Aging affects us all, regardless of income, health, social class, or the other myriad boxes we humans find ourselves in. For 43.5 million people, aging affects them while they are still young or healthy. These are the family caregivers, which care for spouses, parents, siblings, and other relatives over the age of 50. The scope of the care varies from minimal to major, depending on the condition and age of the family member. The Alzheimer’s Association estimates out of  the  43.5 million caregivers nationwide, 14.9 million are caring for a relative with Alzheimer’s disease. When you are caring for a family member with Alzheimer’s or dementia, chances are you will eventually have to tackle these five tough decisions.

Should They Be Behind the Wheel?

Alzheimer’s follows a known course, but the speed at which it progresses varies from person to person. This can make it difficult to know when it’s time to officially take the keys. Fortunately, the Alzheimer’s Association has provided us with some warning signs:

• Getting lost or forgetting the location of familiar places.

• Missing traffic signs or lights, such as failure to stop.

• Slow reaction times and poor decisions, such as stopping in the middle of traffic.

• Driving way too fast or way too slow.

• Exhibiting signs of anger or confusion behind the wheel.

Although spotting the signs may be simple, broaching the subject can be difficult. Although you need to be sympathetic and kind, this is also the time for tough love. Be honest with your loved one – that you worry for both their safety and the safety of others. Don’t leave the keys where they can find them. Driving can be hard to give up since it signifies independence to many, but you must enforce this when the time comes.

Can You Handle This On Your Own?

For many caregivers, admitting that their loved one has become too much for them to handle on their own is the single most difficult thing. Understandably, many balk at the thought of putting a loved one into a longterm care facility. Yet, it’s still vitally important that you recognize when it’s time to let go and ask for outside help.

Fortunately, there is an alternative. In-home caregivers can help relieve the stress of caring for your loved one. This frees up your time so you can tend to the other important things at home, such as your kids, spouse, job, and even yourself. An in-home caregiver also offers an important facet of Alzheimer’s support for your loved one, since the caregiver is trained and knowledgeable in Alzheimer’s care.

Is It Time to Consider a Nursing Home Facility?

Even with loving in-home care and the help of an in-home caregiver, the time may eventually come where your loved one needs the 24-hour care that they can only receive in a long term care facility.

This can be one of the toughest decisions you will ever face. Often, family caregivers feel as though they are abandoning their loved one to strangers, and it may seem controversial to put a spouse or parent “in a home.”

You must look at this objectively. What is best for your loved one? A long-term care facility can be the best, most loving, and most respectful thing that you can do for your loved one. They will receive the Alzheimer’s therapies they require to help the cope with their condition as it progresses. They will also be treated with the respect they deserve. You will no longer be emotionally or physically worn out, so you can focus more positive energy toward your loved one.

Generally, Medicare only pays for a short term stay. The best option is to have a long-term care insurance policy, in some cases your loved one may qualify for Medicaid.

Should You Still Visit If Your Loved One Doesn’t Recognize You?

The short answer is a resounding yes. Researchers are still trying to understand Alzheimer’s, so no one knows for sure that your loved one doesn’t recognize you on some level.

Further, think of it from a humane standpoint – no one likes to be completely alone. Even if your relative doesn’t seem to know you, they may still like having visitors. Since there is no way to know completely what your loved one is feeling and understanding, and what they are capable of expressing, regular visits are always the correct choice.

When Is It Time to Say Goodbye?

Caregivers often fall into a sense of complacency when it comes to their loved ones. Things haven’t been “normal” for so long, they fail to notice or choose to ignore the signs that it may be time for end of life planning. Hospice care is generally recommended when life expectancy is less than six months.

It may be time to look into hospice care if repeated infections, such as pneumonia, have occurred in the last six months or if your loved one is having difficulty eating and is losing weight. Ask your loved one’s doctor for honest answers, because it’s better to prepare now than to be caught by surprise later.