Don and Mary were happily married for 50 years and had two successful children and five grandchildren. They met while serving in the US Army during the Korean War. After their military service ended, they married and embarked on their careers as healthcare professionals. Don was a professor at the local medical school, and Mary was a hospice nurse. Don and Mary were always active in their church and volunteered their time in the community. Both retired at age 65 to pursue their dreams of international travel and spending their children's inheritance. During the early years of their retired life, the couple continued to work part-time, travel extensively, and spend time with their grandkids. Their retirement plans seemed to be going swimmingly until Don noticed that his wife was having memory problems at the age of 78. Mary always kept up on the latest news and was always the first to complete the crossword puzzles and other logic games. However, Mary seemed to become increasingly forgetful; she would run errands to purchase specific items and return home empty-handed. The couple decided to seek help from a gerontologist. An extensive battery of cognitive and neuropsychological tests determined that Mary's language skills and mental abilities had markedly diminished. Mary was diagnosed with Alzheimer's disease. After the initial shock of the diagnosis, the couple developed a plan to cope with this diseaseDon was going to be Mary's caregiver. The progression of the disease was tough for Don and the family to watch. At first, Mary became confused, then she became progressively irritable and aggressive. Five years after the diagnosis, Mary became almost totally withdrawn. Her appetite was nonexistent, and she became incontinent. Additionally, Mary suffered from "sundowners syndrome"a phenomenon whereby a person experiences confusion and exasperation during the late afternoon or early evening hours. Don struggled to care for Mary and keep an upbeat attitude; however, he too was experiencing the effects of aging. After years of being a competitive runner, his knees and other joints prevented him from fully assisting Mary. Don hired a home health aide to visit daily to assist Mary and also to do some light household chores. As Mary's condition grew more serious, he had to make a decision. He was no longer able to care for her, and his own ailments were affecting his ability to take care of himself. Additionally, their retirement savings had dwindled to the point that they needed financial assistance from family members to get by. The case of Don and Mary is similar to those of many older adults facing the inevitable choices of long-term care.

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