Besides Social Security, what local resources can help me pay for care?

Q: My brother who lives on Social Security had a severe stroke and requires an around-the-clock caregiver for his aphasia diagnosis. His speech is minimal and his cognition is compromised. What resources are available to help with the overwhelming cost of a caregiver?

—Judie L.
Pearland, Texas

Gail: My first call would be to the Area Agency on Aging nearest where you live. The www.eldercare.gov Web site lets you search by zip code, and Pearland is apparently served by the Houston-Galveston AAA, which you can reach by calling 713-627-3200 or by visiting www.hgac.com.

One straightforward way to find out what your brother is eligible for is to go to AARP's tool called Benefits QuickLINK. It will walk you through a number of local and federal programs that can help with expenses, saving money so that paying for a home health aide is less of a sacrifice.

Is your brother a veteran? If he is, there are services available for him through the Veterans Administration. Are there other members of his family who can help you put together a plan of care for him? If there is anyone, enlarge the caregiving circle around him and take care of yourself.

How do I find a geriatric care manager?

Q: The wife is caring for an Alzheimer’s patient She needs a person that is knowledgeable enough in health issues to meet this patient at all his doctor's appointments and who can relate to the doctors all the pertinent information and relate back to the wife the proper care.

—Ana A.
Bluffton, S.C.

Gail: Dear Ana, I think the first step is to contact your local Area Agency on Aging for Beaufort County, S.C.: Point South, Yemassee, S.C. 29945; phone, 843-726-5536. Ask them for the nearest Alzheimer's Association in your area. You can also visit the Family Caregiver Alliance and look under Frequently Asked Questions (FAQs).

A care manager can arrange and monitor hands-on services to help your relative. Care managers or social workers may be available through your relative's local department on aging. Another option is to hire privately a care manager or other professional, such as a Certified Nurse Assistant (CNA), to help coordinate services and respond quickly to challenging situations.

Remember to obtain emotional support for yourself. Discussing your situation, letting your feelings out, and listening to other points of view can provide some relief and help you to refuel.

Visit the Web site of the National Association of Professional Geriatric Care Managers, which can help you find someone with expertise in directing the care of seniors and who can do a thorough assessment of your family's situation. Care managers are typically paid out-of-pocket, and their fees vary, although some long-term-care insurance policies cover their services. Listen to an AARP Radio interview about finding a geriatric care manager.

What are resources for severly brain-damaged loved ones?

Q: My caregiving situation is a little different. My 15-year-old daughter is profoundly brain damaged from birth. This has left her completely dependent. She is nonverbal and non-ambulatory. I will care for her in my home until the day I die. What I've been seeking and cannot find is weekend help with her care. There are simply no people who want to do this job. It's not a question of funding, as I have some money put aside for this. And it's not a question of getting approval or on the right list. There is a lack of people available to do this work.

I have been through all the home-care agencies in the area. I have advertised in the paper and online. I have paid to contact workers on both nanny and senior-care Web sites. I check postings on Craigslist.org and supermarket bulletin boards. I'm just out of ideas and out of hope. I would welcome your input should you have any.

Thank you.

—Audrey W.
Medford, N.J

Gail: Dear Audrey, You are doing the wonderful work of angels. Are you able to connect with others in your area who have also devoted their lives to caring for a loved one with disabilities? I share your desire to keep chronically ill and disabled family members at home whenever possible. Here are a few organizations (you may already be familiar with) that provide resources and advocacy for those with disabilities. Perhaps they can steer you in the right direction in your search. Take care of yourself, and don't give up hope.

Family Caregiver Alliance has great resources on its Web pages. Look under Frequently Asked Questions to find a response to: How can I find someone to help care for my family member at home?

The American Association of People with Disabilities (AAPD) will provide you referrals to organizations that can help. AAPD is located in Washington, D.C., and can be reached at 202-457-0046 (V/TTY) or toll-free, at 800-840-8844 (V/TTY).

Independent Living Centers has a site that provides a list arranged by state or you can also go to disabilityinfo.gov.

TASH (formerly the Association for the Severely Handicapped) is also in Washington, D.C., and can be reached via e-mail at Operations@TASH.org.

How can I get help for my mom when I live in a different state?

Q: My mother is 73 and works full time in her home. She also takes care of my grandmother, 98, who is deaf and blind, and getting really bad now. She only receives Social Security, which basically covers her supplemental insurance and prescriptions. She gets absolutely no help from social services. I can't believe there is no help for her out there somewhere. They live in Maryland, and I'm in Florida. My mom doesn't want to send her to a home because she feels it will be a death sentence.

—Heidi
Hollywood, Fla.

Gail: Start by calling your local Area Agency on Aging to find out what resources are in your area. You would call St. Mary's County Dept of Aging in Leonardtown, Md., at 301-727-5670. Your grandmother should qualify for the PACE program. If someone is eligible for nursing home care and entitled to Medicare funding for it, they can get payment for the PACE program as an alternative, which allows them to remain at home. PACE offers an interdisciplinary team in one location and transports the elder to get social services and all their medical care in the PACE center. The team creates a care plan with the participant and the family, integrating social and medical services, a medication-management plan, nutrition services, and possibly respite for the family.

You can also consider looking into other benefit programs that your mother is eligible for. AARP's Benefits QuickLINK tool will guide you to specific municipal, state, and federal programs.

How can I get help for my mom when I live in a different state?

Q: My mother is 73 and works full time in her home. She also takes care of my grandmother, 98, who is deaf and blind, and getting really bad now. She only receives Social Security, which basically covers her supplemental insurance and prescriptions. She gets absolutely no help from social services. I can't believe there is no help for her out there somewhere. They live in Maryland, and I'm in Florida. My mom doesn't want to send her to a home because she feels it will be a death sentence.

—Heidi
Hollywood, Fla.

Gail: Start by calling your local Area Agency on Aging to find out what resources are in your area. You would call St. Mary's County Dept of Aging in Leonardtown, Md., at 301-727-5670. Your grandmother should qualify for the PACE program. If someone is eligible for nursing home care and entitled to Medicare funding for it, they can get payment for the PACE program as an alternative, which allows them to remain at home. PACE offers an interdisciplinary team in one location and transports the elder to get social services and all their medical care in the PACE center. The team creates a care plan with the participant and the family, integrating social and medical services, a medication-management plan, nutrition services, and possibly respite for the family.

You can also consider looking into other benefit programs that your mother is eligible for. AARP's Benefits QuickLINK tool will guide you to specific municipal, state, and federal programs.

What happens if Medicaid won't pay for a nursing home?

Q: My 90-year-old mother has been living with me for the last 12 years. She is very healthy except for a swallowing problem (can only eat liquids or soft foods), dementia, psoriasis on ankle, and incontinence. She is deteriorating very fast mentally, and I'm wondering if I place her in a nursing home and all her money is exhausted, what happens if Medicaid won't pay for the nursing home? Do you have to have some sort of major medical problem to be Medicaid-eligible? I would place her in a nursing home in Kentucky, which is her home state. Thanks.

—Emilie T.
North Charleston, S.C.

Gail: The key is to choose a nursing home that will accept Medicaid when her assets have been depleted. Most nursing home admissions offices will tell you their policies up-front. To help you choose the best home for her, visit the Center for Medicare and Medicaid Services Web site and compare the quality indicators they've gathered. When you narrow the choice to a select few, it's wise to visit in person and take a checklist with you. You can print one from our page on nursing home options.

Besides Social Security, what other agencies can help me pay for care?

Q: My brother who lives on Social Security had a severe stroke and requires an around-the-clock caregiver for his aphasia diagnosis. His speech is minimal and his cognition is compromised. What resources are available to help with the overwhelming cost of a caregiver?

—Judie L.
Pearland, Texas

Gail: My first call would be to the Area Agency on Aging nearest where you live. The www.eldercare.gov Web site lets you search by zip code, and Pearland is apparently served by the Houston-Galveston AAA, which you can reach by calling 713-627-3200 or by visiting www.hgac.com.

One straightforward way to find out what your brother is eligible for is to go to AARP's tool called Benefits QuickLINK. It will walk you through a number of local and federal programs that can help with expenses, saving money so that paying for a home health aide is less of a sacrifice.

Is your brother a veteran? If he is, there are services available for him through the Veterans Administration. Are there other members of his family who can help you put together a plan of care for him? If there is anyone, enlarge the caregiving circle around him and take care of yourself.

Insurance premiums are siphoning my savings. What can I do to care for mom?

Q: I left my job and moved back home to care for my mom when dad passed away three years ago. Mom is now almost 87, and I can only work a job with flexible hours, which have been reduced to about five hours a week. My Individual Blue Cross/Blue Shield plan has a $10,000 deductible and costs $428 a month.

I live off Mom's Social Security and my small savings, which I am going through quickly due to the insurance premiums that have depleted my "retirement money," as it costs over $5,000 a year. Since the deductible is so high, I must also pay out of pocket for medical supplies. Are there any agencies out there to help, since we do have a small savings that Dad left Mom?

—Joann H.
Hammond, Ind.

Gail: There are a number of programs that can help you and your mother. Start by seeing which ones you or she are eligible for using AARP's Benefits QuickLINK tool. Pursuing these programs takes time, but there are forms right on the Web site, and the help you receive will give you a better picture of the choices you both have.

Also, try the Northwest Indiana Community Action Corp., which can provide assistance to you and your mother.

Good luck!

How can I find out if someone qualifies for Medicaid and/or Medicare?

Q: I am a caregiver for a friend. She is 97 years young with no family. She does not qualify for Social Security or Social Security Insurance. She pays her health insurance to BlueCross BlueShield every month, and this leaves her $660 a month to live on. She has depleted her savings and now needs more money to live out the rest of her life. She lives in an apartment and pays $769 a month. She doesn't want to move, because she has lived there most of her life. I am at wit’s end about how I can help her. Can you think of something I can do? I don't know if she would qualify for Medicare or Medicaid. Please help me.

—Annie C.
Chicago

Gail: Dear Annie, Here is a number to call right away to see if your friend qualifies for any services: Chicago Department of Family and Support Services, Division of Senior Services, 312-743-0300. Stay on the line to speak to a live person and ask for help for your friend. It sounds like she may be eligible for Medicaid. Good luck!

How do I find out how much care would cost?

Q: I am a 53-year-old cancer survivor with 11-year-old twins, a home, and a husband. Since January, I have been taking care of my 88-year-old mother, who told me it was time that I got her, since she can't cook, clean the house herself, or do anything anymore. Honored that she finally asked me, I am thinking ahead to when I really can't do it anymore, how do I go about getting Medicare to cover the cost for a nursing home; where do I turn to? This is all so new to me, and I want to do what will be best for my mom. She cannot read or write any language, and she totally relies on me for everything. I don't know where to start and how to get financial aid for her. Please help me.

—Aneesa K.
Eden Prairie, Minn.

Gail: Dear Aneesa, I would begin by calling your local Area Agency on Aging: Metropolitan Area Agency on Aging/Senior LinkAge Line in North St. Paul, Minn., 651-641-8612. Medicare does not cover the cost of a nursing home, but Medicaid does. Your AAA can tell you if your mom is eligible for Medicaid or how to spend down her resources to qualify her. They can also lead you to services and programs that your mom may be eligible for right now.

Do you have any siblings that will share the care of your mom with you? A good Web site with lots of information for caregivers is the Family Caregiver Alliance in San Francisco. AARP's Caregivers Resource Center is also full of suggestions for how to reduce your stress while she’s with you now and how to plan for the future.

Long-term insurance doesn't pay for all my parents costs. What other choices are there?

Q: Help! My mother, 74, who was totally independent five months ago, is now medically and somewhat mentally incapacitated. I am now in charge of my parents' finances and need help. My dad, 77, was not involved with the finances and prefers that I handle it all. Fortunately, they have long-term care insurance, but it is not enough to cover her needs. What other resources do they have available that would help pay for the in-home caregiver? They are deep in debt and are stretched to the max. Is there a reputable financial planner for seniors available in this area? What about respite care? Can I use that to offset the long-term care cost? Is any of this covered through their veterans benefits?

—Cassandra S.
Elk Grove, Calif.
 
Gail: Dear Cassandra, You've had a big shock! Your mom was well, and suddenly, she's dependent and you're the designated caregiver! Do you have any siblings who can help you set up a care plan for your parents? There is help out there, even though it will take some time and phone calls to find it, but be persistent: explain your situation, ask questions, and stay on the phone until you get through to someone who can help you with resources in your community. 
 
To start out, call your parents' long-term-care insurance company, and ask to speak to a care manager. There may be supports and payment options that aren’t obvious to you, and since they’ve paid into this coverage for so long, you all will want to get your money’s worth! Then you can find out how to complement what’s covered by insurance with other services.

Since your parents are veterans, definitely visit the Web site of the Department of Veteran's Affairs  (or call 800-827-1000) and ask whether or not your parents are eligible for any benefits. You can also use the tool on AARP.org called Benefits QuickLINK to see what other local, state, and federal services can help them.
 
I would also put in a call to your local Area Agency on Aging to find out about services in your area, such as case management, transportation, meals, adult-day-care services, in-home caregivers, and legal assistance. To find the closest AAA, call Eldercare, toll-free, at 800-677-1116 or visit the organization's Web site. Elk Grove, Calif., is served by the Area 4 Agency on Aging out of Sacramento. Find the agency online at www.a4aa.com or call 916-486-1876, if your parents live in the same town you do.

Watch my video, "Hotline Help for Caregivers," to find out about the Family Caregiver Alliance in San Francisco. No matter where you live, the alliance offers assistance when you feel like you can't make it or don't know where to turn. Call its hotline, toll-free, at 800-445-8106. Staff members will steer you to resources in your area. The group's Web site also hosts three online support groups for caregivers. On this Web site, there's also an active online community for caregivers.

How do I find out how much care would cost?

Q: I am a 53-year-old cancer survivor with 11-year-old twins, a home, and a husband. Since January, I have been taking care of my 88-year-old mother, who told me it was time that I got her, since she can't cook, clean the house herself, or do anything anymore. Honored that she finally asked me, I am thinking ahead to when I really can't do it anymore, how do I go about getting Medicare to cover the cost for a nursing home; where do I turn to? This is all so new to me, and I want to do what will be best for my mom. She cannot read or write any language, and she totally relies on me for everything. I don't know where to start and how to get financial aid for her. Please help me.

—Aneesa K.
Eden Prairie, Minn.

Gail: Dear Aneesa, I would begin by calling your local Area Agency on Aging: Metropolitan Area Agency on Aging/Senior LinkAge Line in North St. Paul, Minn., 651-641-8612. Medicare does not cover the cost of a nursing home, but Medicaid does. Your AAA can tell you if your mom is eligible for Medicaid or how to spend down her resources to qualify her. They can also lead you to services and programs that your mom may be eligible for right now.

Do you have any siblings that will share the care of your mom with you? A good Web site with lots of information for caregivers is the Family Caregiver Alliance in San Francisco. AARP's Caregivers Resource Center is also full of suggestions for how to reduce your stress while she’s with you now and how to plan for the future.

Finding a resource to manage the stress of caregiving.

Q: This is more of a comment than a question for Gail. I've worked it the adult caregiving industry for 15 years, have been a family caregiver on two occasions, and currently serve as a state rep for the National Family Caregivers Association. In reading your info, I cannot tell you how happy I am to see that AARP chose you as an ambassador.

Typically, the stories and articles I hear about family caregiving are from some self-serving source and don't really deliver the true message: Caregiving is an overwhelming experience, so prepare yourself. So it was extremely refreshing to read your info, and I look forward to the updates. If I can ever be of assistance, you now have my contact information. Thank you very much.

—Blake M.
Omaha, Neb.

Gail: Thanks, Blake. The National Family Caregivers Association does a great service in advocating for family caregivers. They can join free by going to their Web site.

How can I release myself from an abusive care recipient?

Q: I have been married for 48 years, and my husband is 81. He has Alzheimer's. My question is this: Reference is always made about caring for "loved ones." But what if the person you care for, you don't really like? My marriage fell apart many years ago, and I had to come to grips with the situation. I had my period of "mourning" in order to survive. Why is this never addressed?

—Lupe C.
Mill Valley, Calif.

Gail: You are not alone. Many people care for unloved ones or for a family member who never loved enough. This is also a hidden face of domestic abuse. I'm talking about the family caregiver who is trying her best to meet all the needs of a parent or husband or wife who is chronically ill, but who is being beaten up for it, emotionally or even physically. Two books that offer good suggestions on how to handle a combative elderly person who is driving you crazy are "Elder Rage – or Take My Father, Please: How to Survive Caring for Aging Parents" by Jacqueline Marcell and "Coping with Your Difficult Older Parent: A Guide for Stressed-Out Children" by Grace Lebow and Barbara Kane. (Both apply to spouses)

An excerpt from "Elder Rage," for example: "If it is early in the dementia, you can still set limits of acceptable behavior. Correct them every time inappropriate behavior occurs and when foul or embarrassing language is used."

"If you are being verbally abused ("I hate you … I never want to see you again.") … Stay calm … don't escalate it to a screaming match. Don't expect a rational discussion. Say that you know they don't mean to be this way, give three calm warnings, use the silent treatment, walk away if the behavior does not stop."

Get in touch with the Marin County Area Agency on Aging to find the Senior Centers and Adult Day Care center nearby. It may take a lot of coaxing and compassion to get your parent to step out of their comfort zone of being at home and to consent to go to day care where they don't know anyone. Take your husband out for lunch and then casually stop by 'The Center' to say hello to that social worker. Perhaps the staff can offer a 'job' saying that their help is needed with the bingo, cooking or singing classes.

How can I deal with a difficult mother who berates me?

Q: My 92-year-old mother lives in assisted living after moving near me. She is a/oX4, quite intelligent after having been married to a career military man. She presents well and is very cordial and friendly with everyone she meets. Her new pulmonologist told me he would never have thought she was 92, more like 75, and with no dementia.

If she is all of the above, why does she constantly call me and leave hateful, accusatory voice messages on my phone (never directed at anyone else but me)? How do I learn to cope (right now, my best coping mechanism is to delete her messages before I listen to them and to stay away from her). How do I enlist the understanding and support of my sister (who was the point of her phone calls years ago), who lives out of state?

—Judy M.
Branson, Mo.

Gail: She is probably desperately lonely and maybe depressed, and you may be her only outlet to vent her frustration. You need to protect yourself and "retrain" Mom. Continue to delete her messages until you can talk to her in person. Tell Mom you will call her, on your terms, and remain on the phone only as long as she is civil and you can have a pleasant conversation. If she changes her tune and is kind to you, you will call more often. Set boundaries and stick to them. Let her know if she can be considerate with you, you might try to coax your sister to try to re-establish contact. And if she doesn't change her habits and you continue to delete her messages, make sure you answer the calls from the assited-living residence, in case of an emergency.

I need help coping with the stress of raising a son alone and caring for my grandmother.

Q: I am a 23-year-old single mother of one, and I also take care of my 81-year-old grandmother. She has had cancer, and since her surgery in June 2008, she has become increasingly "needy" and very self-centered. I find myself becoming very frustrated having to take care of her and my son at the same time, while trying to complete my college education. Do you have any advice for me on how I keep from getting so frustrated and stressed out all the time?

—Jennifer S.
Salem, Ore.

Gail: Jennifer, while traveling around the country interviewing family caregivers, I met a 28-year-old woman who had to assume caregiving duties for her dad while working full time and juggling her own life. Lindsey's story, along with a video, is up on my AARP Web pages now. Watch for her; you may be able to relate.

The AARP Web site offers a lot of information for family caregivers. A great place to start is www.aarp.org/caregivers.

I also suggest visiting National Family Caregivers and the Family Caregiver Alliance for information and resources. In your area, contact the NorthWest Senior & Disability Services (or toll-free by phone, 800-469-8772), and ask them to point you in the direction of a nearby Area Agency on Aging. Ask for resources in your area that are available for you and your grandmother. This might help free up your time a little bit.

Lastly, since I am sure you're feeling "stressed out" by this additional responsibility, please try to take care of yourself as well! Choose one small thing you can do each day to soothe yourself. Hang in there. You're doing a wonderful job.

How can I help a friend who is an overwhelmed caregiver?

Q: Dear Gail, I am very concerned about a friend who has been immersed in taking care of everything for her parents, who have been in crisis for more than six months. Her father was diagnosed with Alzheimer's, and her mother is dealing with bad physical health and has been in and out of the hospital. My friend has a stressful job and drives at back and forth more that two hours (one way) at least once a week to take care of her family. I haven't seen her in about five months; every time I encourage her to take care of herself and take time for herself, she says she just doesn't have a moment. She has health issues of her own, and all of this came right after dealing with several other prolonged crises. She does have a very close and supportive housemate, and other family members are available, but as far as I can tell, she has isolated herself totally from everything except caregiving and trying to maintain her job. I have offered support and friendship, but I never hear from her except in a group e-mail about every three-four weeks.


—Karen A.
Decatur, Ga.

Gail: Dear Karen, Your friend is obviously overwhelmed. She doesn't have time to be a friend right now, which doesn't mean she won't come back. The best you can do for her is to be a heart with ears—listen if she needs to vent. Just keep letting her know you're at the other end of a phone or e-mail, if and when she just wants to come up for air.

In addition, if you have time to do something proactive, could you go to her home and mow her lawn as a surprise gift? Drop off a frozen-lasagna dinner with a note? Bring her some expensive lavender hand lotion, or a book on tape for her commute? With this attention, she might begin to trust that you're really there for her and open up more.

What can I do if my mother refuses to stop smoking?

Q: My 89-year-old mother refuses to quit smoking. She has been evicted from one assisted-living facility for smoking in her room. Back in her condo, I am caring for her twice a day. She also refuses a caregiver for even a few hours a day. Is it even possible for her to give up cigs when her next move comes? I consider my time with her at 70-90 hours monthly, and I feel bad to keep track.

—Tom M.
Redlands, Calif.

Gail: Get in touch with the County of San Bernardino Area Agency on Aging to find out about local resources—you must insist that she accept another caregiver for some of the time. You can't do it alone. You could tell Mom you'll bring her chocolates when you visit, but she can only have them if there are no cigarettes.

What if my husband is abusive when I'm trying to care for him?

Q: I have been married for 48 years, and my husband is 81. He has Alzheimer's. My question is this: Reference is always made about caring for "loved ones." But what if the person you care for, you don't really like? My marriage fell apart many years ago, and I had to come to grips with the situation. I had my period of "mourning" in order to survive. Why is this never addressed?

—Lupe C.
Mill Valley, Calif.

Gail: You are not alone. Many people care for unloved ones or for a family member who never loved enough. This is also a hidden face of domestic abuse. I'm talking about the family caregiver who is trying her best to meet all the needs of a parent or husband or wife who is chronically ill, but who is being beaten up for it, emotionally or even physically. Two books that offer good suggestions on how to handle a combative elderly person who is driving you crazy are "Elder Rage – or Take My Father, Please: How to Survive Caring for Aging Parents" by Jacqueline Marcell and "Coping with Your Difficult Older Parent: A Guide for Stressed-Out Children" by Grace Lebow and Barbara Kane. (Both apply to spouses)

An excerpt from "Elder Rage," for example: "If it is early in the dementia, you can still set limits of acceptable behavior. Correct them every time inappropriate behavior occurs and when foul or embarrassing language is used."

"If you are being verbally abused ("I hate you … I never want to see you again.") … Stay calm … don't escalate it to a screaming match. Don't expect a rational discussion. Say that you know they don't mean to be this way, give three calm warnings, use the silent treatment, walk away if the behavior does not stop."

Get in touch with the Marin County Area Agency on Aging to find the Senior Centers and Adult Day Care center nearby. It may take a lot of coaxing and compassion to get your parent to step out of their comfort zone of being at home and to consent to go to day care where they don't know anyone. Take your husband out for lunch and then casually stop by 'The Center' to say hello to that social worker. Perhaps the staff can offer a 'job' saying that their help is needed with the bingo, cooking or singing classes.

My mother leaves hateful messages for me. What can I do?

Q: My 92-year-old mother lives in assisted living after moving near me. She is a/oX4, quite intelligent after having been married to a career military man. She presents well and is very cordial and friendly with everyone she meets. Her new pulmonologist told me he would never have thought she was 92, more like 75, and with no dementia.

If she is all of the above, why does she constantly call me and leave hateful, accusatory voice messages on my phone (never directed at anyone else but me)? How do I learn to cope (right now, my best coping mechanism is to delete her messages before I listen to them and to stay away from her). How do I enlist the understanding and support of my sister (who was the point of her phone calls years ago), who lives out of state?

—Judy M.
Branson, Mo.

Gail: She is probably desperately lonely and maybe depressed, and you may be her only outlet to vent her frustration. You need to protect yourself and "retrain" Mom. Continue to delete her messages until you can talk to her in person. Tell Mom you will call her, on your terms, and remain on the phone only as long as she is civil and you can have a pleasant conversation. If she changes her tune and is kind to you, you will call more often. Set boundaries and stick to them. Let her know if she can be considerate with you, you might try to coax your sister to try to re-establish contact. And if she doesn't change her habits and you continue to delete her messages, make sure you answer the calls from the assited-living residence, in case of an emergency.

How can I help my mom, who refuses to let me help?

Q: My mom is suffering with some type of dementia. She refuses to accept, acknowledge, that she is getting forgetful, paranoid, and accusatory toward me, her only living relative. I am concerned she will not let me take over at the right time, and I don't even know when the right time is/was? Her doctor has asked me to sit with her while she organizes her medication for a heart condition, but she refuses. How can I get her to cooperate? Thank you,

—Cheryl F.
Burlington, Mass

Gail: Dear Cheryl, Frustration is a normal and valid emotional response to the difficulties of being a caregiver—especially where dementia is concerned. You can't get past this typical barrier by yourself: Fighting with your mom about it will only make her more resistant. People in her state of mind are usually terrified that admitting to any problem may lead to having their independence taken away. Help is out there. You are not alone.

You need a neutral third party, such as a professional social worker, or patient coordinator or her doctor, to sit with you and your mom and let THEM insist that she have a diagnostic workup. You are close to Boston and many top medical centers. The reason this workup is so vital is that Alzheimer's is very difficult to diagnose, and primary care doctors are not trained to do so. Many other conditions—like dehydration, urinary tract infection, sleeping medications, or conflicting prescriptions—can appear to be cognitive decline, but the symptoms you describe may subside once the root problem is addressed.

The Family Caregiver Alliance in San Francisco has focused attention on caregiving for dementia patients for the last 30 years. Their Web site has tons of information on skills and strategies to help you deal with this kind of frustration. Visit their Web site or call them on their national hotline 800-445-8106. One of the Frequently Asked Questions is: How can I deal with my family member's challenging behaviors without losing my patience?

The Alzheimer's Association is also a terrific resource. In some cities, the local chapter offers a patient coordinator and one-on-one family counseling, starting with the caregiver. They guide caregivers in your situation all the time. They also periodically offer a series of workshops for families of Alzheimer's patients. These workshops may also turn into a support group in which you can share your frustrations and discuss coping strategies.

See my Web site at www.aarp.org/gailsheehy. Look for the video and journals about Keith Wolfard; he was in exactly the same position as you are. His wife's forgetful behavior was dismissed by three different doctors as not Alzheimer's, before they got a complete diagnostic workup at a medical center that dealt all the time with Alzheimer's.

Call the main chapter of the Alzheimer's Association in your state, in Watertown, Mass., at 617-868-6718. Good luck!

I'm told that I will lose VA aid if I bring my dad home. Is that true?

Q: Gail, In June 2006, I went through a company downsizing after 18 years in corporate America. I learned that my father could no longer care for himself, and he lived with me for three years. I have not been able to work, so my income and savings have been depleted. In June 2008, my dad went into assisted living and I was able to get Veterans Administration aid and attendance for him. I am now bringing him back home at the recommendation of his doctor because of his increased depression there.

It is a true honor to care for my father, but I am worried about my own retirement at this point. I am getting my CNA certificate this month. I have been told by the assisted living I will lose my aid and attendance if I bring him home. How can that be true? If I am taking care of him in my home, what can I do to try and keep the VA aid and attendance for him? I provide him his protection, transportation, meals, and medicine. I was doing this for three years before and never knew about VA benefits.

—Care B.
Mableton, Ga.

Gail: It is a wonderful thing that you want to care for your dad. This may be a time to call on your congressman, woman, or Senator, and ask for help from the "constituent caseworker" who communicates with federal agencies on behalf of people like you and your father. You appear to be in the 13th Congressional District, with Rep. David Scott, and Sens. Saxby Chambliss and John Isakson representing your interests at the federal level. Veteran's matters are complicated, and an answer to your question should come from someone who understands the ins and outs.

Also, for your self-education, I have listed a few Web sites below that may answer some of your questions regarding Veterans Administration aid:

• Department of Veterans Affairs
• National Organization of Veterans Advocates
• Disabled American Veterans
• Warrior Assistance Program in Illinois, 24-hour, toll-free help line, 866-554-4927
• A straightforward way to find out all the programs your father is eligible for is go to the tool called Benefits QuickLINK; it will walk you through a number of local and federal programs.

As a caregiver, you also need to think of yourself. The Family Caregiver Alliance offers good advice. Their Frequently Asked Questions offer tons of information.

In addition, the AARP Caregivers Resource Center features tips and information for family caregivers.

I wish you luck and remember, take care of yourself.

How can I make my sister think about my parents' future needs?

Q: I have always been an admirer of you and your wonderful books. I have been struggling with my parents, who are getting older and have more health issues that will worsen as time goes on. I have an older sister, 10 years older than me. I am 51years old and find that she is downplaying their health and medical problems. That really frustrates me and angers me, since she does not seem to understand the potential dangers and possibility of surgery, needing more assistance down the road, and possibly needing to sell their home. It scares me that I am the only child who is there for them and that my sister may not be able to help out when crunch time comes.

I am hoping for some advice that will better prepare me to deal with my reluctant sibling. Thank you,

—Julie S.
Wyckoff, N.J.

Gail: You are so right, Julie, to anticipate the potential dangers and need for future assistance. If ever there was a good time for a family meeting, this is it. But you want to head off a sibling fight based on old scripts. You will do much better if you first get thorough health assessments on both your parents.

You have many great resources in your state. Consider calling local caregiving networks, such as Caregivers of New Jersey, The Family Resource Network, in Trenton, at 609-392-4900. Ask where you can get your parents assessed, and hook up with a social worker who can set up the family meeting and be the neutral voice. Your older sister will be more likely to listen to a professional.

You can also watch the Colbert family videos on my AARP Web pages to see how they did it.

If family members just aren't interested in helping, move on before the next crisis occurs. There are great resources on AARP's Caregivers Resource Center Web site.

Enlist friends and neighbors to help out. Two excellent guides to help you organize an ongoing group to care for your parents if one becomes seriously ill are the following: Share the Care and Lotsa Helping Hands.

How do I prepare today for my care tomorrow?

Q: Having cared for my mother (who had multiple health problems and dementia) in my home for 12 years, I am well aware of the blessings and the challenges. Although Mom had a pension and medical insurance, I had to work in a lower-paying job to be closer during the day and could not afford help during the evenings or weekends. Although I wouldn't change my decision, I don't want the same future for my daughter.

My daughter is a nurse who used to work in nursing homes and has declared her determination to care for me if and when the time comes. I am still young, and, except for having a stent placed three years ago, I'm healthy, but now is the time to plan. I will have a pension and Social Security, and I have long-term care insurance. Is there any other way I can plan now to ensure that my daughter has more freedom and monetary support for my care than I did? I know there are limitations on reimbursement for care by family members, but she is an experienced nurse. Will that make a difference?

—Judy C.
Rochester, N.Y.

Gail: Dear Judy, When seasoned women gather to talk turkey about aging, I've heard the same joke more than once: "The best long-term health care plan is a daughter." It's wonderful that your daughter wants to take care of you. Being a medical professional, she will be invaluable as your advocate—and that's what we need most of all.

Here are three ideas:

1. It's worth it to call your insurer to ask what services the company offers to supplement family caregivers. Some cover care managers. If you know what’s covered, you can prepare for what isn't.

2. Consult with an attorney who specializes in eldercare law. Get your advanced directives in order. See if there’s any way to protect your assets so that your daughter will get them. Perhaps setting up a trust, or revising your will would ensure that happens.

3. Since you are healthy and young, develop a positive action plan for preventive medicine—small, regular decisions that affect health, diet, exercise, and lifestyle. The top two from my experience are: 1) regular sleep, seven hours; and 2) regular aerobic exercise and strength training. (I combine the last two in yoga.)

Congratulations on talking NOW with your daughter and other family members. We should all start that conversation after age 60. I call it Preventive Caregiving. Good luck!

What "power" do I have with a Power of Attorney?

Q: I have Power of Attorney for finance and health from my mother. She is in a nursing home and will never be capable of moving back into her home because of dementia and stroke-related problems. She has not been declared incompetent, but she is incapable of making decisions. I want to sell the house to help pay for the nursing-home care. She has good days and bad days for comprehension. Do I need permission from her to sell the house? Should I consult her attorney?

—James S.
Tucson, Ariz.

Gail: Hello, James, Yes, you need permission, but you may already have it. The agent only has the authority and/or permission to do what the principal wants the agent to do. If the permission is not there, the agent can't do it.

The first step is to look at the powers, or "permissions" granted in the power of attorney for finance. Is there language in the POA that shows that the principal (your mother) gave the agent (you) the authority to sell real estate? If Mom was competent when she signed the POA and the document authorizes the sale of real estate, then you could proceed to sell the house. This is written evidence of "permission" to sell. The POA would be filed with the deed of sale to document that you had the authority to sell the home on behalf of the principal (your mother).

If the POA doesn't mention anything specific about giving your permission to sell the home, then it gets more complicated. On a "good" day, which could be documented by a written doctor's opinion, when Mom understands the need to sell the home and that she wants to give you authority to sell it, she might be able to sign a new power of attorney giving authority for the sale. The need for medical assessment of her legal capacity to sign the POA at the time she signs it is essential to avoid further complications.

If she doesn’t have the capacity to sign a new power of attorney, then you will need to get a limited guardianship for the purpose of selling the home. By this method, the court gives you "permission" to sell, because the mother is not legally able to do so.

Oral permission under these circumstances will not be enough. You will need to be able to document, in writing, how you obtained the authority to sell on behalf of the mother—either with a valid POA or court order. Yes, do talk with an elder-law attorney about these complicated issues.

How can I comprehensively research an illness?

Q: My husband was diagnosed with Stage 4 pancreatic cancer this past fall, and I am caring for him. I just heard your interview on 'Prime Time Radio,' and it was very helpful. I look forward to being able to read your journals and watch the videos to help me navigate through this. During the interview, I believe I heard you talk about a service that comprehensively researches illnesses for you. Could I get more information on this?

—Debbie M.
Hallstead, Pa.

Gail: Henry Dreher is a cancer guide, a master researcher, and the author of "Mind-Body Unity" and "The Immune Power Personality: 7 Traits You Can Develop to Stay Healthy." Dr. Dreher consults with patients and caregivers in need of experienced help in researching a disease or treatments. Then he scours the database that doctors use—pubmed.com—which is the most comprehensive primary source for research in medicine.

You can use pubmed.com yourself. It's made available, free, and online, by the National Library of Medicine. But for those of us who are not trained academic researchers, searching the database is more than challenging. It's a brain-cruncher.

Dreher's job is not just to do conventional searches for answers and to send the caregiver a printout of all the references. He also suggests all the complementary, non-medical avenues that can be beneficial and that may alter the survival rate. He finds the natural herbs and supplements, nutritional support, exercise regimens, and psychological support that could be helpful in fighting the particular cancer or autoimmune disease. He charges for consulting and research. He winds up with a written summary of the options. I've found Dreher to be empathetic, thorough in his research, and, best of all, able to turn indigestible medical jargon into ideas that a layperson can swallow.

Is there a service that notifies me when my mother-in-law falls?

Q: What service do you recommend to assist my 85-year-old mother-in-law? She fell outdoors over the weekend and was barely able to get up on her own. I'm afraid next time she may not be able to get up. She needs to be able to call for help at all times. She has a cell phone but always forgets to take it when she takes the dog out. SOS.

—Peggy D.
Savannah, Mo.

Gail: Don't we all forget to take our cell phones when they're most needed! I once got lost walking in a state park without noticing when it got dark, and I had to borrow a dog walker's phone. But for the older people, the best is a medical-alert service.

Many smaller companies also offer medical-alert services. The owner simply pushes a button on a necklace or a watch. It signals a response center. Within 30 seconds, an associate pulls up a computer screen with everything he or she needs to know about the owner's medical condition and will phone local resources for whatever is needed.

Ask your mother-in-law's physician which system he likes best. These days you can have any item shipped to her house in a matter of days.

What is better flooring: carpet or hardwood floors?

Q: Which is better for a 92-year-old woman who has just recovered from a broken hip: hardwood floors or wall-to-wall carpet? Where can I find more information on how to make a home safe for her?

—Susan G.
North Collins, N.Y.

Gail: Dear Susan, One in every three people age 65 and older falls each year, and half of those who survive a fall never return to their prior level of mobility or independence. So I’m pleased to learn the woman you mention in your inquiry has recovered from her broken hip.

When choosing flooring that will help an older person stay safe, it is best to use non-glare, slip-resistant flooring material. This includes tight, very low pile carpeting, but be sure to avoid bold, elaborate patterns that could cause perception confusion. Natural materials like bamboo or cork, which are softer and have some cushioning, are another good choice, but be sure there is no height difference when making a transition between flooring materials. Do not use a transition strip, as it can lead to tripping or falling.

The AARP Web site provides information on home improvements you can do to make a home safer and more comfortable for residents of all ages. Be sure to check the AARP Home Fit Guide and Taking Steps to Prevent Falling Head Over Heels. The Home Safety Council®, a national nonprofit dedicated to preventing home-related injuries, is another good resource.

If you're interested in hiring a contractor to make these changes, there are companies that are Certified Aging-in-Place Specialists.

When do we know it's time to move mom into a facility?

Q: My mother, 88, lives in her home with one of my brothers and his wife. They both work. Another brother drives a school bus but is retired from his other job. After the bus route each morning this brother stays with mother during most of the day. She is often confused but is able to shower and dress herself and to function in this setting. She visits me monthly and does well physically. She knows people in this community now and remembers them. I am concerned that we do the most for her Alzheimer's as we can. When do we know that it is time for assisted living away from the home? Each of the siblings has different opinions of course.

—Billie R.
Gulfport, Miss.

Gail: Fortunately, you have an Area Agency on Aging right in Gulfport. They can refer you to the local chapter of Alzheimer's Association and other resources. Your AAA is located at 9229 Highway 49. Toll-free number is 800-444-8014 or go to www.smpdd.com.

Is assisted living the best option for my parents?

Q: Hi, Gail, My mom has moderate dementia. Morning and night are the most difficult times. She is 88. Dad is 85 and getting tired. Mom has had two TIAs and has spatial, memory, and emotional problems. She is blind and in a wheelchair. My parents are "managing" in their own home in Arizona. My husband and I live in California. I've taken a semester off my teaching to live with them in Arizona to "help." In my view, assisted living is the next step...however, my mom's not ready. My dad is unsure. How do we deal with this fuzzy in-between place? What other options aren't we seeing?

—Pamela L.
(Loving daughter and wife)
Fresno, Calif.

Gail: Dear Pamela, Your description is so accurate: the "fuzzy in-between phase." It's wonderful that you are able to take time to be with your parents, help stabilize the situation, and look at options for the future. Do you have any siblings or other family members? This would be a good time to have a family meeting and discuss what each person has to offer. Perhaps it would help you to meet with a mediator or counselor to discuss the very big decisions that are looming and will have to be addressed. Don't do all this alone. There are resources out there.

The Family Caregiver Alliance in San Francisco is a wonderful resource. In their FAQ pages, they have an answer that deals directly with long-distance caregiving, handling cognitive illnesses, and much more. If you call them, they will be able to lead you to other resources as well. Also visit Share the Care or Lotsa Helping Hands to learn how you can organize a group to care for loved ones who are seriously ill.

What car is best for caregivers?

Q: I have become a caregiver for my father-in-law. My husband drives a truck and I drive a small subcompact. Neither seems suitable for Dad to get in and out of. Can you suggest a vehicle, other than a van, that would be easy for Dad to access? The truck handles our gravel roads and chores. The car gives me good mileage to visit family. Help! Thank You!

—Karla W.
Yates Center, Kan.

Gail: I found out from one of AARP's mobility experts that you might want to reconsider a van to help transport your father in law. Many manufacturers offer "crossover" models—vehicles that include many of the popular features of SUVs and minivans both. There are compact and midsize versions in price ranges from the high teens to well past $30,000, and both domestic and international manufacturers offer something in this line. Most have at least as much ground clearance as your economy car. Given your father-in-law's limitations, I think the side-opening door would be a big advantage for him. A vehicle with center opening doors might also come in handy. Good luck! One thing we can say about the current economy: It’s a great time to get a good deal on a vehicle.

Are there services other than Social Security to help my mom?

Q: My mother is 73 and works full time in her home. She also takes care of my grandmother, 98, who is deaf and blind, and getting really bad now. She only receives Social Security, which basically covers her supplemental insurance and prescriptions. She gets absolutely no help from social services. I can't believe there is no help for her out there somewhere. They live in Maryland, and I'm in Florida. My mom doesn't want to send her to a home because she feels it will be a death sentence.

—Heidi
Hollywood, Fla.

Gail: Start by calling your local Area Agency on Aging to find out what resources are in your area. You would call St. Mary's County Dept of Aging in Leonardtown, Md., at 301-727-5670. Your grandmother should qualify for the PACE program. If someone is eligible for nursing home care and entitled to Medicare funding for it, they can get payment for the PACE program as an alternative, which allows them to remain at home. PACE offers an interdisciplinary team in one location and transports the elder to get social services and all their medical care in the PACE center. The team creates a care plan with the participant and the family, integrating social and medical services, a medication-management plan, nutrition services, and possibly respite for the family.

You can also consider looking into other benefit programs that your mother is eligible for. AARP's Benefits QuickLINK tool will guide you to specific municipal, state, and federal programs.

How do I find a geriatric care manager?

Q: The wife is caring for an Alzheimer’s patient She needs a person that is knowledgeable enough in health issues to meet this patient at all his doctor's appointments and who can relate to the doctors all the pertinent information and relate back to the wife the proper care.

—Ana A.
Bluffton, S.C.

Gail: Dear Ana, I think the first step is to contact your local Area Agency on Aging for Beaufort County, S.C.: Point South, Yemassee, S.C. 29945; phone, 843-726-5536. Ask them for the nearest Alzheimer's Association in your area. You can also visit the Family Caregiver Alliance and look under Frequently Asked Questions (FAQs).

A care manager can arrange and monitor hands-on services to help your relative. Care managers or social workers may be available through your relative's local department on aging. Another option is to hire privately a care manager or other professional, such as a Certified Nurse Assistant (CNA), to help coordinate services and respond quickly to challenging situations.

Remember to obtain emotional support for yourself. Discussing your situation, letting your feelings out, and listening to other points of view can provide some relief and help you to refuel.

Visit the Web site of the National Association of Professional Geriatric Care Managers, which can help you find someone with expertise in directing the care of seniors and who can do a thorough assessment of your family's situation. Care managers are typically paid out-of-pocket, and their fees vary, although some long-term-care insurance policies cover their services. Listen to an AARP Radio interview about finding a geriatric care manager.

I need weekend help for my non-ambulatory child.

Q: My caregiving situation is a little different. My 15-year-old daughter is profoundly brain damaged from birth. This has left her completely dependent. She is nonverbal and non-ambulatory. I will care for her in my home until the day I die. What I've been seeking and cannot find is weekend help with her care. There are simply no people who want to do this job. It's not a question of funding, as I have some money put aside for this. And it's not a question of getting approval or on the right list. There is a lack of people available to do this work.

I have been through all the home-care agencies in the area. I have advertised in the paper and online. I have paid to contact workers on both nanny and senior-care Web sites. I check postings on Craigslist.org and supermarket bulletin boards. I'm just out of ideas and out of hope. I would welcome your input should you have any.

Thank you.

—Audrey W.
Medford, N.J

Gail: Dear Audrey, You are doing the wonderful work of angels. Are you able to connect with others in your area who have also devoted their lives to caring for a loved one with disabilities? I share your desire to keep chronically ill and disabled family members at home whenever possible. Here are a few organizations (you may already be familiar with) that provide resources and advocacy for those with disabilities. Perhaps they can steer you in the right direction in your search. Take care of yourself, and don't give up hope.

Family Caregiver Alliance has great resources on its Web pages. Look under Frequently Asked Questions to find a response to: How can I find someone to help care for my family member at home?

The American Association of People with Disabilities (AAPD) will provide you referrals to organizations that can help. AAPD is located in Washington, D.C., and can be reached at 202-457-0046 (V/TTY) or toll-free, at 800-840-8844 (V/TTY).

Independent Living Centers has a site that provides a list arranged by state or you can also go to disabilityinfo.gov

TASH (formerly the Association for the Severely Handicapped) is also in Washington, D.C., and can be reached via e-mail at Operations@TASH.org.

What device is there to monitor my mother-in-law if she falls again?

Q: What service do you recommend to assist my 85-year-old mother-in-law? She fell outdoors over the weekend and was barely able to get up on her own. I'm afraid next time she may not be able to get up. She needs to be able to call for help at all times. She has a cell phone but always forgets to take it when she takes the dog out. SOS.

—Peggy D.
Savannah, Mo.

Gail: Don't we all forget to take our cell phones when they're most needed! I once got lost walking in a state park without noticing when it got dark, and I had to borrow a dog walker's phone. But for the older people, the best is a medical-alert service.

Many smaller companies also offer medical-alert services. The owner simply pushes a button on a necklace or a watch. It signals a response center. Within 30 seconds, an associate pulls up a computer screen with everything he or she needs to know about the owner's medical condition and will phone local resources for whatever is needed.

Ask your mother-in-law's physician which system he likes best. These days you can have any item shipped to her house in a matter of days.

My mother has strained our relationship. What can I do?

Q: My 92-year-old mother lives in assisted living after moving near me. She is a/oX4, quite intelligent after having been married to a career military man. She presents well and is very cordial and friendly with everyone she meets. Her new pulmonologist told me he would never have thought she was 92, more like 75, and with no dementia.

If she is all of the above, why does she constantly call me and leave hateful, accusatory voice messages on my phone (never directed at anyone else but me)? How do I learn to cope (right now, my best coping mechanism is to delete her messages before I listen to them and to stay away from her). How do I enlist the understanding and support of my sister (who was the point of her phone calls years ago), who lives out of state?

—Judy M.
Branson, Mo.

Gail: She is probably desperately lonely and maybe depressed, and you may be her only outlet to vent her frustration. You need to protect yourself and "retrain" Mom. Continue to delete her messages until you can talk to her in person. Tell Mom you will call her, on your terms, and remain on the phone only as long as she is civil and you can have a pleasant conversation. If she changes her tune and is kind to you, you will call more often. Set boundaries and stick to them. Let her know if she can be considerate with you, you might try to coax your sister to try to re-establish contact. And if she doesn't change her habits and you continue to delete her messages, make sure you answer the calls from the assited-living residence, in case of an emergency.

My sister is reluctant to admit our parents need care. How can I convince her otherwise?

Q: I have always been an admirer of you and your wonderful books. I have been struggling with my parents, who are getting older and have more health issues that will worsen as time goes on. I have an older sister, 10 years older than me. I am 51years old and find that she is downplaying their health and medical problems. That really frustrates me and angers me, since she does not seem to understand the potential dangers and possibility of surgery, needing more assistance down the road, and possibly needing to sell their home. It scares me that I am the only child who is there for them and that my sister may not be able to help out when crunch time comes.

I am hoping for some advice that will better prepare me to deal with my reluctant sibling. Thank you,

—Julie S.
Wyckoff, N.J.

Gail: You are so right, Julie, to anticipate the potential dangers and need for future assistance. If ever there was a good time for a family meeting, this is it. But you want to head off a sibling fight based on old scripts. You will do much better if you first get thorough health assessments on both your parents.

You have many great resources in your state. Consider calling local caregiving networks, such as Caregivers of New Jersey, The Family Resource Network, in Trenton, at 609-392-4900. Ask where you can get your parents assessed, and hook up with a social worker who can set up the family meeting and be the neutral voice. Your older sister will be more likely to listen to a professional.

You can also watch the Colbert family videos on my AARP Web pages to see how they did it.

If family members just aren't interested in helping, move on before the next crisis occurs. There are great resources on AARP's Caregivers Resource Center Web site.

Enlist friends and neighbors to help out. Two excellent guides to help you organize an ongoing group to care for your parents if one becomes seriously ill are the following: Share the Care and Lotsa Helping Hands.

How can I become a professional caregiver?

Q: I am interested in becoming a caregiver. What sort of training or certification programs are there? Do these have job placement?

—William W.
Middletown, Calif.

Gail: The demand for home caregivers is enormous and growing. The quickest way to become a Certified Nursing Assistant, or can, is to take a course. The American Red Cross of Sonoma and Mendocino Counties apparently has a class for certified nurse-assistant training. With a search engine, I was also able to locate CAN training programs near you in Napa, Santa Rosa, Fairfield, and Angwin, Calif. Once you complete your training, your program is likely to help you find a job, and you should have no trouble finding one, even on your own.