Mrs. C. is an 80-year-old woman in good health. She still drives and is very active. Her brother is visiting from out of state and they have decided to visit a sister who lives nearby. Halfway to the sister’s house Mrs. C. loses her way and is unable to remember how to get to her sister’s home. They turn around and she manages to find her way home. Unfortunately, Mrs. C. is beginning to show signs of Alzheimer’s disease.

Mrs. C. has been married to the same man for 50 years, and he loves her very much. In fact, he still refers to her as “his bride.” They have two grown and married daughters. One lives in a nearby town and one lives out of state, halfway across the country. Both daughters have two children.

Over the next several years, Mrs. C. is expected to experience a slow decline in cognition. Her memory will deteriorate. She will no longer be able to take care of the house or make the meals. Her ability to walk will slowly worsen until she is unable to get out of a chair. She will lose control of her bladder. Her food will have to be blended and her coffee will have to be thickened so she can swallow without choking. She will repeatedly ask the same questions over and over again. She will be unable to leave the house.

• What burdens will this place of her husband?

• On her daughter who lives nearby?

• On her daughter who lives far away?

• How might this affect the relationship between them?

• What services might be needed to enable Mrs. C. to remain in her own home?

• What if the daughters want to put Mrs. C. in a skilled nursing facility but the husband wants to keep her at home?

o What criteria do you think should be considered when making this decision?