club or do volunteer work where he would meet people close to his own age. He may or may not find a partner, but he can make new friends and have a good time.

Will this be awkward for both of you? Probably, at least at first. Your dad might be embarrassed by some of it, and he might even lash out at you, like a teenager -- but he may also appreciate your input.

In fact, this could end up being an enjoyable period for you. Your father is attempting to seize life and reach out to the world, and in some ways that's a gift for both of you at his age. Helping him deal with his new romantic life is a point of connection -- something you can talk about and share. Having honest and open discussions now will also make it easier to talk about other issues, such as his health and future.

Finally, your sister is clearly not as comfortable with all this because she's still grieving the loss of your mom. Everyone is on a different timetable -- and your father's is probably expedited because he feels he isn't getting any younger. You can try explaining this to your sister, but you may still just want to handle this area of care giving yourself. Don't feel that you need to report all the details to her.

Like you, your sister is protective of her dad and worried about his safety. At any age, it's nice to have someone to watch out for us, and love is risky business. But if he has a chance of finding a companion, isn't that worth a little unease to you?

My mother is gambling away every last penny -- and her financial independence. What should I do?

Carol O'Dell — Mon, 05 May 2008 07:00:00 -0000

Since my father's death two years ago, my 75-year-old mother's casual interest in bingo has turned into an obsession. Now her life revolves around bingo and casino gambling. She lives in Florida, where there's no shortage of gambling seniors to keep her company. And it's not a matter of if this situation will damage her financial independence, but when.

Because we had a miserable relationship when I was growing up, I have a terrible relationship with her now. I can't talk to her about the weather, much less about something that will clearly end up in a fight. But I'm also the executor of her will. Is it my responsibility to intervene as the executor -- and as her daughter? Or should I stay out of it, since it's her money?

You're not alone -- senior gambling is a touchy issue for many caregivers. And normally I'd encourage you to talk to your mother and try to help her find a way out of her addiction. But if that's not a possibility for you, given the history of your relationship, you need to protect yourself first and then do what you can for her.

No doubt your mother is hurting since her husband's death, and she's comforting herself with an addiction. Gambling may have even given her a new social network. It fills a void for her, as it does for many elders who feel lonely and "useless," and you may not be able to stop her. Ultimately, we're all responsible for our own decisions and actions. So you need to be okay with whatever decisions you make, regardless of the outcome. This is tricky because the decisions will be difficult and the outcome may not be rosy.

First, since you're the executor of her will, contact an attorney about your legal responsibilities and financial obligations. Make sure you speak to a lawyer in Florida, because each state handles wills and personal matters differently.

Second, if you can't intervene in this situation, are there any other family members or friends who can? How about someone in her religious community?

Third, you'll need to decide what you can live with. Think about how you would deal with these possible scenarios:

Your mother not only gambles all her money away but also goes into debt. Will you then be responsible for her debt?

Her health fails and she has to enter a state-run facility. Are you okay with that?

You need to become involved with her eventual care needs. How involved do you plan on being -- both in terms of your time and, if necessary, money?

The solution seems to be to remove her from her current living situation. Is she capable of building a new life in a new setting? How involved would you have to be, and would she resent your intrusion?

She eventually comes to you and asks for help or care -- many elderly people try to make peace with their families before they leave this world. How do you plan on handling this if it happens?

This last question is an important one. Some relationships are simply beyond repair, and you may have had to break bonds with your mother for your own mental health. If this is the case, accept that you are being a responsible daughter and caregiver by getting involved on whatever level you can. You're not obligated to step back into a toxic relationship.

But I also encourage you to examine whether there's any hope for reaching some sort of reconciliation with your mother before her death, even just within your own heart. For your sake, I hope that you can at least love her from a distance -- an emotional distance. However painful your past and your relationship with her, forgiveness and acceptance are part of healing. If you can find a way to them, it may give you -- perhaps both of you --- a sense of personal peace.

My mother's growing needs are putting a strain on my marriage, and I find myself wondering which will fall apart first -- her, my marriage, or me. What can I do?

Carol O'Dell — Mon, 28 Apr 2008 07:00:00 -0000

Since my dad died five years ago, my mother has had hip-replacement surgery and been diagnosed with early-stage bladder cancer. I quit my part-time job to be available for her. Every day, it seems, I spend more hours transporting her places and comforting her until late evening. When I'm not with her, I'm rushing around to care for my two teenage girls. More than ever, I need my husband of 17 years to pick up the slack at home, but he has a high-pressure job and says he can't reduce his time at the office. I think he's happier there than at home. I'm increasingly angry and defensive with him. He wants me to hire a caregiver and go back to work to ease our financial pressure, but Mom isn't comfortable around others. I want to feel that I did everything I could for her if this cancer turns out to be terminal, but I miss my husband terribly. We communicate mostly by e-mail, and sex is a distant memory. And no, we have no money or time for couple's counseling.

It's time to put your marriage first. Your mom is substituting you for her husband, but you can't begin to fill this void. And if you try, it could cost you your own marriage. As much as you love your mom, you need to wean her from your constant attention.

What you're going through is very common. Care giving can put a big strain on marriage because it demands that everyone in the family adjust and make sacrifices. And it's not unusual for this to happen at a critical marital juncture, what we might call in your case the "17-year itch."

So first, turn your attention to your husband. Have a heart-to-heart talk with him about these things. Put it all out on the table -- the neglect and avoidance and exhaustion -- but also tell him how much you miss him. Then do your best to move past it.

To do that, you need a plan. It's been easy to avoid one another -- he stays at work while you're with your mom -- but you can't let that continue. Try starting some new traditions. Plan a date night once a week, even if it's just eating takeout sushi and watching a video in your bedroom with the door locked. Meet for lunch every other week. Plan to get out of the house together at least once a month. Buy him his favorite cookies. Continue to e-mail (e-mails can be fun and flirty!). Take some morning showers together. These things may feel a little contrived at first because you're out of practice, but they can become spontaneous. However you two show affection -- whether it's hugs or kisses, winks or water-gun fights -- bring them back into your relationship.

If financial worries are putting pressure on him, let him know that they're your concern too, and talk about a reasonable way to deal with them without neglecting your mother. Or you might tell him that you're working on a plan to reduce the hours you spend with her, and by the end of a certain period -- say, six months -- you'll be available to help the family financially. Ask for his input. Deal with this as partners.

Then, have a serious conversation with Mom. Let her know that you love her and will continue to care for her, but that you need to put your marriage first. No explanations are needed. You don't need to involve her in your marriage issues. Just let her know that this is the way it's got to be.

Make a six-month plan to get her through this initial phase of cancer. If you normally leave her house at 8 p.m., begin leaving at 7:30. You don't necessarily have to announce it to her -- just move a little faster or even make up an excuse, if necessary -- but begin the process. In another week or so, leave by 7 p.m. Within four or five weeks, you may be leaving by 5:30. Explain to her that you need to do this to have dinner with your family, and tell her that's a priority for you. Let your husband know about this plan so that he can help keep you on track and even assist you once he realizes that you're both on the same team.

This may take an initial time investment -- and willpower -- from you. If she needs other people to provide care when you're not there, consider home health aides, friends, and community and church members. She may hesitate and insist on having you, but this isn't healthy for either of you. You might try talking to her about why -- about the void that her husband's death left in her life and how it's time to fill it in by branching out and meeting new people. Let her know that you still need to care for your daughters. And for your part, don't think that teenagers (or even college-age "kidults") don't need their parents. They do. You don't want to miss your time with them. (Remember the bumper sticker: "Be nice to your kids, they'll be the ones picking out your nursing home!") If your mother goes further and tries to sabotage your plan, even unintentionally, be prepared. Stay the course.

It would also be wise not to talk about Mom too much to your husband, especially while you're trying to recover the core of your relationship. Try ranting to a trusted girlfriend, writing in a journal, or screaming while you're alone in the car, but cultivate good habits in your marriage. Focus on the two of you, not the three of you.

Finally, and not least importantly, invest in yourself. Those of us in the "sandwich generation" can get so caught up in other people's needs that our lives become one big to-do list. How do you fill up your own well? For example, do you get exercise every day? Start small. Walking the dog for 10 minutes and humming a song you love can set the tone for the rest of the day or help you unwind at night. Care giving is rewarding and necessary, but it shouldn't consume us to the point of damaging our health and closest relationships. Very likely, you'll outlive your mom. Love her well, but don't sacrifice yourself or your bonds with your husband or children along the way.

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