Dearie:   I like that this family is working together and communicating with each other.  I wish for them to be able to share the work that it will take as their father changes and needs more care.  Some of the children may live closer to him and able to do one kind of care, the daughter who wrote the letter can do other things from a distance.  And then the brothers and sisters, will need to take care of each other.


Barbara:  First and foremost, find out from the assisted living what their limits and abilities are for taking care of your father. At what point will they say he cannot stay and what is their process for informing the family.  The worst thing would be for the assisted living to give you too short notice.  It also might be worth asking the facility now, if they ever do make financial accommodations for residents who have been in their community for many years. Other financial planning should be done with a knowledgeable elder care attorney, as well as completing your father’s advance directives, including a will, a living will and powers of attorney.  The other professional expertise that you will need is a geriatric care manager – they come in all flavors and sizes.  Typically, a care manager has a degree in either social work or nursing and may have other credentials in the field of aging.  Care managers can do as much or as little as you ask — from short consultations on options for care to daily managing home care aides and doing regular visits and assessments. Lastly, your father’s primary care physician will be monitoring his normal pressure hydrocephalus and his cognitive decline.  Some treatment options may be available.  Here is information from the Alzheimer’s Association on Normal Pressure Hydrocephalus https://alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia/normal-pressure-hydrocephalus And here is a good article about the importance of advance care planning https://www.nia.nih.gov/health/advance-care-planning-healthcare-directives To find a geriatric care manager go to the Aging Life Care Association at www.aginglifecare.org/ For an elder care attorney go to the National Academy of Elder Law Attorneys at www.naela.org/