Irene began suffering multiple serious effects of her diabetes, including some mild dementia, in her early 70’s. By then she had been married 6 years to her third husband, Hank, who gradually took on more responsibility as her caregiver as her mental and physical status declined. During the first 6 years of their marriage Irene and Hank traveled around the country in their RV, played golf, and were generally active, independent, and happy, but as her disease progressed, their outside activities and their social interactions virtually ceased. Except for the occasional visit with Hank’s only stepson’s family, the two became isolated from the outside world. They lived in eastern Pennsylvania while each of Irene’s three children lived hundreds of miles away. Her children would travel to Pennsylvania several times a year to visit her, but Hank made it very clear that he was in charge of all decisions about her care. He welcomed their visits, but wanted no interference in the routines he had established to get through the day. When Irene’s youngest daughter expressed concern to Hank about his impatience with her mother and her mother’s isolation, the heat and accusations of the ensuing argument resulted in her refusal to visit their home again until a week before Irene’s death two years later. A year after that incident, Irene’s oldest daughter suggested that respite day care might help take some of the pressure from Hank’s 24/7 caregiving. When she offered to accompany Hank and Irene to check out a nearby respite day care facility, Hank angrily confronted her for trying to interfere with his ‘job’. After that all three children limited their communication to what was necessary to stay informed of Irene’s condition. Hank loved Irene and cared for her as best he knew how, but his determination to go it alone created undue stress for both him and Irene and made no allowance for her children to participate in her care in any way.
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