“Help please!” my daughter asks. It sounds more like “Hep Peas”, but it is always stated without pride or frustration. “Hep Peas,” as a fact. It could be help putting on her shoes, reaching for a snack, opening the toothpaste or refilling her water. “Hep Peas, Mama.” So I help, grateful she knows her limits. Grateful she still needs me. I also love “Hand,” when she insists we hold hands either to go down stairs, or cross a road, or fall asleep. “Hand,” she insists, and I wonder if it’s more for me than her sometimes.

When a parent or grandparent has dementia, and is still driving, a very difficult situation can arise when the adult children realize that mom or dad’s situational awareness and functional ability have decreased to the point where the parent is no longer safe to drive. Sometimes the parent realizes this and is willing to give up driving. But giving up driving when you have done it since you were 16, and when it is often a means of meeting friends and family or just going shopping for something to do, is often not easy. What are some ways to handle this without harming the elders feeling of independence in order to keep them and others safe?

I can’t remember how many times people with dementia have answered questions with those three words. It could simply be forgetting something for a moment. Everyone does from time to time. But if it is a regular and near complete occurrence, then it means two things: the ability to make decisions is impaired and some other family member or trusted person must be given the power to make financial and health care decisions if you cannot. That is where a power of attorney and health care directive are a must, because when a person’s memory becomes so impaired that rational decisions cannot be made, someone has to do it. When I was a Navy lawyer in the JAG Corps, the high command had a simple unavoidable rule: every new recruit should do power of attorney, a living will, and a will to pass on assets if the worst occurred. Why did the Navy have this strict rule? Because every one of those young sailors might by assigned to commands where it might be difficult to communicate with the outside world, or had some risk of being hurt and unable to handle their own financial affairs for a period of time.

When one spouse of a married couple has serious physical or cognitive issues that require far more care than the healthy spouse can give, the goal is to find appropriate care, hopefully at home, to provide the help necessary to keep the sick one safe and the healthy one sane. With a typical situation of a gradual decline in the ability to do the normal activities of daily living (ADLs), such as eating, transferring, bathing, dressing, and toileting, and staying safe from harm, the spouse and or children who live nearby often provide that care. In our experience, the family members frequently push themselves far beyond what they can realistically do on a long term basis. At some point their hard efforts may not be enough to keep the needy spouse safe. That is when it is important for families to find good advice and counsel on what state and federal programs and funding may be available to help keep the sick spouse safe and living in the best environment possible, and the healthy one sane. Safe is a key word here because the care, whether given by the family or caregiving agencies, or in an institution has to be enough to avoid serious accidents, or even minor accidents that can reduce the ability to stay at home.

It’s not pleasant thinking ahead about what happens if we become incapacitated or die, but since one day we all will take our final breath, and some will need long term care, it’s wise to take a few moments to think ahead about being proactive.

Every day of our lives we perform basic functions that are known as activities of daily living (ADLs). They are dressing, bathing, eating, toileting and making transfers on and off chairs, and in and out of bed. We take these for granted as we go about our daily routines. But when the frailties of age, sickness, or mental capacity become so diminished that someone cannot do these basic needs of living, then outside help is needed. That help typically comes from a spouse, or adult children, but if there is no spouse, or children do not live nearby, or when it is simply not practical for family to help, then homecare agencies must be hired to keep that elder person safe at home. Families then need to pay for that help out of their own resources until they can qualify for government programs. If the elder person cannot do three or more activities of daily living, then the Connecticut Home Care Program for Elders (CHCPE), or Medicaid will pay for help with the things the elder cannot do, if the elder person qualifies financially and functionally.