I need to make a decision fast

Hello,
I know the sundown syndrome is devastating but you said it came as a surprise to you after the fall. Here are some questions for the hospital, the social workers and the nursing staff.....
1. What medications does your mother take?
2. What was her baseline before the fall?
3. How long has you mom been in the hospital? Is she isolated?
4. Did your mom have any kind of anesthesia? I know from seeing my father in law experience significant sun-downing and memory impairment. The first time he had surgery it took several months for him to gain back most of his origional congitive functions. This past time he was under anesthesia for a broken hip and he's slowly gaining back what he did have. Unfortunately, we have no way of telling how much he will remember, since his dementia had progressed significantly.

Finally, music, and fidget toys help a lot. They seem to calm and stimulate thought and memories.

Good luck, keep us posted.

There are never any guarantees, as everyone truly is different. But one thing about hospitalization and elders is that delerium can factor in and make the dementia worse. The hospital atmosphere is so bad for them. Some recover totally and some don't.

As for elder attorneys and estate attorneys, again a lot depends on assets. Medicare covers 20 days (the last I checked) of nursing home care if they come out of a hospital, but not if they go to the facility from home.

Not every move needs an attorney's advice, but if there are a lot of assets, it's advisable.

You all have such great advice to offer because each of you has had a different, but related, experience. You're all the best!
Carol

Dear crislynp, my own Dad was hospitalized, and very ill. He could barely walk, couldn't talk, couldn't feed himself, and I never saw him look so bad. I spent many hours and days at his bedside. He did get better, but didn't regain everything. In fact, after he went back to the Nursing Home he had come from, he had truly lost ground from his previous state. It was sad to see him spend so much time in bed, and all the other losses. He wasn't thriving. I decided to move him to another facility. They told me moving him was the best thing I could have done, because if I hadn't, it would have killed him, because he just wasn't getting the care he needed.

For the longest time after his move to the new facility, he didn't do well. I had expected so much more, because it was a much nicer place, and his care so much better. But Dad struggled...for months. I was so disappointed, because I had such high hopes. And then I watched him suffer some seizures. That was so scary! I thought more than once we would lose him. But one day, a few months later, he did get better. And he surprised everyone, including the Nursing Staff, and has exceeded their expectations. He became ambulatory again, and more active; even social. We marveled. That was a while back. He is still doing better than during his bouts with illness, though he'll never be 100% due to his Alzheimer's Disease.

Medications can help, and other factors, as well. I've heard they lose ground with each relocation. That may be true in some respects, but it isn't necessarily always that way. My Dad is adjusting, finally, and does fairly well.

On the flip side, we have spent a lot of time in Nursing Homes over the past several years, with loved ones there, and it can be very sad to watch the other residents you come to know decline. Some decline rapidly; some slowly. Some rehabilitate, and some do not. There's no guarantees. I think it's an individual issue. We have learned to value each moment as precious.

I also understand feeling overwhelmed. We rarely anticipate illness and its effects, and are often unprepared for it. That is a helpless feeling watching a loved one suffer. It causes us heartaches. And the decisions that need to be made quickly are often beyond our understanding. I made tons of mistakes. But things smooth out eventually. Ask lots of questions, and try not to be bullied by the pressure others are applying. Tell them you'll do the best you can when you have enough information to make the right decisions.

An Elder Law Attorney will usually give you the first 45-60 minutes free. If not, go to one who will. And definitely get a second opinion. I mean, make that second opinion with another Elder Law Specialist, not just a "regular" attorney. It has to be someone well acquainted with Medicare/Medicaid, etc. I actually did everything without one, and haven't had to pay the $2,000.00 to $4,000.00 to someone else to do exactly what I did myself for $40.00, so be cautious who you trust. Some give real poor and costly advice, but there's also good ones.

Most of all, remember to also take care of you!:) SS

I don't know if they ever get it completely back, but if you are able to create a stable predictable environment that is stimulating, without being overwhelming it may help.

I did notice that music helped as well when I brought my mom home from the hospital after a lengthy stay. I feel for what you are going through.

Do they ever come back out of it? The Drs cant answer that I was just wondering if they ever go back to the way they were pre fall, hospitalization, confusion etc?

Great ideas from everyone. When an elder's body is shocked by such a fall, then the added trauma of the hospitalization, that often brings out the dementia full blast. The confusion of the hospital is hard on them.

She'll have 20 days on Medicare in the nursing home, then it will go to private pay until she spends down to Medicaid. The divorce definitely complicates this. An estate attorney or elder attorney is definitely recommended.
Carol

No wonder you feel overwhelmed, crislynp. You have had a lot to deal with, especially during this last week by the sounds of it. I am sorry everyone is asking for everything and I can understand your need for time to learn about it all first. I hope you can withstand the pressure of people asking you to make decisions on the spot. I think you have the right to say that you need a bit of time to think before you make each decision. Surely all these people that are hounding you can grant you a day or two to think. At least I hope so!! You need time too to catch your breath. May you have a restful Sunday.

Thanks to everyone who responded. Let me clarify- I spoke with two social workers which prompted me to post here because both lead me to believe that I couldnt do things like pre arrange her funeral, and to use money for her. For example they told me she could keep 50.00 a month. To me that isnt right. She doesnt have much but her seperated husband has a lot and because of that they count his assests because there is no divorce. So when I said the state would take everything I was referring to everything that she has, owns etc leaving me with enough to pay for her hair cuts, and some snacks and maybe an outfit now and again. Her pension is only 1100.00 a month. I get "why" they do it just that it isnt enough left over. What if she wants to go do something? And on top of that I did call the funeral home and she told me that I could sign over the insurance policy to them before medcaid stepped in so I guess I feel like everyone is telling me what to do and not why. Which is why I made the appointment with the attorney. Its a very tough situation- and also we built an apartment onto our house, if we sell our house she would go with us. Do I feel guilt? yes. And every other emotion all at the same time. Do I want her here with us? yes but the question is am I willing to do it at the expense of my entire family, no which leaves guilt because we are supposed to care for our elderly parents. Another question is can I afford it? no I cant and I have had to deal with the guilt of that too. I spent the majority of today at the nursing home, its a sad place. I personally dont think that they are going to be able to deal with my mother. She is a tough one, but at the same time even though she is hateful, onry and yells at people I dont want to see her cry. And lastly the reason why I said that I was going to put everything in my kids names is because I dont want them to have to go through this. I also am going to check my insurance policies because if they dont cover long term care then I need one that does. It would be different if I could sell my moms house and use that money to pay for someone to help me with her, I cant because its tied up in divorce court so I guess its that lack of control that I am feeling too like everyone, drs, nurses, social workers , her lawyer his lawyer all just swooped in on me all at one time. Everyone is asking for everything and I just want time to learn about it all first, even the nursing home admissions lady is pushing me into all sorts of directions. I told her mom is just there for rehab I need time to think. Last week she was living with me with mild demensia and a lot of grumpyness. This week she has severe demensia, sundowning and is broken. Its like someone flipped a switch and turned out world upside down. I am just overwhelmed.

Good point, Cat. Healthcare finance is an interesting puzzle. I understand your U.S. president is trying to bring into existence some kind of healthcare system - somewhat like we have in Canada. I believe I heard that Obama is thinking of upping the taxes on the rich to help cover some of the cost of this new health system he has in mind. That idea will probably go over like a lead balloon even though America claims to be a Christian country and thus it would only be right for the rich to be their brothers' keepers.

But back to you, crislynp. I previously made the suggestion that if you have time, you might google "guilt". It is a very hot afternoon here where I live so, instead of being outside attacking weeds, I took a few minutes to google "guilt" myself in order to save you some time. I came across an article that led me to the website livestrong.com . If you go to that website, when it comes up click on mental health. When the mental health page opens you will find a place in the upper righthand corner where you can enter a search term. Enter the word "guilt" and click on search. Two articles will come up on the first page, both titled "Handling Guilt". You might look into these and find them helpful. I hope so.
But going back to the articles that came up when I googled "guilt", the fourth article deals with the topic of guilt from a Buddhist perspective. The author is of the opinion that guilt has such a prominent place in Western culture "because of the Judeo/Christian background of our culture." The author goes on to state that "the concept of being born onto the earth with an 'original sin' easily puts a feeling of guilt in our minds."
I hope you can have some time this weekend, while your mom is in the hospital, to take a break with your husband and do something that you both enjoy. Best wishes.

The state "takes everything" because it is looking to recoup what it spends on the elder for their care when they are signed up for a state Medicaid plan - and usually are placed in a nursing home where the expenses are high. As long as the care is paid for privately without getting state fund, then the state isn't involved.
Although it can seem draconian, the system is fair to the state taxpayers as a group. Its an interesting puzzle - healthcare finance.

Crislynp, you say that what you are experiencing "is hurting our family life". If your mother is hateful and yells at you, no wonder it is hurting your family life. A family consists of many, many people and I think no one person in a well-balanced family has the right (no matter what) to "take over" the family unit. I'm sure when you were a child your mother taught you that you had to consider EVERYONE'S in the family needs and wants - not just your own. In fact I believe that the whole world would be in a better state of affairs if we considered all the people on Earth as one big family and we knew we had to share with all our brothers and sisters and not take more than our share. But that's another topic! :-) Getting back to the topic at hand, I feel from reading your comments ("we need to move to a smaller house"; "I am tired of being yelled at"; "it is hurting our family life"; "since she has been here everything has stopped") that what you REALLY want to do is take your MIL's advice and have your mom placed in a nursing home. It is the feeling of GUILT that is stopping you. May I suggest that if you have time, you google "guilt". Doing some research into the topic might help you. Personally, considering what you have written, I think your mother needs to go to a nursing home.

And PLEASE do not be in a hurry to sign everything over at the age of 46 to your children . This is something that I would consider VERY carefully and is a decision that shouldn't be made in haste or when you are emotionally upset because of the situation with your mom. Things will look better once you have placed your mom in the nursing home. I'm sending love your way.

In our state you are allowed and ask the lawyer but I think in all states you can prepay their funeral in our state they cost between $8000.00 and $14000.00 and creamations are almost $8000.00 simple ones just putting it in the paper once and a short one at that was over $600.00 for me so if you prepay it figure on the most expensive if she has the assests like insurance to pay for it-when I started medicaide before my husband died even my life insurance was an assest for me-I said then I am taking with me to heavan and when God asks me why I have all that money I will say it is my assests-they told me it had a cash value I never thought of cashing it in for myself and I never would have but they think of everything that is why you need a lawyer and I have been told if you have a lawyer social service will go easier on you when you apply.

Dear crislynp, I understand "crazy," and the confusion feeling, and the mixed emotions, which can be intense. So many demands and decisions, and some have to be made so quickly, often before we feel comfortable making them. I am responding to a couple comments you have made. I am wondering who told you the State could take everything? Regarding life insurance, I had to do several things with my parent's assets. Since life insurance is considered an asset that they or you could liquidate into cash, the state considers it like having a savings account with interest. As Conservator for my Mom and Dad, I had to spend down all their assets to qualify for financial help. I used my very own life insurance policy for their needs, because they did need the money Dad had contributed to it over the past 30 years. But all the money went to pay off debts and for their medical care. I had to liquidate other assets, as well. But "the State" allowed me to purchase an Irrevocable Funeral Contract. The limit for my state last year was $11,000.00, and this they can never take away. That is more than adequate for future needs. I did the same for each parent. It is only right that a parent's money be used for their care. Isn't that why they worked all their lives? You can also talk to an Elder Law Attorney regarding a Trust, but be careful whom you talk to. Some suggest unethical things regarding sheltering assets, and I had to steer clear of those.

Regarding your MIL's advice, sounds like she has your best interest at heart. She may be able to guide you in finding suitable alternatives, and comfort you in making decisions. As for your Mom's thin bones, a fall could happen anywhere, and you can't prevent it at home any better than somewhere else. I think the consideration needs to answer the following: How much care does your mother require, and are you adequately equipped to provide it? If you need assistance in providing for your mother's legitimate needs, there are many alternatives to choose from. Ask a Social Worker to guide you through the process, and provide you with enough information to help you make the right decision for you and your Mom. Take care.

Thank you for all of your words of encouragement and advice. I have hired an elder care attorney and will see him on Tuesday. The emotions are unreal, everything from empathy to concern then from grief (realizing my mom is no longer there) from resentment to sadness. Everything is crazy.

In the morning time she pleads to not go to a nursing home then in the afternoon she is not mentally there. She already lives with us …my choice is…. do I bring her back. The nurses said that sundowners will go away but what I am seeing is a worse version of what was already there. When she is here and in a routine she seems closer to normal but grumpy and hateful.

Frankly I am tired of being yelled at and it is hurting our family life. Since she has been here everything has stopped, but at the same time I feel tremendous guilt and sadness by wanting her to stay in the nursing home. We need to sell our house and move into a smaller house we can’t do that if she lives here. And she won’t listen to me about her care.

The Dr said her bones are like paper so I am afraid she will fall again and break something else. My mother in law said that this is the opportunity to keep her in the nursing home, that if I let her come home it will be very hard to get her back there.

The emotions and guilt is enough to make you go insane and OH MY GOSH the legalities in our country. I had no idea that the state could take everything including her life insurance leaving me with nothing to burry her with. I am shocked. We work all our lives to have something and hope that our children will not feel a burden, we think we are doing the right thing and then the state comes in and takes it all away.

So really its better to never have anything. My husband and I (we are 46) are putting everything in our children’s names now because its crazy to loose it all if something happens to one of us and now I am looking at 20 more years before this happens to me. It happens to mom and her mom in their 60’s. I am staring my future right in the face and it scares me to death. Thanks for listening.

God tells us to honour our parents. That doesn't always mean we honour the bad behavior, but respectfully honour their position. The Bible also says to give honour unto whom honor is due. Such as people in authority. Our parents fall into that category, as well. At least in our growing years. And as humans, we have an obligation to one another, as our brother's keeper. So much more our parents. As Christians, we are to be kindly affectioned one to another with brotherly love; in honour preferring one another. And if we are saved by grace through faith, we serve Christ when we serve each other. It's not always easy, but it is always right. So if we can look at serving the risen Saviour, when we are caring for someone (regardless of whether they "deserve" it or not,) it will be counted as serving Jesus. One day we will all stand before our maker, and we don't want to be ashamed. Instead of focusing on someone's behavior, we can focus on their needs, and the grace we've been given. Take care.

Austin always has such good insight. She was especially right to mention the pitfalls of hiring someone independently rather than through an agency. Many CNA's working at hospitals (not nursing homes) are registered through agencies so the option is there to avoid the headache and heartache of dealing with independant contractors tax issues.

Aside from Carol Bursak, our moderator the go to expert (in my opinion) in dealing with difficult personalities it is Austin who did it with grace for a long time and made it look easy. She has been there, done that and supported so many of us with her courage and selfless sharing of what it takes to commit to caring for a loved one.

I hope that you find help and lots of caring support in dealing with your mom's medical issues - the sundowning- and the whole kit n' kaboodle of caregiving. It is not easy, not for everyone and certainly a challenge. For those who choose to do it - this is the place for support. Hope you stay awhile - we will be learning as much from you and how you handle your issues as you will from us.

with respect and admiration for your courage - Cat

Austin, good questions to consider... And if you do get shot down, Ics, there's plenty here to defend you. Seems like there's two camps: those who do the Caregiving at home, and those who's loved ones are residing separately, or in facilities or institutions. Each person makes decisions based on their particular situation and personal choices. Neither choice is necessarily right or wrong, but the emphasis is on "choice," or need. We shouldn't be too quick to judge one another's situation until we have walked their path. That said, you have offered several good suggestions, and asked some searching questions. The answer to those will differ according to each individual's world view and belief system. Again, this is not a debate, but personal decision.

For some, adult "children" have had to assume some of the decision making for their parents. Ideally, this should be done respectfully, keeping in mind the desires and wished of their loved one. In cases where a parent was abusive, or difficult, does that mean we have no duty to them? This is a moral issue. Again, the answers will be as individual as the people answering them.

My own growing understanding and ideas have come from a variety of sources, including the Bible, my family values, and from ideas presented by Caregivers on this site. One parent is living in an adult community with other seniors, and one, by necessity, is living on the Dementia unit in a Nursing Home. Neither could care for themselves. And by necessity, one could not live with us. The other is a difficult, cantankerous individual, who makes those around her miserable. So, for our sanity and peace, she lives in a small apartment. Both parents lack judgment for decision making. As their adult child, I can choose to help, or not. To me, it was unthinkable to walk away. I consider that neglect and irresponsible. But caring for my Mom is emotionally challenging. Sure, I could hire it done, but I would ultimately be responsible to oversee her care. And if I gave the responsibility away, I would also lose the right to make decisions, were I to pass the baton to a legal entity.

On a "down day," I consider the options. Do I hire a professional to care for Mom? Again, I'd still be responsible to monitor the care she is receiving. Then I'd be watching two, or more! No thanks. And with multiple Caregivers, there may possibly be multiple problems and situations to deal with.

It always comes back to me caring for Mom. And this, with a combative, argumentative, complaining, and very negative individual. Encounters with Mom are never enjoyable. They push my buttons, my limits, and my abilities. But I have decided she will not get the better of me, and regardless of her attitude toward me, she will get the best from me. Someday, I will be grateful for my perseverance, tenacity, and determination. I am grateful to this site, and to the wonderful suggestions by fellow Caregivers here, who encourage me, challenge me, and applaud my efforts.

Do I have to care for a mean Mom? No. But I sleep better at night, and will not regret that choice in the future. Do I like doing it? Not always. But I like myself better for doing it, and I like myself better when I keep my attitude as positive as possible despite hers.

I also think of Mom's choices. She chose to give birth. She chose to clothe and feed me and also did a lot of nice things. Not everything with Mom was great or perfect. But I'm here because of her choice. She didn't choose to become sick or old, and needs help. Do I walk? No. She didn't walk out on me or give up when I wasn't the perfect child or teen. She might not have been the best Mom, but she's still Mom. Some days it's hard. Some days I'm weary, upset and downright angry. I hate it when I respond back to her in a disrespectful way, regardless of how she treats me. I pray for guidance, grace and joy. Some days I find all three. I remain hopeful, because God's still working on Mom, and God's still working on me. Just some thoughts.

Crislynp, you mentioned that your mom was hateful and grumpy before her fall and you didn't know if you can handle having her in your home if she becomes even worse. My sisters and I are facing a somewhat similar situation with our mother. I would like to know what the caregiver community out there believes adult children OWE their aging parents? Some parents, when they are young and healthy, abuse their children, are not supportive of their children, or only give conditional love. What is owed to parents like this?

It seems to me that as parents become old and sick, the adult children really become the "parents" and the parents become the "children". If this is the case, then I wonder if you, crislynp, as a "good parent" of your mother, HAVE to give in to her pleas to not place her in a nursing home. I imagine when your mom was the parent, she didn't always give you what you (as a child) thought you should have. Perhaps a GOOD nursing home is where your mom will receive the BEST care (and she might even grow to like being there). This doesn't mean you will be ABANDONING her!!! You and your children could visit her EVERY day and this way everyone would look forward to seeing each other and you can see that your mom is being well looked after. If you and your mom have had difficulties getting along before, I think it's doubtful that your relationship will improve now. It sounds like you might get some help from some of your adult children, crislynp, if you take your mom into your home but do you have a husband? What does he think? What are his needs? What are your needs? How is your health? How is his health?

I will probably be shot down in flames by all the wonderful caregivers out there who are devoting their entire time to caring for their parents but for what they are worth, these are my thoughts. Now I will look forward to reading the responses of experienced caregivers.

I have seen with one of my husbands' roomates in a nursing home and it indeed did start every evening about the samr time so she would need help at night but you could start with medicare pending with the social worker she will have to spend down her assets but if she can not be left alone you have no other choice taking her into your home could very well be a big mistake maybe some professional in the nursing home could do an evaluation and if they feel she can be home alone or have aides at night they will tell you and you can go from there you could hire a CNA from the nursing home to cover the nights or more than one but I found it a mistake hiring personal from the nursing home you really need someone bonded from an agency for your own protection even though it is more expensive you can use the cost on her or your income tax and why is not her spouse getting involved if they are not divorced yet it seems to me he is still responsible and if not maybe she would qualify for medicaide- I would talk to an elder lawyer you should not have to deal with all of this we are not responsible for our parents medical cost.

Ezcare has as always great practical advice. I would like to add that you should take advantage of the fact that your mom is in the hospital to ask the nurses for referrals if you need supplemental help. You may be able to pick up a CNA who needs a few extra hours and has been prescreened by her employer (the hospital or agency contracted with the hospital). Another benefit is that you will be able to see in advance whether or not that person is actually capable providing the help you need.

As far as Sundown behaviour goes, it is called that because the behaviour is tied to evening behaviour - which is controlled by their circadian rythms. It is a catch-all term. As such, it is hard to stop/control the behaviour; so a successful strategy will be unique to your mom & her behaviour triggers. If you have enough stamina and time, you can start watching her and you will see a pattern. I will give you a laundry list of things that may or may not help just to give you an idea.

1. Use music to engage her brain, and mood - headphones if she will keep them on otherwise a cd player withspeakers is good. Try to start out with classical. If you go online to the major seller sites, you can even buy boxed collections that are marketed for new mom/baby - there is one I have used that is sleepytime, naptime music. She won't go to sleep, but it may calm her mood....depending on her hearing, keep the level low enough so she can hear, but not loud enough that it drowns everything else out.

At night make a ritual of dancing/walking in rythm to fun music - oldies that she likes. Get her singing. Whether you are Fred Astaire & Ginger Rogers or doing the latest showtunes doesn't matter. Feel free to sprinkle kisses & hugs as needed. (it's help your blood pressure too)


2. You have to check her meds and medication times. Some medications can cause drowsiness during the day & flip wake sleep cycles. Likewise some meds and combinations can increase agitated behaviour at night.
3. Diet always plays a role - keep a schedule, plan good nutrition and make food available at the times she may be starting to wander - check food webites for info. (Example: potatos increase seretonin. Turkey contains melatonin....a good diet can help alot)
4. Boredom & habit - she has to have things to work on & do. If you give her something that she can repetatively do, that will also take her attention for a while.
5. If you can afford it, like Ezcare said, hire or have someone in your family give you a break. It will not be easy - especially if there are additional hurdles like a divorce in progress.

Stay focused on evaluating her patterns and what you observe. There are never any easy answers, and sundowning continues to be a mystery. Take notes on & I hope stay on this board for advice & stress relief. There is an old country saying that has always helped me when facing tough problems - "if your socks aren't in your shoes, don't look for them in heaven". Which I take to mean that caregivers can only deal with what is - not what we wish.

That said, wishing you encouragement and sympathy for the challenges you are now facing. Hang in there.

Sundowning can mean a lot of things. Everyone is different. Sometimes there's agitation, wandering, pacing, acting out. It depends on the individual, and the stage of their dement. Full spectrum lighting can help, a little. But no one can advise you exactly what to expect since it's different for everyone. And if Mom comes home for a short period of time, she can be rehospitalized if things get worse. Take things one moment at a time, and stay calm. A soft answer and loving, but firm responses can disarm the meanest. Walk out of her presence if things get too bad, then come back, cheerily. Sometimes that will help, because one never knows what is triggering her responses. Try to find out, even if she has difficulty expressing it. While things may seem urgent, they usually work out better than we imagine. And many situations are fleeting and temporary. (May not feel like it sometimes.) Praying for you, because it helps! Take care.

I just left a message for an elder care attorney to make an appointment. I did speak with family- My oldest daughter (27) is willing to do it m-f 8-4 (not sure what to pay her). I asked my son and his wife to give me one free weekend a month- they said they couldnt. My youngest would help at night if I needed to go out for something she is a cna and works at the rehab facility that mom is going to tomorrow. I guess what I really want to know is what am I about to take on? It was hard living with her before the fall she was hateful and grumpy and always asking questions- but now with this sundowners I dont know if I can handle it. If she were to go back to her old grumpy self that would be much better - she was grumpy and mad but at least she was in the present (unless she was having a delusion) and I know she hid the dementia very well by saying "I Know" and "yes" a lot. Stinker! But with sundowning, omg what can I expect?

I was also an only child with POA so I know what you are faced with. I do not know your full situation but from what info you provided you MUST focus on the financial problems first. If you can find a Financial Adviser who specializes in Eldercare Law for your state that would be a good start. Do your homework first to be sure this person has CSA credentials and has references in your community. DO NOT SIGN ANY PAPERS ON YOUR MOM'S BEHALF RELATED TO THE DIVORCE SETTLEMENT. If your mom has legal counsel for the divorce then make sure this attorney in briefed on the current situation. If she did not have her own own attorney then you need to get one. You need expert legal advice here--not opinions from Uncle Eddy or Aunt Matilda. Once you have the financial matters under control, then you can plan for your mom's Long Term Care. Also, DO NOT bring any strangers into your home unless they are from a Licensed Homecare Agency that is bonded. But that is a last resort. First try to enlist the aid of friends, neighbors and family members. You'd be surprised how much help you can get if you just ask for it. Be specific: can you bring lunch in for mom this week? Can you sit with mom for 2 hours on Thursday while I meet with her Doctor? You get the idea.