For years now, my mother has been the focus of all of my caretaking energy and my father, who is actually nine years older, has quietly taken a back seat. Until now. Dad just turned 94, lives independently and, until recently, has been in great health. He was running a homeless feeding program, volunteering at a hospital and taking care of his long time “ladyfriend”, who has many health issues. I’d have a couple of meals with him while in town dealing with my mother’s issues and he was always very understanding about the demands her condition put on my time, as he had always been when she was healthy and put demands on my time.

Everything changed this past year. My first clue that things weren’t as peachy as I imagined was when he fell ill with a skin infection and was hospitalized for a week. I went to his apartment to pick up a robe and a change of clothing only to discover that he had been living in squalor. There was a robe behind the bedroom door that was stiff and caked with dust. The linens clearly hadn’t been changed in a long time and were beyond salvaging, everything was covered with dirt and dust, and there were papers on every surface. I had encouraged him to hire someone to clean in the past, but he had always brushed it off and told me he was taking care of it himself. It took my daughter, a cleaning lady and me three days to get the place in livable shape. I bought sheets, pillows, towels and a vacuum cleaner, took everything to the laundry, and he promised he would hire someone to help keep it up.

In February, during one of the worst winters in recent memory, he slipped on the ice while trying to bring his girlfriend flowers on Valentine’s Day, dislocating his shoulder and whacking his head really hard on the pavement. Though the scans didn’t show any damage to his brain, he remained confused and forgetful months after the fall. I took him to a neurologist who told us that he had a normal 93-year-old brain with some natural atrophy, but nothing to worry about. She said she hopes her brain looks that good at 93. He wasn’t satisfied, but I told him that we couldn’t fix something that wasn’t broken.

In March, he went to the ER with what turned out to be a kidney stone. The social worker at the hospital called me to ask if he had help at home because he seemed quite confused. I explained that he didn’t, but asked his girlfriend’s daughter to pick him up and take him home so they would release him. Over the course of the next week or so, he ended up in the ER twice more because he was in pain from the stone, confused and frightened. At this point, his doctor called me and said he didn’t need to be in a hospital and, in fact, what he needed was an aide. I scrambled to find someone to stay with him, at least until he felt better, and the doctor made an appointment for him to see a Neuropsychologist who could assess him for dementia.

Fortunately, I had a visit planned and was able to take him. She spoke with both of us for an hour and then did a standard two hour assessment with him alone. I was finally coming to grips with the depth of his confusion and memory loss. He was clearly not okay. By the time it was done, he was exhausted, completely wrung out and discouraged because he felt he had performed poorly on the test. For a while now, he has said that he feels like a 20 year old from the neck down, but terrible from the neck up. I used to laugh it off and tell him he was doing great for a guy his age. I was beginning to see his point.

A couple of weeks later I received a call from the neuropsychologist with the news I had been anticipating. My father has significant cognitive loss in all areas and has been officially diagnosed with Dementia, probably early Alzheimer’s. The “probably” is because it is impossible to definitively diagnose Alzheimer’s until autopsy. I will talk to him about it when I visit in a couple of weeks. It doesn’t seem like the kind of conversation you should have on the phone.

So, here we are. I will embark upon arranging care and making a claim on his long term care policy. Another chapter begins and I take a deep breath as I consider being responsible for the care of both of my parents.